LITERATURE UPDATE
Candida auris: a selection of current research into this drug-resistant fungal pathogen
In the December issue of this magazine, Markus Meyer looked at how early and accurate identification can assist in controlling outbreaks of Candida auris, thanks to advances in polymerase chain reaction testing and strain typing technology. Here, to complement previous coverage, Pathology in Practice Science Editor Brian Nation compiles a small selection of recent research interest in this important fungal agent.
Candida auris: the new fungal threat Pallotta F, Viale P, Barchiesi F. Infez Med. 2023 Sep 1; 31 (3): 323–8. doi: 10.53854/ liim-3103-6. eCollection 2023.
Candida auris is an emergent fungal pathogen of particular concern. Since its first identification in Japan in 2009, it rapidly spread all over the world, including Italy. The main concern related to the diffusion of this fungus is its antifungal resistance. It is speculated that about 90% of isolates are resistant to fluconazole, 30% to amphotericin B and 5% to echinocandins; furthermore, some
cases of pan-antifungal resistance have been described.
Critically ill patients are particularly at risk of being colonised by this yeast and person-to-person transmission may generate hospital outbreaks. In fact, C. auris can survive on inanimate surfaces for a long time and commonly used disinfectants are not effective. Additionally, devices such as central venous catheters (CVCs) or urinary catheters are particularly at risk of being colonised, representing a possible source for the development of bloodstream infections caused by C. auris, which
carries a high mortality rate. Given its capability to spread in the hospital setting and the limited therapeutic options, it is of outmost importance to promptly identify C. auris. However, commonly used biochemical tests frequently misidentify C. auris as other Candida species; currently the best identification techniques are MALDI- TOF and molecular methods, such as PCR of the ITS and D1/D2 regions of the 28s ribosomal DNA. Whole genome sequencing remains the gold standard for the phylogenetic investigation of outbreaks.
The majority of cases of colonisation
by C. albicans will not cause bloodstream infections and contact precautions and surveillance of contacts will be sufficient. When invasive fungal infections occur, echinocandins still represent the first therapeutic choice. A combination therapy or the use of novel antifungals (such as ibrexafungerp or fosmanogepix) would be required for echinocandin- resistant strains. In conclusion, C. auris represents a
growing threat because of its antifungal resistance characteristics, its difficult identification and its easy spread from person to person. This mini-review aims is to summarise the main aspects concerning this pathogen.
Candida auris genetics and emergence Chowdhary A, Jain K, Chauhan N. Annu Rev Microbiol. 2023 Sep 15; 77: 583–602. doi: 10.1146/annurev- micro-032521-015858.
A strain of Candida auris cultured in a CDC laboratory.
WWW.PATHOLOGYINPRACTICE.COM FEBRUARY 2024
Candida auris is a multidrug-resistant fungal pathogen that presents a serious threat to global human health. Since the first reported case in 2009 in Japan, C. auris infections have been reported in more than 40 countries, with mortality rates between 30% and 60%. In addition, C. auris has the potential
51
Shawn Lockhart Public domain Wikimedia Commons
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
