Medical professionals battle ‘superbug’ in secrecy

For the past eight years, Indian medical and scientific circles are waging a hidden war against Candida Auris — a fungus which has developed resistance against antibiotics.

Candida Auris (or C.auris as it is sometimes called) is highly contagious and increasingly resilient to antibiotics. The pathogen can be passed on by touch. But afflicts people with a weakened immune system, including those using steroids or suffering from viral infections, HIV, alcohol-induced liver problems and people recovering from surgeries in hospitals.

According to the US Centre for Disease Control (CDC), several Canadian, American and French citizens infected with C.auris had returned home following treatments for unrelated problems in India.

Many of infections took place in hospital ICUs, where studies show that the fungus can thrive for more than 14 days on dry, moist and plastic surfaces.

A survey of 27 ICUs across India between 2011 and 2012 found 1,400 patients infected with various types of candidaemia — 74 (or 5.3 per cent) of whom had been infected with Candida Auris. The results were published in 2017, in the Journal of Antimicrobial Chemotherapy at Oxford University.

Dr Arunaloke Chakrabarti, President of the International Society for Human and Animal Mycology (ISHAM), who co-authored that paper, described C.auris to Deccan Herald as a “game changer of fungal disease” because here is a fungus which behaves like a bacteria by rapidly acquiring resistance to drugs as bacteria does and because it possesses rapid transmissibility, and because it is difficult to identify by commercial phenotype systems, which most labs use.

By 2018, the number of C.auris isolates in India had risen to 243, according to meta-analysis data published that year. Dr Chakrabarti suggested another comprehensive survey to determine the true number of cases.

Part of the fungus’s growing prevalence was due to lack of an awareness campaign and a general reluctance by staff in private hospitals to discuss the matter with the general public. However, as the fungus’ increased resistance to antibiotics became clear, members of the scientific community tried to warn the world. Dr Anuradha Chowdhary, of Vallabhbhai Patel Chest Institute in Delhi, and former consultant to WHO, was one of them.

“When we finally saw in 2012 that C.auris was becoming resistant to antifungals, we tried to contact everyone,” Dr Chowdhary said. “They were not interested. It was only after there was an outbreak in London in 2015 that people began to take notice.”

Dr Chowdhary attributes recent press reports in the United States and the declaration of an emergency by the CDC for alerting the world to the problem.

The fungus, which has a mortality rate of between 43 and 60 per cent, an incubation period of under 96 hours and can cause death within 30 days, is currently being controlled by a combination of drugs, some of which may be ineffective in the near future.

Dr Hemant H R, a senior consultant of Microbiology at the Mazumdar Shaw Health Centre said the fact that the fungus has not erupted into a larger outbreak is cause for cheer.

“I am happy about the fact that C.auris has not proliferated — which means we are still in control of the situation. But the fungus is gaining immunity against several classes of drugs, and two or three years down the lane, who knows what might happen?”

Dr Arunaloke Chakrabarti: “Private hospitals are not getting the message out about this disease and the government really needs to step up to spread awareness because C.auris is spreading like a wildfire.”

What's Candida Auris?

♦ Candida Auris is a member of the candidaemia fungus family, many of which reside in the human body.

♦ The fungus can survive in the environment for up to three months.

♦ While the fungus is impervious to common household detergents, it is not resistant to antiseptics, including hydrogen peroxide, chlorhexidine. A simple soap handwash or alcohol can eliminate it.

♦ The first case was noticed in Kolkata in 2011. The patient died of infection. Doctors unable to verify the origin of the pathogen.

♦ Some studies blame extensive use of pesticides and overuse of antibiotics for the rise of disease.