This superbug has been in Tarrant County for 2 years, part of ‘alarming’ spread in U.S.

A difficult-to-treat fungus has been spreading in Tarrant County hospitals and long-term health care facilities for two years, part of an “alarming” spread identified by the U.S. Centers for Disease Control and Prevention.

Candida auris, a type of fungus that is part of the yeast family, was first confirmed in Tarrant County in 2020, said Russ Jones, chief epidemiologist for Tarrant County Public Health. The case was isolated and did not spread to other patients.

But in May 2021, an outbreak began after a patient at a hospital was diagnosed with a Candida auris infection. Multiple health care facilities were affected, and the outbreak is still spreading, albeit much more slowly than in 2021.

“This has been rolling for the past two years,” Jones said.

The fungus is known by its scientific name, Candida auris, and it was first identified in Japan in 2009. It is believed to have begun spreading in U.S. health care facilities in 2015. During the first two years of the COVID-19 pandemic, the bug spread at an “alarming rate” in U.S. health care facilities, according to a news release from the CDC. Part of that increase was driven by cases in Texas, where more than 150 clinical cases have been identified since 2021.

Most cases of Candida auris don’t cause infections or any symptoms in the people who are acquire it. But for the people who do develop cases, the symptoms can range depending on what type of infection occurs. The fungus can infect the urinary tract, bloodstream, ear, or a wound, according to the CDC, and symptoms vary depending on the source infection. And many patients who do get infected are already quite sick, and thus have a range of symptoms from other conditions, according to the CDC.

Although the fungus has been identified as an urgent health concern by the CDC and the World Health Organization, it is unlikely to pose a threat to healthy adults who are not in a health care facility, experts said.

“For the general community, I think the risk is pretty low,” said Dr. Nasia Safdar, a professor in infectious diease and infectino control at the University of Wisconsin School of Medicine and Public Health

But for adults with pre-existing conditions and those who are already very sick and in need of hospital care, an infection with Candida auris is not a welcome addition to their condition.

The fungus has been particularly vexing for public health officials and physicians because of the unusual way in which it spreads and because it is resistant to many of the antifungal treatments that physicians give patients to clear an infection.

The first challenge of Candida auris is the way it spreads: The fungus starts by colonizing on a person’s skin, where it can live for weeks undetected and without causing an infection. But while the fungus might not cause an infection, it can spread to other people. From there, it can cause an infection in someone if it gets the chance to enter their bloodstream, Safdar said.

Most fungal infections happen after someone inhales spores of the fungus, said Dr. Jeniel Nett, also a professor at the University of Wisconsin’s medical school and an expert in Candida auris.

“It’s only one fungus that we have to worry about spreading person-to-person in a in health care settings,” Nett said. “Candida auris is behaving very differently in this way.”

Candida auris is also a worrying superbug because it can survive many of the antifungal medications designed to kill it. Candida auris is part of a larger problem across the globe of drug-resistant pathogens, Safdar said. These are germs that have evolved to become resistant to the very medications that are designed to kill them.

At its peak, the outbreak in Tarrant County affected eight health care facilities, Jones said. The spread of the fungus has slowed in 2023. There have been 10 infections identified. Three facilities are testing for the fungus to see if they’ve eliminated it, Jones said.

Public officials did not publicize the May 2021 outbreak. The health department sent a notification in June or July 2021 to notify health care providers, infection preventionists, and emergency departments, according to a statement from a department spokesperson.

“The public was not notified as C. Auris is still healthcare associated, and we have not seen a community association,” according to the statement.

Candida auris is estimated to have a fatality rate of between 30% and 60%. In Tarrant County, the numbers are similarly dire: In 2021, of 23 clinical infections, 14 died. And then in 2022, 22 clinical cases and seven died, Jones said.

But experts on the fungus noted that it’s not yet clear how many patients with an infection are dying of the infection versus dying with it. People who get infected with the bug are generally quite sick, Safdar said, and already have a higher mortality rate than a healthy person.

“It’s a bit hard to calculate the mortality of Candida auris, but I think it’s safe to say that it’s often the tipping point for people,” Safdar said.

But she added that as more people begin to get long-term health care outside of hospital settings, like in their home, the chance for the fungus to spread increases.