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Mold In The News: Candida Auris

by Catherine

How to Confront a “Super Fungus” In An Increasingly Pathogen-Friendly World

From time to time, I try to use this blog as an opportunity to introduce and discuss the latest news topics concerning mold/fungus and human health that come onto the scene and temporarily dominate mainstream media platforms. These stories seem to pop-up overnight, consume headlines and social media feeds, and then disappear without warning or explanation, leaving all of us wondering if we still need to be concerned and vigilant. This is going to be one of those posts, because it is important to me to formally address the news of the “recently-discovered,” rapidly-emerging fungal pathogen, or “Super Fungus,” Candida auris.

Before I get into the details, I want to be clear as to why I decided to write about Candida auris when the topic has already been covered ad nauseam: It is my opinion that most current stories on Candida auris generate a climate of increased fear and confusion surrounding how and why the pathogen spreads, our inability to eliminate it with standard antifungal drugs and treatment, and the high fatality rates of those infected. And while, those are definitely some of the hard facts about this fungus, Candida and other fungal infections have been around for centuries causing sickness and high mortality rates for systemic infection, but for some reason, just haven’t been given the focus, the importance, or the same “billing” as their bacterial and viral counterparts. This has been especially true in the medical community. For example, just think about how many times you have walked out of a doctor’s office with a prescription for a broad-spectrum antibiotic. Did they take a culture and identify the specific pathogen before writing the prescription? On the other hand, how many times has a doctor mentioned the possibility of fungal source when you have been sick or has prescribed an antifungal? Not many, right? Thus, I thought it might be helpful for me clear things up and to demystify Candida auris by focusing only on information that is evidence- and scientific-study based, so that I can bring you an easy-to-digest, and hopefully relatable take on the story. I also believe that when anything fungal is causing acute sickness to humans, especially at the magnitude of Candida auris, I would be missing the mark not to discuss some basic connections between the emergence of an increasingly virulent yeast and why we are becoming so vulnerable to it.

What is Candida auris?

If you Google “Candida auris,” you will find a multitude of stories and recently-published articles from various news outlets and the Centers for Disease Control (CDC) detailing the rather sudden (over the past 10 years) emergence and rapid spread of this potentially deadly and increasingly drug-resistant yeast. And, while various forms of Candida are nothing new to the medical world, heck, the yeast that causes diaper rash is part of our vernacular almost from birth, this particular yeast is different in that it is behaving more like a bacterium in its spread and ability to swiftly infect patients. While, for the most part, confined to immunocompromised patients in hospital or long-term care facilities, this “new” fungal invader has actually existed for thousands of years, but is only recently materializing as a growing medical threat worth a closer look.

To break things down as simplistically as I can, Candida auris (C. auris) is a species of fungus which grows as yeast (single-celled fungi). In people with healthy immune systems, cells called macrophages and neutrophils engulf these pathogens, nipping them in the bud. But when the immune system is weakened by disease or drugs, fungi can grow unchecked.  Candida auris is one of the few species of the genus Candida which can cause candidiasis (fungal infection) in humans. Many of the yeast infections with which we are most familiar are localized and can be treated. Less often, a fungal infection can enter the bloodstream and become systemic and fatal. Candidiasis infections are most often acquired in hospitals by patients with already weakened immune systems. Since C. auris is a pathogenic fungus that can cause invasive candidiasis (fungemia) in which the bloodstream, central nervous system, and internal organs are infected, it is especially dangerous to the most at-risk hospital patient population.

Candida auris was first described after it was isolated from the ear canal of a 70-year-old Japanese woman in 2009. Its mycology revealed it to be a fungus that could infect humans and, in severe cases, cause potentially fatal blood infections like those that we are seeing spread throughout certain chronically ill and immunosuppressed populations in hospital settings today—the most at risk populations being the elderly, diabetics, patients with venous catheters or feeding tubes, ICU patients, and those with other co-morbid conditions, especially those who have already been on high-dose antibiotics and/or antifungals. The factors of advanced age, suppressed immunity, and openings in the skin and mucous membranes seem to be what helps Candida auris (and most hospital-acquired fungal infections) gain access to the body.

Do I Need to Be Concerned About Being Infected?

While Candida auris doesn’t appear to pose eminent danger outside of hospitals and long-term care facilities yet (all reported cases have been confined to those settings and populations), understanding how and why it is spreading may be the best way to go about answering this question.

So far, the spread of Candida auris has been swift and broad. To date, the fungus has been reported and identified in more than 30 countries around the world, including the United States (the first reported case in 2013), Australia, India, Germany, Israel, Venezuela, and South Africa. But Candida auris has not been traceable in the same way most outbreaks tend to be, with an identifiable host, epicenter and a circular projection of cases spanning and growing all around it. Rather, Candida auris, from an epidemiologic perspective, seems to be evolving separately and independently on each continent. In other words, the fungus is changing, adapting, and spreading within each different environment, independent of its source or host. For example, strains of the fungus in one country have different anti-fungal resistance than those in another, with some strains even developing resistance during drug usage. Doctors usually do not know which exact drugs will be effective until a patient begins treatment.

