What are the other Names for this Condition? (Also known as/Synonyms)

• C. Auris Infection
• Infection due to Candida Auris

What is Candida Auris Infection? (Definition/Background Information)

• Candida Auris Infection is an uncommon fungal disease that is caused by Candida auris (or C. auris). Immunocompromised individuals, exposed to the pathogen, are at a high risk for systemic infection
• Certain strains of Candida auris are emerging as multi-drug resistant infectious disease agents (‘superbugs’) causing infections in hospital settings around the world. Such hospital-acquired infections (nosocomial infections) in immunocompromised patients have proven to be very difficult to diagnose and treat, resulting in high mortality rates
• In a normally healthy individual, the Candida Auris Infection may not present any signs and symptoms, but in those with severely weakened immune systems, the infection can be debilitating resulting in complications such as organ failure and coma
• The treatment of Candida Auris Infection is difficult due to the multi-drug resistance (MDR) and immunocompromised status of the affected individuals. Often, high-dose antifungal medications belonging to multiple major classes have to be administered to treat the infection
• The prognosis of C. Auris Infection depends upon a set of factors including the severity of the condition; although currently, the prognosis of the infection is guarded and often unpredictable

Who gets Candida Auris Infection? (Age and Sex Distribution)

• Candida Auris Infection can affect individuals of any age group. However, elderly adults and immunocompromised individuals are more susceptible to developing infections with severe symptoms
• There is no gender preference and both males and females are affected
• The infections can occur in all racial and ethnic groups; no specific geographical distribution is noted
• Over the last decade, the following countries have reported C. Auris Infection, or a higher incidence of cases, or an emerging multi-drug resistant infection
  • Asian countries: Japan, South Korea, India, and Pakistan
  • South American countries: Colombia and Venezuela
  • North American countries: USA and Canada
  • Middle East and Africa: Kuwait, Israel, Kenya, and South Africa
  • European countries: Great Britain

What are the Risk Factors for Candida Auris Infection? (Predisposing Factors)

The risk factors for Candida Auris Infection may include:

• A weak immune system caused by diseases/conditions such as:
  • Poorly-controlled diabetes
  • Recent organ transplant
  • Chemotherapy for cancer
  • AIDS or HIV infection
  • Major surgeries
  • Any other medical condition that decreases one’s immunity
• Kidney dialysis for a long duration
• Placement of intravenous catheters (central venous catheter); urinary catheters
• Individuals on broad-spectrum antibiotics or antifungal agents
• Individuals who have been hospitalized for a long duration (such as patients on life support systems, ventilators, ICUs, etc.)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Candida Auris Infection? (Etiology)

Candida Auris Infection is an opportunistic fungal infection caused by the microorganism Candida auris. Individuals with normal health may not be infected, or if they are infected, may not present significant signs and symptoms.

• Candida auris is a yeast-like fungus that may be present on contaminated equipment or surfaces within a hospital setting; it may spread through the environment
• Some subtypes of C. auris can cause fungal infections that are considered to be multi-drug resistant (MDR). Such C. auris MDR diseases are the cause of outbreaks within healthcare facilities
• The exact method of transmission of the pathogen is under investigation. It may be an airborne infection and/or spread through direct contact
• Individuals with Candida in the past, may have infection on the skin (or mucus membranes) and cause its spread to high-risk or immune-suppressed individuals
• The infection may spread through open wounds on the skin

What are the Signs and Symptoms of Candida Auris Infection?

Individuals with normal health status may not have any signs and symptoms. The signs and symptoms of Candida Auris Infection in those with poor immune systems may include:

• Ear infections
• Flu-like symptoms that includes fever and chills
• Fatigue and weakness
• Open wound infections
• Disorientation, confusion
• Infection of the blood resulting in sepsis; fungemia, when fungi are present in blood
• The signs and symptoms may be specific to the body part affected

Also, the immunocompromised individual does not respond to conventional therapy with antifungal medications, which may be an indication of the disease.

How is Candida Auris Infection Diagnosed?

