Candida Auris

Candida auris (C. auris), is a fungal infection of current public health concern due to the emergence of multidrug-resistant (MDR) strains. This was first isolated from the external ear of a patient in Japan in 2009 and has since spread worldwide. The first case of MDR Candida auris infection in Hong Kong occurred at the end of June 2019, and sporadic cases have appeared since then. Most of the cases involved carriers and had no symptoms. However, once Candida auris enters the blood, it can cause invasive , life-threatening infection, with a crude mortality rate from 30% up to 72%. The multidrug-resistant characteristic of C. auris also makes infection control considerably more difficult.

Risk factors for Candida auris infection

Candida auris is a type of fungal (or “yeast”) infection. It is generally no different from infections caused by other Candida species (notably C. albicans), but it is relatively rare and can cause serious infections. The following conditions contribute to the spread of this infection: Poor personal and environmental hygiene
Long-standing implanted devices such as endotracheal tubes/artificial airways, and urinary catheters, and use of contaminated, improperly disinfected endoscopes Immunocompromised patients such as diabetics, patients on chemotherapy and immunosuppresants (e.g. transplant patients) and long-term hospital admissions

Patients who recently underwent major surgery and is on broad spectrum antibiotics and antifungals

Candida auris vs. Candia spp.

	Candida Auris	Candida
Preferred environment	humid environments and dry environments such as plastic surfaces for several weeks.	Can survive in humid environments.
Areas of the body usually isolated from	Can survive anywhere in the body, including urine, sputum and human mucous membranes.	Mostly survive in human mucous membranes including the mouth, vagina and intestines.
Symptoms	Carriers are asymptomatic	Symptoms vary depending on the location of the infection
Pathologic manifestation	It may enter the bloodstream through the urinary tract, central venous catheter, etc., causing invasive infection and symptoms such as dizziness, fever, and low blood pressure. People with poor immunity may develop sepsis.	It usually causes inflammation of the vagina (vaginitis), urethra (urethritis); may cause sepsis in the severely immunocompromised.
Drug resistance	About 90% are resistant to the antifungal drug "fluconazole", about 30% are resistant to the antifungal drug "amphotericin B", and less than 5% are resistant to the novel antifungal drug class "echinocandins".	Prescription antifungal medications and (adjuvant) probiotic vaginal suppositories can be effective treatments.

Symptoms and signs of Candida auris infection

Immuno-competent individuals harboring Candida auris may remain asymptomatic. However, at-risk patients may have wound, ear or catheter-related infections which can enter the bloodstream causing invasive infection that can spread throughout the body, causing symptoms and signs such as:

Dizziness
fever
pain
fatigue
low blood pressure
Elevated heart rate

Fungal sepsis is a serious, life-threatening complication of C. auris infection.Generally, judging from the symptoms alone is difficult, and the diagnosis must be confirmed through testing.

Diagnostic methods for candida auris

Candida auris is difficult to identify using standard laboratory methods and must be identified using a "protein spectrometer".

The Hospital Authority has formulated infection control guidelines since 2018. Patients who have been admitted to hospitals overseas and are admitted to high-risk wards in Hong Kong, such as the intensive care unit, clinical oncology department, hematology department and bone marrow department, are required to undergo admission screening.

The instrument used for testing is a protein spectrometer, which tests combined swab samples from the patient's nasal cavity, armpit and groin; if the result is positive, the hospital will isolate the confirmed patient.
Conduct contact tracing investigations based on infection control guidelines and individual risk assessments
All confirmed cases need to be reported to the Office of the Chief Infection Control Officer of the Hospital Authority
If Candida is found in clinical samples or an outbreak occurs, the Center for Health Protection will be notified immediately

Candida auris prevention methods

Maintain good personal and environmental hygiene
Proper hand-washing
Rational use of antibiotics and antifungal medications
Hospital staff should use protective equipment appropriately
Disinfect the environment with bleach (sodium hypochlorite solution) 1000 ppm

Avoid sharing items or clothing with others
Maintain healthy living and eating habits
Control co-existing diseases such as diabetes
Do exercise to boost immunity
Appropriate catheter care
Quarantine controls for high-risk individuals/patients

OT&P Healthcare Advice

Candida auris is the same as the more common Candida species (albicans), but the multi-drug resistant nature of C. auris can cause serious infections. Generally, Candida auris is difficult to diagnose based on symptoms alone, and a diagnosis must be confirmed through high clinical suspicion and testing.