Yeast Rising

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Yeasts, aka fungi, can infect people, and one of the common types of yeast is called Candida. This species of yeast causes mostly skin infections, especially in moist areas of the body where there is skin-to-skin contact, like the armpits and groin. These skin infections are more common in those with impaired immune systems, for example diabetics, but can usually be successfully treated with topical creams and lotions. Rarely, yeasts may cause systemic (bloodstream) infections in severely ill, hospitalized patients. These infections are much more resistant to treatment and often may cause septic shock and death. Many genetically unrelated forms of yeasts emerge worldwide for reasons that are as yet unknown. It is thought that the use of antifungal medications in people and animals or fungicides in agriculture may play a role in the emergence of new species of yeasts and fungi.

In 2009, a new yeast species called Candida auris (C auris) was discovered. This yeast has caused outbreaks of infection in hospitals and nursing homes. Unlike other yeasts that originate in human bodies and are passed from person to person, C auris can be acquired from the healthcare environment and spread from patient to patient. It can cause serious infections of the bloodstream, gut, wounds, and other sites. It is resistant to all current antifungal drugs and does not usually respond to treatment; death rates from this infection can reach 60%. Some patients may have C auris on their skin or in their rectum, wounds, or mouth, but they feel well and have no symptoms of infection. This is called asymptomatic colonization and treatment with antifungals will not eliminate it.

Those who get C auris infections are usually very sick, have many illnesses, and tend to remain in healthcare facilities for a long time. They have impaired immunity and often have feeding tubes, catheters, or intravenous lines. With rare exceptions, healthy people do not become colonized or infected with C auris, therefore routine screening of contacts of patients with it is usually not performed. Detection of C auris is difficult in most hospitals so, if infection with C auris is suspected, the sample must be sent out to a specialty lab. When being admitted to a hospital or healthcare facility, patients (or their families) should alert physicians if they have been diagnosed with a C auris infection or stayed at a facility where it was present. If there is concern that a patient has been exposed to C auris, they must be placed in isolation as a precaution until the diagnosis has been confirmed. Isolation for C auris requires placing patients in private rooms or placing patients diagnosed with it together. All staff must use gowns and gloves, and frequent hand washing is imperative. The room must be cleaned frequently with special disinfectants. Cultures of C auris may grow for up to three months after it is first detected.

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By Peter Galvin, MD

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