Diagnostic challenges in identifying the particular fungus strain causing Candida Auris Infection:

• It is difficult to identify the subtype of Candida, if Candida auris species is not considered by the healthcare provider. Identifying C. auris requires specialized testing that are not routinely available in many hospitals and healthcare institutions
• Even though Candida can be recognized, C. auris is often missed. Detecting Infection due to Candida Auris may require a higher standard healthcare setting with more advanced testing facilities and equipment
• Moreover, since C. auris can be seen alongwith C. albicans or other Candida species (presenting a co-infection), diagnosing the exact species is a challenge
• Additionally, Candida Auris resembles many other fungus types (such as C. haemuloni), and hence, it is often misidentified as C. haemuloni (or other) infection during regular lab testing

A diagnosis of Candida Auris Infection may include:

• Physical examination with evaluation of medical history
  • The individual’s history of illnesses such as diabetes, cancer, HIV, or other chronic diseases, is checked
  • Any history of major surgical procedures or hospitalization is also evaluated
• Blood and urine culture
• In cases when the organism is suspected, molecular testing using gene sequencing can be performed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Candida Auris Infection?

The following complications may arise when individuals with weak immune systems are affected by Candida Auris Infection:

• Extended hospital stay because of severe infection
• Inappropriate treatment due to misdiagnosis of the condition; delay in providing proper treatment
• Systemic infection can result in multiple organ failure
• Coma, which may result in fatalities
• Candida Auris Infection is known to occur in healthcare institutions as an outbreak and affect several immunocompromised patients as an infection cluster

How is Candida Auris Infection Treated?

Treatment for Candida Auris Infection depends on the infected site, the immune status of the individual, and their risk factors.

• Regular C. Auris Infection may be treated using standard antifungal medications
• However, in case of multi-drug resistant infection, where the fungus is resistant to major class of antifungal medication, the treatment options are difficult and limited. Often regular doses of antifungal medications may be inadequate or ineffective
  • Antifungal medications belonging to multiple major classes (high-dose, multi-class antifungal therapy) may have to be administered
  • Systemic infection requires systemic therapy and other additional treatment agents as well

How can Candida Auris Infection be Prevented?

A prompt recognition of Candida Auris Infection followed by an accurate diagnosis and appropriate treatment is very important. It is the primary preventative step to help contain its spread through the institution of early and effective infection-control measures within the healthcare facility.

Additionally, the following preventive measures may be adopted for minimizing the risk of C. Auris Infection, and thus, avoid outbreaks within a healthcare setting:

• Proper hand washing by healthcare professionals
• Informing and educating patients, caretakers, and hospital visitors on maintenance of proper hygiene practices and cleanliness
• Disinfection and regular cleaning of hospital spaces and surfaces, such as patient rooms, consultation rooms, medical equipment, intensive care units, and surgical procedure areas, using antifungal disinfectants
• Cleaning and disinfecting hospital environment; adherence to standard bio- and other medical- wastes disposal techniques
• Advanced cleaning techniques in the hospital environment, including UV light, hydrogen peroxide, use of proper air cleaning, filtration, and ventilation techniques
• Local health department has to be notified to help prevent infection outbreaks in healthcare settings

Extensive laboratory research, surveillance, and outbreak investigations are currently underway in the research community to prevent and/or contain C. Auris Infections.

What is Prognosis of Candida Auris Infection? (Outcomes/Resolutions)

The prognosis for Candida Auris Infection depends on the cause, severity, chronicity, and response to treatment.

• The prognosis is mainly dependent upon the condition of the affected individual. Immunocompromised and elderly individuals with poor immune systems are more likely to suffer from prolonged infection
• In general, due to the diagnostic challenges, poor immune status of the affected individual, an invasive and systemic nature of the infection, and nature of its multi-drug resistance, the prognosis of C. Auris Infection is mostly guarded
• High-mortality rates (up to 50%) have been associated with the illness in healthcare institutions. The cause of death is mostly related to the underlying cause for poor immunity in the individual

Additional and Relevant Useful Information for Candida Auris Infection:

The most common fungal infection caused by the Candida species (C. albicans) is called Candidiasis.