Isolated for the first time in 2009, in Japan, Candida auris mainly affects immunocompromised patients
An emerging species of bacteria, with lethal potential in immunocompromised patients, deserves further studies to truly assess the transformations it may undergo, generating serious public health problems, particularly regarding hospital infections. The alert comes from infectologist and professor Maria Luiza Moretti, from the Department of Clinical Medicine, from the Faculty of Medical Sciences (FCM) at Unicamp.
This new species of fungus, Candida auris, of the genus Candida, made up of a large spectrum of species in which the most commonly responsible for infections in humans are albicans - cause more than 50% of infections caused by Candida, tropicalis, parapsilosis e glabrata. They are responsible for so-called systemic infections that, generally disseminated through the blood, can affect various organs.
The most feared infections Candida are those that reach the bloodstream, that is, the fungus spreads hematogenously to different organs of the body, which is called candidemia. A Candida auris, in addition to candidemia, can give rise to outbreaks.
the species auris was isolated for the first time in Japan, in 2009, from a patient with an ear infection, and then in South Korea. It was later found in India, Pakistan, Kenya, South Africa, Europe, USA, Venezuela , Colombia and also in Brazil.
However, these occurrences occur in hospitalized patients, primarily admitted to intensive care units, or rather, seriously ill and immunocompromised. This is the case for people with certain cancers, leukemias and those who have been using corticosteroids for a prolonged period. It is, therefore, an opportunistic agent, waiting for conditions to manifest itself.
The resistance of this fungus arises from its ability to produce biofilms in which it lodges and defends itself from the environment and even antifungals. As a result, he
It survives in the environment, in medical instruments such as catheters, on the hands and skin of healthcare professionals who, when caring for successive patients, can carry the fungus from one to another, causing an outbreak. However, it causes disease only in patients who are very susceptible to systemic infections.
Leak
For a while Candida auris may have gone unnoticed, or even confused with other species of Candida already known, but also rare, such as Candida haemulonii, Candida sake, Candida lusitaniae, Saccharomyces cerevisiae, Rhodotorula glutinis. The mistake was dispelled with the emergence and use of more sophisticated identification resources.
Today it is accepted that the resistance of microorganisms to antifungals is a consequence of both the widespread use of these drugs by humans and the systematic use of antifungals in agriculture, which, although different, contribute to the manifestation and emergence of more resistant fungi, having repercussions on the body as a result of consumption of agricultural products that contain traces of fungicides. This hypothesis, also suggested in relation to the Candida auris, would explain its resistance to antifungals and the difficulty of combating it.
What to do?
With the aim of inhibiting the manifestation of the fungus, facilitating its identification and enabling the treatment of affected patients, Professor Maria Luiza emphasizes the need for some measures, also recommended by Anvisa in Risk Communication No. 01/2017. The first refers to hand washing by health professionals before and after caring for each patient, which significantly reduces the risk of contamination and transmission not only through Candida auris as for all opportunistic or non-opportunistic microorganisms. The second measure refers to the rational prescription of antifungals and antimicrobials, which would contribute to controlling the emergence of increasingly resistant microorganisms.
Finally, the third important measure is the recommendation for immediate communication of the occurrence of the previously mentioned fungi with which Candida auris can be confused. Isolation of the fungi mentioned above in blood cultures or other clinical specimens must be sent to reference centers, such as the Laboratory of Molecular Epidemiology and Infectious Diseases at FCM, as hospitals do not have more sophisticated equipment for these analyses. By the way, says the professor: “In our laboratory we are able to sequence the samples sent and correctly identify this microorganism so that hospitals can even take preventive measures to avoid contamination and outbreaks.” The expert also notes that, as microorganisms that can be confused when identified with Candida auris are rare in everyday life, patients who present these infections can easily be subjected to differentiated care in order to prevent their spread.
