Which States Have Fungal Infection Candida Auris?

Cases of deadly and drug-resistant fungal infection Candida auris have been spiking across the United States, with 28 states and Washington, D.C. having recorded cases in 2022, and 17 states identifying their first C. auris case between 2019 and 2021.

According to a new study in the journal Annals of Internal Medicine, U.S. Centers for Disease Control and Prevention (CDC) data shows that the 44 percent increase in cases seen between 2018 and 2019 spiked to a 95 percent increase in cases between 2020 and 2021. There were 1,471 cases in 2021, while estimates suggest that there were 2,377 clinical cases in 2022.

What is Candida auris?

"Candida auris is a member of a group of yeast fungi (Candida species) that usually cause minor infections in humans such as oral thrush (infection of the lining of the mouth) or vaginitis (infection of the vagina)," Mary Hayden, a professor of pathology, and director of the Division of Infectious Diseases and of the Division of Clinical Microbiology at Rush University Medical Center, told Newsweek. "Sometimes, Candida species can invade our bodies and cause serious infections of the blood, heart valves, or deep organ systems."

Which states have cases of C. auris?

CDC data shows that as of December 2022, 28 states and D.C. had seen cases of C. auris. These states include Alabama, Arizona, California, Colorado, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin.

The states with the highest number of cases include Nevada, with 384, California with 359 cases, Florida with 349, New York with 326, Illinois with 276 and Texas, with 160. The rest of the states have had fewer than 100 cases.

C. auris was first reported in 2009 in Asia and in the U.S. in 2016.

"It has generated more concern than some other Candida spp," Hayden said, "because 1) many strains are resistant to antifungal medications, 2) it colonizes human skin quite well, so that patients may be carriers for long periods, 3) it survives in the inanimate hospital environment well and it is not killed by some of the common disinfectants used in hospitals, 4) it causes outbreaks in healthcare settings; skin and environmental reservoirs may facilitate outbreaks."

"These four features are unusual for Candida spp," she said.

C. auris mainly affects people already in hospitals, especially those with weakened immune systems.

"According to the U.S. Centers for Disease Control, the mortality rate in the U.S. has been reported to be between 30 to 60 percent in many patients who had other serious illnesses," Rodney Rohde, a regents' professor of clinical laboratory science at Texas State University, previously told Newsweek.

"In a 2018 overview of research to date about the global spread of the fungus, researchers estimated mortality rates of 30 to 70 percent in C. auris outbreaks among critically ill patients in intensive care," he said.

Why are cases of C. auris rising?

The reasons for the recent spike in cases in the U.S. is likely due to a combination of difficulty in detecting this kind of fungal infection and hospital practices, although researchers aren't sure of the exact cause.

"I don't think it is entirely clear why cases are rising in the U.S. and elsewhere across the globe," Hayden said. "The Annals paper correlated the increase in C. auris cases in the U.S. to the COVID-19 pandemic. The authors hypothesized that increased stress on the healthcare system and a shift in focus of infection prevention towards SARS-CoV-2 forced a reduction in focus on C. auris, which then allowed spread in hospitals and long-term care facilities."

One major concern about the increase in cases of C. auris is that it is often resistant to antifungal drugs, with many samples of C. auris having been found to be resistant to at least one class of antifungal drug.

"Even more alarming was a tripling in 2021 of the number of cases that were resistant to echinocandins, the antifungal medicine most recommended for treatment of C. auris infections," Rohde said. "CDC has deemed C. auris as an urgent antimicrobial resistant [AMR] threat, because it is often resistant to multiple antifungal drugs, spreads easily in healthcare facilities, and can cause severe infections with high death rates."

To prevent the further spread of the infection, healthcare professionals must effectively identify the infection when it occurs.

"First, make sure that a facility can recognize the problem. C. auris can sometimes be missed or misidentified in clinical laboratories," Hayden said. "Second, if a patient who is a C. auris carrier is identified, separate (isolate) that patient from other patients and require that healthcare providers don gloves and gowns before caring for a patient and then discard the gloves and gowns before caring for their next patient."

Hygiene is also essential to prevent fungal infections from spreading, especially in hospitals.

"The need for thorough disinfection has never been greater, but studies have shown that less than 50 percent of high-touch surfaces in healthcare settings are adequately disinfected, allowing organisms like Candida auris to spread and leading to other healthcare-associated infections that affect more than 2 million people every year and kill nearly 100,000 of them," Jason Kang, chief innovation officer and co-founder of biotechnology company Kinnos, told Newsweek.

Do you have a tip on a science story that Newsweek should be covering? Do you have a question about Candida auris? Let us know via science@newsweek.com.