Michigan’s first case of a drug-resistant, highly contagious and often deadly fungal infection in at least the last five years has been identified in a 76-year-old Oakland County man.
Candida auris, a potent form of a yeast infection, was discovered May 27 in drainage from the ear of the man, who had a history of chronic ear infections, according to a document obtained by the Brown Institute for Media Innovation at Columbia University that was shared with the Free Press.
When it gets into the bloodstream, it is deadly in 1 in 3 of people. It’s especially a threat to hospitalized people and those who live in long-term care facilities, the U.S. Centers for Disease Control and Prevention reports.
“In the demographic that’s a greatest risk … those folks have up to an 80% mortality rate,” said Dr. Russell Faust, medical director for the Oakland County Health Division.
“I look at this as potentially our Ebola. So we need to be very, very cautious when we’re talking about C. auris. We know it’s here. It’s in Canada. It’s in Illinois to the west of us. It’s in New York to the east of us. It’s south of us, in those states. So we know it’s here and we know it’s now in Michigan.”
In the last year, the CDC identified 948 cases of the fungal infection in 18 states and the District of Columbia. Most were clustered in New York, Illinois, Florida and California.
Those at highest risk for death from the fungal infection, Faust said, are people who have a tracheotomy, gastrostomy, central catheters, long-term IVs or catheters, those who are on ventilators and anybody who is elderly and has been on multiple antibiotics or antifungals as well as people who have had multiple health care stays especially at long-term care facilities.
Luckily, the Oakland County man’s case was isolated, he said, and no other Candida auris infections have been identified that are linked to it.
But Faust said the fungus can be stealthy and quickly spread through a hospital or long-term care facility, silently infecting the vulnerable.
He detailed an outbreak in the Chicago area in 2017 that ripped through a specialized nursing unit with patients who were were almost entirely on ventilators or had tracheotomies. Ten months after the first patient with Candida auris was identified, 62% of patients were infected, he said.
“Patients passed away. Patients were transferred to big-time facilities to save their lives,” Faust said. “This place was shut down to disinfect it. … They ended up finding it everywhere in the rooms, and used the usual disinfection in there, wiping down all the surfaces of bleach. But then they continued to find it.”
Eventually, the specialized nursing facility brought in disinfection robots to spray hydrogen peroxide in the rooms and use ultraviolet light to kill the fungus.
“They finally got rid of it in most places except for the ceiling tiles,” Faust said. Ultimately, they had to replace the ceiling throughout the facility.
“So it’s a real problem. It’s a big deal.”
Among the factors that play into the high fatality rate with Candida auris is that it often doesn’t respond well to the three anti-fungal treatments now available, and it’s also hard to identify a person with an infection with this particular pathogen. By the time doctors detect Candida auris, people are often already very sick, Faust said.
“What that means is you have a patient in the hospital, and they’ve been there awhile. They have an infection, and you send (a sample) to the lab,” he said. “The lab comes back and tells you it’s some other Candida species. You keep treating it, and they don’t get better.
“So finally, you send the sample off to MDHHS (the Michigan Department of Health and Human Services), which has to send it to CDC or something called the ALRN, the Antibiotic Resistance Laboratory Network. Those are the only places that have the instrumentation that’s validated to diagnose Candida auris.
“We’re talking about an enormous delay in treatment. … It’s a really big deal when you’re talking about an infection in a hospitalized patient.”
Faust didn’t know what happened to the Oakland County man who had the Candida auris infection. He also didn’t know where the man contracted it. But as soon as the case was identified, Michigan’s Health Alert Network sent notification to all of the local health departments in the state as well as to epidemiologists and health care providers, said Lynn Sutfin, a spokesperson for the state health department.
“There was no threat to the public and the patient’s health care providers were aware and took the proper precautions,” Sutfin said. “There have not been additional cases identified at this time.”
Candida auris was first identified in 2009. It wasn’t until June 2016 that the CDC began requiring health care providers to report it. Faust said Oakland County had at least two previous infections in the years before that. Since 2016, the number of infections has grown around the world, and Candida auris is now considered a serious global public health threat.
“Moving forward, we can expect more of these cases to pop up and we can expect the resistant strains to pop up,” Faust said.
Several steps should be taken now to rein in the spread of Candida auris, Faust said. Among them:
- People should seek medical care for any wound that is not healing as it should. Don’t delay care.
- Doctors and medical providers should avoid prescribing unnecessary antibiotics and anti-fungal treatments.
- More investment should be made in the instruments and technology needed to diagnose it.
“We really need to develop our ability at containment so that when these do pop up, we diagnose them more rapidly,” he said.
Contact Kristen Jordan Shamus: [email protected] Follow her on Twitter @kristenshamus.