A MYSTERIOUS INFECTION, SPANNING THE GLOBE IN A CLIMATE OF SECRECY

A MYSTERIOUS INFECTION, SPANNING THE GLOBE IN A CLIMATE OF SECRECY

The rise of Candida auris embodies a serious and growing public health threat: drug-resistant germs.

Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.

For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine.

“It’s an enormous problem,” said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review on the rise of resistant fungi. “We depend on being able to treat those patients with antifungals.”

Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines.

Yet even as world health leaders have pleaded for more restraint in prescribing antimicrobial drugs to combat bacteria and fungi — convening the United Nations General Assembly in 2016 to manage an emerging crisis — gluttonous overuse of them in hospitals, clinics and farming has continued.

Resistant germs are often called “superbugs,” but this is simplistic because they don’t typically kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body’s defenses.

Scientists say that unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier populations. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in 2050, eclipsing the eight million expected to die that year from cancer.

In the United States, two million people contract resistant infections annually, and 23,000 die from them, according to the official C.D.C. estimate. That number was based on 2010 figures; more recent estimates from researchers at Washington University School of Medicine put the death toll at 162,000. Worldwide fatalities from resistant infections are estimated at 700,000.

Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.

Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy.

With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.

Ndërsa mikrobet përhapen lehtësisht – barten përmes duarve dhe pajisjeve brenda spitaleve, mishit dhe perimeve të fertilizuara nga plehrat; transportohen përtej kufijve nga udhëtarët dhe nga eksportet dhe importet; dhe transferohen nga pacientët nga shtëpi të pleqëve në spitale dhe anasjelltas.

auris, i cili infektoi njeriun në “Mount Sinai”, është një nga dhjetra bakteret dhe kërpudhat e rrezikshme që kanë zhvilluar rezistencë.

Shtame të tjera të kërpudhës Candida – një nga shkaqet më të zakonshme të infeksioneve në gjak në spitale – nuk kanë zhvilluar rezistencë të konsiderueshme ndaj barnave, por më shumë se 90 për qind e infeksioneve të C. auris janë rezistent ndaj së paku një bari dhe 30 për qind rezistente ndaj dy ose më shumë barnave, sipas CDC.

Dr. Lynn Sosa, epidemiologe e shtetit të Connecticut, tha se tani e sheh C. auris si “kërcënimin më të lartë” midis infeksioneve rezistente. “Është shumë e rezistente dhe e vështirë për t’u identifikuar,” tha ajo.

Pothuajse gjysma e pacientëve që kontraktojnë C. auris vdesin brenda 90 ditëve, sipas C.D.C. Sidoqoftë ekspertët e botës ende nuk e kanë gjetur se nga ka ardhur.