Candida auris: this infection spreads in total secrecy without being able to fight it.

Pesticides and fungicides widely used in agriculture have produced resistant mutants that threaten humans. This would be the case for Candida auris. This fungus is resistant to all fungicide treatments and drugs. It is spreading all over the world and is beginning to become a true serial killer since half the people who get it die from it. In the face of this threat, discretion, even silence, prevails in hospitals, where it is spreading rapidly in epidemic form, and among public health officials.

 

On thought that resistance to antibiotic and anti-infective treatments was reserved for bacteria. The media have often warned of the emergence of " superbugs "resistant to antibiotics. However, there has also been a marked increase in the proportion of resistant species in fungi of the Candida family. This is particularly the case for Candida aurisa yeast that has proven to be multi-resistant to commonly used antifungal treatments. This resistant fungus is believed to cause epidemics that are very difficult to control and are life-threatening for those affected. It is first found in cultivated soil, but also in buildings, housing and especially hospitals, where it is found in the smallest of gaps. The infection, which can affect the ear canals, urinary tract and bloodstream, targets immunocompromised people and can kill nearly half of those who contract it in 90 days. And when it is spotted, it is very difficult to get rid of.

 

The spotlight was turned on this mushroom by a long front-page story in the electronic edition of the New York Times this April 6th. The journal publishes several testimonials from researchers explaining how the widespread use of fungicides, particularly in agriculture, has contributed to the emergence of fungi resistant to all treatments and drugs available to treat humans. This was to be expected because it is a classic Darwinian phenomenon: the attacked organisms defend themselves by constantly evolving in order to escape the treatments intended to eradicate them. The more we use antibiotics, fungicides, pesticides, the more we encourage the birth of organisms that modify themselves to better resist them. These new organisms, bacteria, germs or fungi become polyresistant and render our current chemical and pharmaceutical arsenal perfectly ineffective.

 

The New York Times gives an idea of the magnitude of the consequences of this phenomenon. In 2010, in the United States alone, there were 23,000 deaths due to resistant infections. Today, there are studies of the University of Washington report seven times the number of deaths.

 

The case of the Candida Auris is the newest, but this fungus seems to be becoming a star in its field. It appeared a few years ago, in 2009 in Japan. Candida Auris seems to like to travel. It's quietly spreading all over the world. In the last five years, it has hit a neonatal unit in Venezuela, swept a hospital in Spain, forced a prestigious British medical centre to close its intensive care unit, and moved to 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 considered "urgent threats.

 

 

But what was less well known, and which is well highlighted by NYT journalists, is the extreme resistance of this fungus. As proof, the story of this man, admitted to Mount Sinai Hospital in New York City... He died 90 days after his admission to the intensive care unit. During this period of hospitalization.., C. auris colonized everything in the space the patient had been in: the walls, the bed, the doors, the curtains, the telephones, the sink, the bed bars, the mattress, every hole, every crack, every gap, from floor to ceiling, had become "positive". The hospital had to destroy part of the room's floor, ceiling and tiles to get rid of this particularly tough fungus.

 

Yet, as the problem grows, it is poorly understood by the public - partly because the very existence of resistant infections is often obscured.

With bacteria and fungi, hospitals and governments are reluctant to disclose epidemics for fear of being considered outbreaks. Even the C.D.C., under its agreement with the states, is not allowed to make public the location or names of hospitals involved in infections. In many cases in the United States, federal governments have refused to share information publicly without acknowledging that they have had cases.

 

In France, the National Reference Centre (CNR) for Invasive Fungal Diseases and Antifungals (Institut Pasteur) is responsible for the report infections. This organization claims that there is no epidemic situation in France and that since 2013, only two sporadic cases have been identified.

However, not far from our country, in Great Britain, several cases have been reported and one hospital had to close his I.C.U. for several days because of this infection. In Valencia, Spain, 372 people have been infected with the infection and 41 % infected patients died within 30 days. France would be protected, Chernobyl Cloud Syndrome?

 

The emergence of this pathogen appears to be due to the selection pressure of antifungal agents. Full genome sequencing of 47 strains isolated from different parts of the world revealed that they varied considerably from region to region, suggesting that C. auris had appeared simultaneously and independently in at least four locations around the planet before spreading around its point of emergence. The differences between the four strains are so profound that they suggest they would have diverged thousands of years ago. They would have become resistant pathogens from harmless environmental strains in four different locations at the same time. « Somehow it apparently jumped out almost simultaneously, and seemed to spread and it's resistant to drugs, which is really amazing. "Dr. Snigdha Vallabhaneni, a fungal expert and epidemiologist at the CDC, told the NYT.

 

Researchers believe that this resistant fungus may have developed as a result of the intensive use of fungicides on agricultural and horticultural crops. This is indeed the case, C. auris appears in soil samples, flower beds, compost, leaves, plant seeds, tea plantation soils, rice paddies, etc. The intensive use of azole fungicides has created such a hostile environment that the fungi have had to evolve to develop resistant strains and survive. C. auris would have existed for thousands of years hidden in the soil, and would have remained harmless for a long time. But as azole fungicides began to destroy it, the resistant fungus emerged.

 

Today, the world's public health agencies are quietly on the warpath. There is no need to panic the population, they think, and scare patients into a situation over which doctors can do nothing. For now, these super-resistant fungi are deadly to people with immature or weakened immune systems, such as infants, the elderly, diabetics, smokers, or patients with autoimmune diseases.

 

However, because the germ spreads so easily, there is a concern that healthy people may also contract it. To darken the picture, this phenomenon of super-resistance should not be limited to C. auris. In addition to bacteria, other germs and fungi could acquire a resistance against which we can do nothing.

 

All the more reason to reduce the irrational use of plant protection products in agriculture and to consume antibiotics with extreme caution. A change in our behaviour which, once again, comes up against the wall of money and industrial interests: the antibiotics market alone is worth 40 billion dollars worldwide. With C. aurisIn a way, we are witnessing the Darwinist mutation of a living organism, a sort of natural reaction to unbridled globalized capitalism.