This also makes prevention and identification of new cases challenging, because

1.) specific testing mechanisms are required to properly diagnose an infection and not all hospitals have those capabilities or enough experience with the pathogen yet to have to have the foresight to do so, making misidentification frequent and problematic for swift intervention;

2.) most patients that acquire invasive Candida auris also have other significant health issues, so the symptoms are not always glaringly apparent until the infection has spread systemically in the blood or progressed to a very serious state;

3.) and, when treatment with antifungal drugs begins, the patient has to be frequently checked and evaluated for progress, since no one drug seems to be effective for most patients.

This concept of a fungus that is genetically evolving may be difficult to fully grasp, especially if you, like me, are not very scientifically inclined. But, this evolutionary divergence of different strains of the same pathogen that are all developing similar antifungal resistance is what makes C. auris both fascinating and scary. This is because, it shines a light on the fact that both our bodies and our environments are becoming more inviting hosts to pathogens and toxins. And, while Candida auris may be a microcosm of this issue, it brings to the forefront that there is a misunderstanding and disparate level of education in the medical community when it comes to identifying and treating fungus as a pathogen and threat. In other words, while the medical focus has been on bacteria and viruses, fungi have materialized as formidable dangers in many forms. Unfortunately, this fact also makes most doctors and healthcare facilities ill-prepared to defend against them. When you recognize this and also acknowledge that every single one of us or someone whom we love will likely have to be a patient in a hospital for some reason, at some point in our lives, knowing that Candida auris could be present and could possibly cause significant infection and illness is a concerning proposition.

Why is Candida auris So Difficult to Get Rid Of?

The answer seems to circle back to how the fungus is behaving. According to Dr. Tom Chiller, chief of the CDC’s Mycotic Diseases Branch, “It’s a yeast that’s acting like bacteria.”

Meaning, from an infectious disease perspective, that Candida auris is doing what “germs” do, not what “fungus” is assumed to do.

  •  It is staying alive on surfaces and medical equipment despite traditional cleaning and disinfectant protocols.
  • It is spreading directly from one person to another through contact.
  • It is colonizing and living on skin surfaces of hosts without their knowledge and absent symptoms.
  • And, it is developing and sustaining resistance to many tiers of antifungal drugs that are typically used to treat invasive fungal infections.

To put it simply, Candida auris’s environmental resiliency combined with its antifungal resiliency makes it easy to spread, but difficult to kill.

A Frontiers in Medicine article about Candida auris sums this idea up well:

“Although C. auris does not share some of the virulence factors found in many Candida species, the non-aggregative phenotype, in conjunction with its biofilm-forming ability and innate resistance to antifungal agents, may help explain why it is so pathogenic and resilient on environmental surfaces despite disinfection.”

The Environmental Resiliency of Candida auris

Candida auris’s ability to hang around in the environment for a lengthy period of  time (14 days is cited) may also lead to its pathology against medications. Additionally, C. auris has been cultured from contaminated bedding for up to 7 days. The persistence of this pathogen on environmental surfaces presents opportunities to colonize or infect hospitalized patients and healthcare workers. There is some evidence that skin colonization of C. auris can persist for weeks to months as well–this is similar to other yeasts. In turn, the transfer of this pathogen from colonized patients and healthcare workers also presents further opportunities for it to contaminate other environmental surfaces.

Once on surfaces, rather than becoming inert, Candida auris retains its ability to infect, as it is able to form biofilm (a protective layer or covering that is difficult to penetrate) with the other microbes present to protect itself. This has made cleaning the rooms of colonized or infected patients extremely difficult. This is obviously a very concerning aspect of C. auris and is getting further attention and study by the CDC as they seek to stop its spread. To date, the CDC has found the best lines of physical defense to be stringent hand-washing and sanitizing protocols, isolating affected patients in separate rooms with posted warnings and infection protocols strictly adhered to, and using cleaning and disinfecting protocols in line with those used for Clostridium Difficile (an highly infectious and antibiotic resistant bacterium) in the rooms of affected patients both during their hospital stay and to clean their rooms after discharge. I will add that these advised cleaning products are mostly chlorine-based (not always the most effective chemical against fungus, as it does not address hyphae or biofilm). As of now, from what I can see, little to no research has been done on naturally-derived cleaning products that have been proven effective against other fungi and mold as alternatives to the standard and more toxic chlorine and oxidizing products.

