Mysterious fungal pathogen worries Canadian doctors

Physicians and specialists from across the country have been working on a partially drug-resistant fungal pathogen for nearly a decade to determine its origin and control it.

This is Candida auris, identified for the first time in 2009 by a Japanese patient.

Since then, the presence of this pathogen has been noted in several countries, affecting hospitalized patients, mainly those with weakened immune systems, such as patients receiving chemotherapy, those having undergone surgery or those being treated.

Dr. Isaac Bogoch of the Toronto General Hospital says Candida auris is relatively rare, but has some disturbing characteristics.

The pathogen is difficult to identify for some laboratories, its treatment is difficult when it reaches the blood and is often resistant to several antifungal drugs, he says.

“With late diagnosis, it can often delay the proper treatment – and if we delay the treatment of the fungal infection, especially when it is in the blood, people can become very sick, very quickly. “Worries Dr. Bogoch.

According to partial information, specialists estimate that more than one in three patients with invasive Candida auris infection die.

Presence throughout the country

The Public Health Agency of Canada (PHAC) states that a total of 20 cases were recorded in the country from 2012 to 2019, including six in Quebec and Ontario between 2012 and 2017, and 14 cases in the Western Provinces. between 2014 and 2019.

Canada’s first case of multidrug-resistant Candida auris was diagnosed in July 2017 by a returning traveler, according to CPHA’s Anna Madison, who says some drug-resistant infections have been contracted in hospitals overseas.

According to Ms. Madison, this infection comes from people who do medical tourism abroad.

Dr. Bogoch feels that he will have more cases in the future.

The reasons for the spread of this infection remains unknown at the moment.

Heat resistance

According to Dr. Arturo Casadevall and his team at the Johns Hopkins School of Public Health in Baltimore, the pathogen is more resistant to heat and develops at higher temperatures.

Dr. Casadevall said the genome adapts to higher temperatures. This tolerance to heat could contribute to its emergence as a fungal disease in humans.

Dr. Casadevall and colleagues at the University of Texas at Houston and at the Westerdijk Fungal Biodiversity Institute in Utrecht, the Netherlands, suspect that global warming could contribute to the spread of this infection.

They sought a common denominator to explain the appearance of Candida auris in three very different regions of the world, characterized by distinct flora and geographical conditions: South Africa, South America and India.

“Imminent problem”

“The big problem here is that as the planet warms up, more and more of these [fungal] organisms that are not currently a threat can adapt to higher temperatures,” said Dr. Casadevall. “It’s an imminent problem.”

According to Dr. Tom Chiller, the expansion of industrial agriculture, warmer temperatures and mutations of the fungus itself are factors that could promote the emergence of Candida auris .

Even after the treatment of the infection, patients can continue to carry the pathogen to places like the skin, but without causing the disease, according to specialists.

These patients may also transmit the pathogen to other patients.

For this reason, public health specialists recommend measures such as hand hygiene, wearing gloves or placing Candida auris patients in a single room.

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