America’s New Superbug — Candida Auris — Is Spreading Quickly in Long-Term Care Facilities

Fever, chills, infections… could they be Candida auris symptoms? Health experts are sounding the alarm about a new infection making the rounds in the US. And while there’s likely not cause for concern for most folks — at this time, Candida auris is almost exclusively found in long-term healthcare settings — knowing the signs and next steps can help keep you and your loved ones safe.

What is Candida auris?

Candida auris, commonly known as C. auris, is an opportunistic fungal pathogen. It has become a quietly growing global health concern among infectious disease experts for the past decade.

It was first identified in 2009 in Japan. But the Center for Disease Control and Prevention only recently deemed the fungus an “urgent threat” in the US. Why? It’s been spreading rapidly through healthcare facilities over the last three years.

In 2021, the highly adaptive fungus presented public health officials with another challenge: It became resistant to all of the medications usually given to treat infection. This officially makes it a superbug.

How does it differ from other fungal infections?

Most people are familiar with fungal infections in their more common forms. That includes yeast infections, jock itch, ringworm, or athlete’s foot. What sets Candida auris apart is that, although it’s a fungus, it behaves in a way that infectious disease specialists are used to seeing in bacterial or viral outbreaks: thriving and spreading from person to surface, causing bloodstream infections, and evading treatment.

In a CDC report, researchers found cases of treatment-resistant Candida auris tripled in the US between 2019 and 2021. And clinical cases have been consistently increasing each year.

Where is Candida auris found?

The CDC’s Candida auris data tracker shows over half of all US states reported cases of C. auris in the last 12 months (for a total of more than 2,000 clinical cases). The states that have seen the largest outbreaks include:

• New York
• Illinois
• California
• Florida
• New Jersey
• Nevada
• Texas
• Indiana
• Ohio

How does Candida auris spread?

Most bacteria can spread from contact with an infected surface or person. But this kind of transmission is less likely with commonly seen fungal infections. That’s because fungi need specific environmental conditions to live (think dark, damp, and warm). Candida auris breaks the mold, surviving on surfaces for weeks, according to the CDC.

“This thing gets into the environment,” saysTom M. Chiller, MD, Chief of the Mycotic Diseases Branch at the CDC. “It immediately goes from the skin right on the hospital bed, on equipment, on the floor, even windowsills.”

The high transmissibility rate of C. auris from skin to surface has prompted additional protocols to be implemented in healthcare facilities, including preventative screening of patients currently staying at long-term care facilities.

Who is at risk for infection?

Those most at risk from infection with candida auris those with weakened immune systems, such as patients in hospitals, long-term care centers, and nursing homes.

“Candida auris is developing a nasty habit of causing severe infections in hospitalized patients and those who are immunosuppressed,” says Mark Rupp, MD, infectious disease expert at Nebraska Medicine.

Additionally, those who have undergone recent invasive medical procedures or received prolonged antibiotic or antifungal treatments face an increased risk. As do individuals who have indwelling medical devices, such as feeding tubes, central venous catheters, and urinary catheters.

What are the symptoms of Candida auris?

Symptoms can be difficult to identify because most individuals who experience infection are already sick. To further complicate matters, some patients who contract C. auris experience no symptoms at all.

According to the CDC, the most common symptoms are “fever and chills that don’t improve after antibiotic treatment for a suspected bacterial infection.” Patients may also experience localized infections depending on where C. auris has colonized. This most commonly includes ear infections, wound infections, or urinary tract infections (usually due to colonization near indwelling catheters).

One concerning aspect of Candida auris is its potential to cause bloodstream infections. This can lead to severe complications, especially among those with compromised immune systems.

If someone with known risk factors for Candida auris develops unexplained infections or experiences persistent symptoms despite treatment, healthcare professionals should consider testing for the fungal infection.

How can you get tested?

C. auris can be hard to identify because patients who contract it usually already have an existing illness that may have similar symptoms.

Bhavarth Shukla, MD, Medical Director for Infection Control at the University of Miami Health System, says your first clue of a possible C. auris diagnosis could be “if the lab is taking some time to figure out what the organism is. If they’re able to tell you it’s a yeast but can’t figure out what species it is, that may be a hint that this is a Candida auris infection.”

Luckily, several new testing methods have emerged over the last five years, including an FDA-approved rapid test that provides results in under an hour.

Regular surveillance and screening of patients, particularly those with known risk factors, can also aid in early detection. The CDC provides free Candida auris testing through their AR Lab Network and provides guidance for medical facilities that want to perform in-house swab testing.

Can Candida auris be cured?

While C. auris is increasingly resistant to all three main classes of antifungal medications in the US, there is hope. If a patient contracts C. auris, it’s very likely they can still be treated and fully cured with standard antifungal medications.

Patients with treatment-resistant Candida auris infections have also responded positively to multiple antifungal medications at high doses used at the same time. Plus, scientists and public health officials are working to develop new medications to treat patients with treatment-resistant C. auris.

According to Dr. Chiller, several new antifungals are also close to being approved for use. “They’re in clinical trials — in phase 2, phase 3,” he reveals. “So I do think we’ll have a couple of potential other drugs to use.”

Researchers at the Los Angeles Biomedical Research Institute (Lundquist Institute) are also developing a vaccine for Candida auris. This would help limit the spread between vulnerable populations.

How can you keep yourself and loved ones safe?

Stop the spread from person to person

If a loved one is hospitalized or in a long-term care facility, ask their medical providers about the risk of C. auris and what protocols have been implemented to prevent outbreaks.

Experts say healthcare facilities should prioritize rigorous hygiene measures. That includes ensuring that healthcare workers and visitors adhere to proper handwashing techniques: Washing hands with soap and water for at least 20 seconds or using hand sanitizer with at least 60% alcohol before and after touching the face or surfaces frequently touched by others. 

Stop the spread from surface to person

Additionally, robust environmental cleaning and disinfection protocols, especially in high-risk areas, can help curb transmission.

“Strategies include using the right disinfectant — not just the type of disinfectant, but the amount of time that it’s used, the way that it’s used,” says Dr. Shukla. “And sharing equipment or cohorting equipment is only to be used on patients who are colonized.”

The EPA has compiled a list of disinfecting products that kill C. auris on objects and surfaces, called List P. Healthcare facilities should use these products in the daily cleaning of patient rooms, in shared spaces, and on medical equipment.

Because Candida auris is almost exclusively found in long-term healthcare settings, most folks don’t need to worry about implementing these practices at home. With the proper healthcare facility precautions and preventative screening measures, it’s possible to stem the spread of infection.

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.