If the topic of dangerous pathogens comes up, it’s viruses or bacteria which are usually meant. The United States is, however, currently struggling with a very different pathogen, the yeast Candida auris. If it finds its way into the bloodstream, an infection can then be life-threatening. Thirteen cases were counted by the US health authority CDC (Centers for Disease Control and Prevention) between April 2013 and October 2016. At least four of the patients have since died, although it is still unclear whether the fungus was actually the cause of death.
The fungus spreads in particular in hospitals, probably via contaminated surfaces. Currently it appears that people who have been recently operated, are suffering from diabetes, have been treated with antifungal agents or antibiotics, or have a central venous catheter are especially in danger.
CDC Director Tom Peace has made a plea in the face of the “new challenge”: “to act now in order to better understand the spread of the fungus, to curb and to stop it”.
There are in actuality drugs that combat fungi effectively. The medications of choice for such mycoses are antifungals that, depending on the mode of action, either inhibit fungal growth, or kill the fungus.
Many samples of C. auris however no longer respond to medication. In a first CDC report it was stated that 71 percent of samples extracted from US patients have shown resistance to the medication.
Up to 1.5 million deaths
This is not the only problem with Candida auris. Detection is also difficult. Fungal spores are indeed found in the ears and in the urine but only with the help of special equipment. Many laboratories that work with standard methods cannot track the fungus at all.
The first infection which scientists came to know about happened twenty years ago in South Korea. Since then, several countries in the world have reported cases of illness. Reports have come among other places from Japan, India, South Africa, Venezuela, Israel, Colombia and the United Kingdom.
However there are other fungi which also regularly lead to trouble. It’s true that most of the world’s two billion fungal diseases are more an annoyance than dangerous. Yet there are also less harmless infections, as researchers led by Gordon Brown at the University of Aberdeen in Scotland wrote in 2012 in the magazine Science Translational Medicine. According to their estimates, every year from 500,000 to 1.5 million people die from fungal infections.
The most dangerous species belong to Cryptococca, Candida, Aspergillus and Pneumocystis. Around 90 percent of all deaths are accountable to these.
The most dangerous fungi
Cryptococcosis, which can lead to meningitis, according to the study affects more than one million people every year; depending on the region it is fatal for 20 to 70 percent of them. The lung infection pneumocystis kills a further 20 to 80 percent a year from among the 400,000 affected.
More than 400,000 people suffer candidiasis, an infection caused by one of the various Candida fungi, 46 to 75 percent of whom do not survive. Aspergillosis caused by Aspergillus species, kills more than 200,000 people annually. If the fungus finds its way into the blood, it can attack the heart, the gastrointestinal tract or nervous system. 30 to 95 percent will die from the infection. Whether C. auris is more dangerous than other fungi cannot yet be stated; so far about 60 percent of infected patients have died.
The spread of HIV and AIDS, the increasing use of drugs that suppress the immune system, antibiotic treatments and medical interventions make it easy for various fungi to overcome the defence systems of humans. However, despite the high number of deaths, most countries do not even have a monitoring system for fungal diseases. In addition research on new pharmaceutical agents is lacking. While there are almost twenty different classes of antibiotics available against bacteria, among antifungals there are only four.
In addition, when dealing with Candida auris researchers encounter defences to therapeutic agents. Many other types are becoming increasingly resistant. Worrying in particular is the increasing Echinocandin resistence among Candida species, as well as azol resistence with Aspergillus, as stated in the resistance report in 2015 by the Paul Ehrlich Society and the National Reference Centre for Invasive Fungal Infections.
On rinses and quacks
Fungi leave the medical world with a real challenge. There are also fungi which are unjustifiably feared. Again and again one hears assertions that yeasts in the gut solve numerous conditions, such as depression or migraines. And whoever eats sugar is also said to be “feeding” the Candida fungus in the gut. Help should therefore theoretically come from an anti-fungal diet and colonic irrigation.
The truth is, Candida lives in the body of approximately every second healthy person in central Europe as part of a peaceful coexistence in the intestine. Just because a fungus can be detected does not mean that there is an infection present requiring treatment. A balanced diet is always sensible; there is in contrast no evidence for special diets or rinses.
The former doctor and businessman Tullio Simoncini goes so far as to believe that Candida fungi is the cause of tumours and recommended cancer patients take baking soda.
This thesis is scientifically not only nonsense. Simoncini’s recommendation can also be very dangerous for patients. Following death cases after bicarbonate therapy used with cancer, he was sued. He lost his license and was according to media references sentenced for fraud and manslaughter. Nevertheless, deaths are still happening in association with this therapy.