Candida auris—A Primer

What’s the new yeast infection making people sick?

Since 2020, medical institutions have reported rapidly increasing numbers of yeast infections from Candida auris (C. auris). Yeast is a form of fungus; like many bacteria, fungus species live naturally in our bodies and on skin. When the delicate balance of bacteria and yeast is disturbed—from taking antibiotics or steroids, hormonal fluctuations, uncontrolled diabetes and even stress—yeast can grow out of control. (1)

You might be familiar with Candida, because another type of Candida—C. albicans—can cause overgrowth of yeast in the mouth (thrush) and other soft tissues (candidiasis).

Serious yeast infections can occur in individuals with depressed immune systems, in AIDS, ME/CFS, and patients on chemotherapy or other treatments that depress the immune system. Candidiasis or thrush in the mouth, throat, esophagus, and/or tongue can cause loss of taste, as well as white patches or sores that make eating and swallowing painful. C. albicans overgrowth can also occur on skin and in the vagina. (1)

This new yeast, C. auris, is resistant to many drugs used to treat thrush and other yeast infections.

“Nationally, cases are higher than they've ever been,” investigative writer Sophie Putka reported in MedPage Today on February 6. “Adding to concern is the risk that this microscopic fungus poses to already-sick patients, along with its unusual staying power on surfaces, and surveillance that relies on known cases.” (2)

It’s also possible for healthy people to become silent carriers of C. auris. MedPage reported that “the yeast can spread by attaching to the skin and other body sites, and can ‘colonize,’ meaning people may not become infected or ill but can still spread the disease through physical contact. It can also be spread through contact with contaminated surfaces or equipment.” (2)

For now, multidrug-resistant C. auris appears to be spreading mostly in hospitals or nursing homes, and because it takes advantage of damaged immune systems, public health officials are focusing on the usual suspects: people with AIDS, cancer patients undergoing chemotherapy, and patients in various healthcare facilities. ME/CFS patients with damaged immune systems are also probably more susceptible, like transplant recipients on immunpsuppressing drugs.

The descriptions of how C. auris spreads in hospitals and other medical facilities is disturbing. MedPage Today reported that:  

“C. auris can also linger on surfaces in healthcare facilities for long stretches of time—on floors, bed rails, bed sheets, door handles, oxygen masks, and sinks. In dry environments, it can survive on plastic for multiple weeks, and according to one review, ‘devices in contact with skin may be particularly prone to contamination by C. auris biofilms.’ ... It can also be difficult to tell how much, or if, the fungal infection contributed to death in patients with ongoing medical problems and C. auris.” (2)

About a year ago, an article in the Annals of Internal Medicine warned of the rapidly increasing spread of C. auris. Seven investigators from the Centers for Disease Control and Prevention (CDC) led by Meghan Lyman summarized the then-available statistics (January 1, 2019 through December 31, 2021) describing C. auris spread in the US. (3)

“The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively,” Lyman et al. reported in the Annals of Internal Medicine. “From 2019 to 2021, 17 states identified their first C auris case. The number of C auris cases that were resistant to echinocandins [a class of anti-fungal drugs] in 2021 was about 3 times that in each of the previous 2 years.” (3)

According to CDC’s online explainer on C. auris, some of the people most at risk of infection include those who have breathing tubes or stomach tubes—which numerous ME/CFS patients have because of trouble swallowing, a fact that is rarely acknowledged—and any type of catheter. (4)

Additionally,  “There is not a common set of symptoms specific for C. auris infections,” CDC reported. The ears, bloodstream, and open wounds are suggested by CDC as being most susceptible to infection. (4)

The CDC online description of C. auris also contains a creepy, italicized warning to healthcare workers:

“Retesting patients infected or colonized with C. auris is not recommended and should not be used to change infection control measures because it does not ensure that the patient no longer has C. auris on their skin or other body sites and will not spread it to others.” (4)

In other words: If you ever receive a diagnosis of C. auris, by today’s CDC guidelines, you can never be declared free of the infection.

Author’s Note: This is a developing story about an emerging disease and will be revisited as warranted.

BIBLIOGRAPHY
1.        “Candidiasis.” Cleveland Clinic, June 6, 2022. https://my.clevelandclinic.org/health/diseases/23198-candidiasis
2.        Sophie Putka. “Candida Auris: What to Know About the Fungal Infection Spreading Across the U.S. — The multidrug-resistant organism colonizes skin, lingers on surfaces.” MedPage Today, February 9, 2024. https://www.medpagetoday.com/special-reports/features/108600
3.        Meghan Lyman, MD; Kaitlin Forsberg, MPH; D. Joseph Sexton, PhD, et al.; “Worsening Spread of Candida auris in the United States, 2019 to 2021.”  Annals of Internal Medicine, March 21, 2023; https://doi.org/10.7326/M22-3469
4.        “About Candida auris (C. auris)”; Centers for Disease Control and Prevention; last reviewed October 2022. https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html