Washington State Reports First Outbreak of Deadly Candida Auris Fungal Infection
In a concerning development, Washington state has reported its first known outbreak of the deadly Candida auris fungal infection. Four individuals have tested positive for the rare fungus this month, marking the state’s first cluster of cases. Candida auris is a highly dangerous pathogen that has been spreading across the United States since 2016, with case numbers steadily increasing each year. This particular fungus is resistant to some common antifungal medications and primarily affects individuals with weakened immune systems. It is frequently found among hospital patients who use catheters, breathing tubes, or feeding tubes.
All four individuals who tested positive for Candida auris in Washington were patients at Kindred Hospital Seattle First Hill, a long-term acute care hospital. Fortunately, none of them have died from the infection, according to the public health department for Seattle and King County. The first case was detected on January 10th, and subsequent cases were identified on January 22nd and later on Friday. It is believed that the three patients who initially tested negative for Candida auris upon admission contracted the fungus while at the hospital.
One of the patients developed an infection, indicating that the fungus had entered a part of the body where it would likely cause symptoms. The others were colonized with Candida auris, meaning they carried the fungus on their bodies and could potentially spread it to others without necessarily falling ill themselves. However, those colonized with Candida auris are still at risk of developing infections.
Candida auris was first identified in Japan in 2009, and the Centers for Disease Control and Prevention (CDC) requested that U.S. laboratories report cases in 2016. A review of records revealed cases dating back to 2013. Since reporting began, there has been a significant increase in Candida auris cases, with a 94% rise from 2020 to 2021. As of December 2022, the fungus has been detected in 36 states. The CDC has recorded over 5,600 Candida auris infections from 2013 to 2022, with an additional 13,000 individuals identified through screenings who did not show signs of infection.
The CDC attributes the rise of Candida auris to increased screening and poor infection control practices in healthcare facilities, which may have been exacerbated by staffing shortages and extended patient stays during the COVID-19 pandemic. Dr. Peter Pappas, a professor of medicine at the University of Alabama at Birmingham, warns that the fungus will likely spread throughout the entire country, emphasizing the need for effective control measures.
Alarmingly, approximately 90% of Candida auris strains in the U.S. are resistant to the most commonly used antifungal medication. While most strains can be treated with drugs from one of the three main classes of antifungal medicines, some are resistant to all three.
The first case in Washington was a resident of Pierce County who had initially been admitted to a hospital there before being transferred to Kindred Hospital Seattle First Hill. ScionHealth, the owner of Kindred Hospital, did not provide a comment at the time of publication. Kindred Hospital is the only facility in Washington that screens all newly admitted patients for Candida auris as part of a state-led program launched in 2022. The screening involves swabbing the armpits and groin, areas of the body where the fungus tends to colonize.
Sharon Bogan, a spokesperson for the Seattle and King County health department, acknowledges that while this is the first time multiple cases have been identified in one setting due to the screening program, it is challenging to determine the extent to which Candida auris is circulating. Dr. Pappas suggests that these four cases may indicate a broader spread of the fungus in the Seattle area, as by the time it appears in a hospital, it has likely been present in the community for some time.
Distinguishing between an infection and colonization is usually straightforward, although there can be gray areas. Invasive infections must be treated promptly to avoid severe consequences. The mortality rate for severe Candida auris infections in the U.S. ranges from 30% to 60%, but healthy individuals are generally not at risk of infection.
Dr. Arturo Casadevall, the chair of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, emphasizes the importance of active surveillance in detecting new cases. He believes that while it may be disheartening to know that Candida auris is present, surveillance allows for timely intervention. Casadevall assures that most people should not worry about contracting the infection simply because it is in the community.
Candida auris can be transmitted through direct contact with an infected individual or by touching contaminated surfaces or objects. Studies have shown that the fungus can survive on surfaces for at least two weeks. Once Candida