UPSC Express

In focus: Multi-drug resistant fungus, Candida auris

Introduction

• Candida auris is a fungus discovered in 2009 that has developed resistance to commonly used anti-fungal drugs.
• ‘Candida auris’ is spreading across the globe adding a new dimension to anti-microbial drug resistance.
• WHO recognizes anti-microbial multidrug-resistance as one of the top 10 global public health threats in 2019.
• Thus, in addition to anti-biotic resistance, anti-fungal resistance is also emerging as a major global health threat.

Harmful effects of Candida auris

• The harmful effects of Candida auris is 2 fold
• Direct Infections
• It commonly causes infections in wounds, bloodstreams, and ears.
• In case of patients with weak immune systems it can cause invasive infections in blood, heart, brain, urinary tract and respiratory tract in which cases I can cause deaths in 1 in 3 patients.
• Spread of antifungal resistance
• While it is not life-threatening for healthy population, its spread is a serious public health concern due to multiple drug resistance it can develop.
• Thus rendering various anti-fungal drugs ineffective.

Vulnerable population

• People with weak immune system like old aged, neo-natal groups, patients of diabetes mellitus.
• Doctors and other Health care workers etc

Possible reasons for the spread

• Anti-fungals are usually used to prevent agricultural plants from rotting.
• Rampant use of anti-fungicides on crops could exacerbate the spread and infect healthy population.
• Since they are easily spread in the environment it can travel by way of farm products like vegetables, meat etc.
• It could be transported across borders by travelers (similar to traveler’s diarrhea) and on exports and imports.
• Transferred by infected patients from hospitals and back.

Spread of Candida Auris

• Candida Auris was 1st discovered in Japan in 2009.
• Now it has spread to almost all regions including South Korea, India, South Africa, Kuwait, Colombia, Venezuela, Pakistan, the United Kingdom, and the United States.

Challenges

• Difficult to identify
• It can be misidentified for other types of fungi leading to wrong methods to arrest the spread.
• Low knowledge
• Current knowledge of the fungus is low
• Its origin,
• its spread,
• the way it affects,
• mechanism it adopts to develop resistance
• Rapid contamination of environment
• The fungus is so invasive that it spreads very rapidly in the hospitals and environment in general.
• Drug-resistance
• The fungus is known to be resistant to 90% of the anti-fungal drugs
• Besides it is also 30% effective in case of multiple-drug therapies.
• Low attention
• Most of the attention among anti-microbial resistance is currently focused towards anti-biotic resistance.

Note on Traveler’s Diarrhea

• Traveler’s diarrhea is the other disease vulnerable to be transported across borders.
• The main reasons for traveler’s diarrhea are
• Changes in circadian rhythm
• Travelers moving across border witness changes in diet cycles, sleep cycles etc and thus affecting the life cycles of bacteria and viruses in the intestine.
• Contaminated environment
• Consumption of contaminated food and water in new destinations especially tropical countries like India is the main cause of diarrhea for travelers.
• The most common microbe causing diarrhea is E.coli bacteria.
• Delhi Belly is a case of traveler’s diarrhea caused by an infection in the intestine.
• Spread of infectious microbes
• Giardia is a common parasite vulnerable to spread across borders very easily through the travelers.
• Viruses also cause diarrhea and due to complexity in their lifecycles spread very fast across border through travelers.