Attack, Defend and Persist: How the Fungal Pathogen Candida auris was Able to Emerge Globally in Healthcare Environments

Abstract

Within a decade after its first description, the multidrug-resistant yeast Candida auris has emerged globally as a nosocomial pathogen causing difficult to control outbreaks. This, together with the alarmingly high mortality rate of up to 66% associated with C. auris candidemia, calls for a better understanding of its virulence traits and routes of transmission. Unlike other clinically relevant Candida species, C. auris seems to have the unique ability to be easily transmitted between patients. Although initially thought to express fewer virulence traits than Candida albicans, recent genomic insights suggest C. auris to possess these traits to a much more similar extent. This review highlights the virulence traits C. auris expresses to attack the host, defend itself against antimicrobial agents and to persist within the healthcare environment.

Evaluation of Microsatellite Typing, ITS Sequencing, AFLP Fingerprinting, MALDI-TOF MS, and Fourier-Transform Infrared Spectroscopy Analysis of Candida auris

“…Candida auris was described in 2009 in Japan and since then it has caused infections at a global scale with a serious nosocomial health risk [ 1 , 2 , 3 ]. In less than a decade, C. auris was isolated on all six human-inhabited continents [ 4 , 5 ], and infections were reported from more than 40 countries [ 4 , 6 , 7 ]. Nosocomial C. auris outbreaks were first reported from South Korea [ 8 ], followed by India [ 9 , 10 ], South Africa [ 11 ], Kuwait [ 12 ], Venezuela [ 13 ], USA [ 14 ], and European countries [ 2 , 3 , 7 ].…”

Repositionable Compounds with Antifungal Activity against Multidrug Resistant Candida auris Identified in the Medicines for Malaria Venture’s Pathogen Box

“…It was first reported in a human ear infection in 2009 in Japan [7], although it has been determined retroactively that it was present in an infection in South Korea in 1996 [8]. After its first identification, C. auris has since emerged throughout the world and become a major threat causing outbreaks of infections in hospitals and health care facilities worldwide [9][10][11][12][13][14][15][16][17]. There are several reasons that have contributed to the rapid spread of C. auris.…”

Detection and Control of Fungal Outbreaks

“…The sources of healthcare-associated outbreaks include construction near or renovation of healthcare facilities, contamination of water and ventilation systems, medicines and medical devices, and gaps in infection prevention measures [ 9 – 12 , 14 , 15 ]. An increasingly reported cause of fungal outbreaks is the emergence of novel resistant pathogens within hospital environments, clearly exemplified by the unprecedented emergence of Candida auris , as well as increasing incidence of previously rare resistant species like Candida krusei and Diutina rugosa [ 16 – 19 ].…”