'A double whammy': Ohio health experts sound alarm on rising cases of fungal infection

Candida fungi, Candida albicans, C. auris and other human pathogenic yeasts, 3D illustration

A drug-resistant fungus is increasing its spread through health care facilities in Hamilton County, where 3 out of every 4 cases reported in the state of Ohio have occurred.

Candida auris, or C. auris as it's known, has an origin that can be traced back to Japan in 2009, when a patient contracted a novel yeast infection in their ear canal. A recent surge of the fungal infection in the United States has caused the Centers for Disease Control and Prevention to issue a warning to spread awareness about the "increasing threat."

“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” CDC epidemiologist Dr. Meghan Lyman said in a news release last month.

Here's what you need to know:

'Urgent threat': CDC warns against Candida auris, a drug-resistant fungus invading health care facilities

Candida auris: Ohio ranks 9th in US for potentially deadly, drug-resistant fungal infection

How many cases of Candida auris have been reported here?

Ohio ranks in the top 10 of 29 states that have reported cases of the fungal infection so far. The first cases of infection related to the C. auris fungus were recorded in the U.S. in 2016. And the first case of C. auris recorded in Ohio came at a facility in Cincinnati in 2020.

Hamilton County has since recorded 270 cases of Candida auris as of March 16. The state of Ohio has recorded 416 cases in total, according to the Ohio Department of Health. In Cincinnati, specifically, there have been 26 cases of C. auris so far this year as of March 31. In 2022, there were 95 cases and in 2021, 82 cases, according to data from the Cincinnati Health Department.

There were at least 22 cases of Candida auris in Kentucky in 2022, according to the CDC. There have been 19 cases in Northern Kentucky since 2021, according to the Northern Kentucky Health Department.

What is Candida auris and why is it so difficult to treat?

Candida auris is a strain of yeast fungus that mainly spreads through contaminated surfaces, equipment or person-to-person contact. While its presence in the U.S. is relatively new, the infection can be deadly. Based on preliminary data from the CDC, the agency estimates that anywhere from 30-60% of patients who have C. auris have died.

In addition to affecting sick people, Candida auris is also unique among its species of Candida infections in that it fights against typical antifungal antibiotics.

"It is treatable, but you often have to use two types of antifungal medication at fairly high doses to treat it if someone is symptomatic," said Dr. Denise Saker, interim medical director of the Cincinnati Health Department.

Because the infection is considered a hospital-acquired condition, cases are recorded based on where a test occurred and not by the address of patient, as is the case in reporting other illnesses and infections.

Though case numbers are low compared to some other infections, the concern for this specific fungus, and its rising presence, is that it typically originates and spreads in health care facilities where vulnerable populations of people who are really sick are affected, said Dr. Carl Fichtenbaum, an infectious disease expert at UC Health.

"We have a large population of people who are very sick who we're able to keep alive through modern medicine," said Fichtenbaum, who is also a University of Cincinnati College of Medicine professor. "But they're very susceptible to many kinds of infections. And if you give them an infection that can be serious, and it's hard to treat, that's a double whammy."

Preventing spread of the fungus

Saker and colleague Kim Wright, supervising epidemiologist at the Cincinnati Health Department, said they're engaging with health facilities to spread awareness about the surge of C. auris. Some disinfectants used to prevent COVID-19 or other types of infection, may not work the same in fighting off fungal infections, Wright said, requiring facilities to disinfect surfaces multiple times.

"From the communicable disease unit I can tell you that we're very concerned," Wright said. "Because it's our job to try to prevent transmission from occurring in the region, but what we're seeing in the region is that it's spreading."

Protocols like communication between health care facilities for patients who have been moved from one provider to another are another area of focus for the department, Wright said.

Fichtenbaum said testing for the fungal infection has gradually become "sharper" as experts have learned more and more about C. auris. But the continuing challenge, he said, is testing which medications work and which ones don't.

"That's not something that's done in most standard microbiology labs," he said. 'You have to send it out to another lab and it sometimes takes three to five days to get the information."

This article originally appeared on Cincinnati Enquirer: Ohio ranks in top 10 states reporting drug-resistant fungus in the US