The Anti-Fungal Resiliency of Candida auris

Once a patient is infected, treatment can become especially difficult, because many prescription antifungals are ineffective against C. auris. For example, in a paper published on an epidemiological study of the C. auris cases in NY, in the first 51 clinical cases, all but one had C. auris strains that were resistant to fluconazole. One quarter of those cases were resistant to both fluconazole and amphotericin B. Since there are not that many classes of antifungal drugs, the fact that C. auris already has beaten the first line of defense is worrisome. As the fungus is studied more and scientists are able to understand more about how and why it is adapting, new combinations of antifungals from different categories are being tried and some antifungals are even being given to some of the most at-risk patients preemptively to thwart infection. It is still yet to be determined whether or not these actions will be successful. There is also little to no adoption in clinical settings of attempts to combine 2 antifungals which are structurally different in order to stop drug resistance during treatment. In addition, there are many natural herbals that, in combination with prescription antifungals, may work well, especially as preemptive therapy, like Oregano, caprylic acid, cinnamon, and pau d’arco. These herbals do not foster anti-fungal resistance either the way that prescription drugs do. Unfortunately when a potentially fatal pathogen rears its ugly head, there are not many doctors or hospitals who would want to “try” such remedies to see what works. I can’t say I find fault with that, but this certainly identifies another possible line of defense that needs to be investigated further.

Making Additional “Fungal” Connections

Worth noting is also the evidence-based speculation about the new prevalence of C. auris having something to do with the use of azole anitfungals in the world’s food supply. These antifungals, when sprayed on produce, can create antifungal resistance both on the foods and in within the bodies of those ingesting them. This theory makes sense of the pathogen’s early ability to withstand even some of the most potent antifungal pharmaceuticals available, because, with this line of thought, C. auris has been adapting within our environment for a long time, so that now, as it surfaces, it is already extremely virulent.

Another interesting take on a possible pathophysiologic mechanism of the spread of pathogenic yeast—that you will NOT find elsewhere in the news, by the way—is that the typical “sick person” diet and the generic hospital diet are both high in carbs and sugar. Hospital IV’s also contain dextrose (sugar). Candida has a sugar receptor on the cell wall that causes it to change its physical shape from a harmless “yeast” form to an invasive hyphal form. Hyphae are like tentacles or roots that can grow down into tissue. They are often 3 feet long, microscopic and invade tissues to seek more sugar. The hyphal form of Candida is more drug resistant. You cannot kill it in the presence of sugar. Therefore, with continual exposure to sugar, a patient is feeding the yeast, despite using antifungals to kill it. Further, environment plays a part in fostering yeast in the body, because all fungi have the same cell wall structure, so if a patient has been breathing fungal air and mycotoxins, they are already reacting to their own gut Candida which can be a tremendous inflammatory reaction that cripples the immune defense system. This both predisposes a person to infection and already gives yeast a foothold in their bodies.

What Can We Do?

I have thought long and hard about this question and about offering any sort of insight or advice, especially since I am not a licensed medical practitioner of any kind, nor am I qualified to give medical advice. But, since I do feel that putting some actionable steps out there is beneficial for everyone’s sanity and well-being, I didn’t want to only leave you with facts and nothing to do about them. Thus, the only way for me to weigh in is to anecdotally offer the things I am doing in our home to protect us from fungal pathogens as well as the things that I would do, should I or one of my loved have to be admitted to a hospital, to safeguard against acquiring a fungal infection of any kind.

Everyday Action Steps to Prevent Fungal Infections:
  • Try to eat organic produce that is not sprayed with pesticides or antifungals.

    I realize that this is easier said than done. It can also be an expensive endeavor. My advice is to just do your best and to eat the organic variety whenever you can. I have also started growing some of the fruits and veggies we eat most often in a small garden in our yard. This have given us access to lettuces, squash, berries, watermelon, radishes, and herbs that have never been sprayed or treated. In the past, I was overwhelmed at the prospect of growing anything, much less food, but I took a free class at our library and started small. It has been easier, cheaper, and more rewarding than I ever imagined. Farm-shares and community gardens are also less expensive local options for organic produce.

  • Clean your produce with a natural antifungal and antibacterial to remove pesticide and microbial build-up. In our home, this is a no-brainer. Everything we eat is washed and soaked in CitriDrops Dietary Supplement prior to being cooked or eaten. HERE is my post on my fruit and veggie wash.
  • Take a probiotic with multiple strains of beneficial bacteria to strengthen your microbiome for protection against pathogens. This is especially important if you have taken many courses of antibiotics or have had gut dysbiosis, both of which make you more susceptible to fungal overgrowth and infection.
  • Avoid drinking tap water from municipal water supplies. All treated water contains chemicals, like chlorine, pesticides, antibiotics, and potentially heavy metals. All of these things can disrupt the microbial balance inside your body. We now know that when this happens, bacteria, fungi, and parasites can flourish. Whenever possible, try to only drink purified (with added minerals) or spring water that has not been supplied from a municipal source.
  • Use hand-sanitizing and home cleaning products that are naturally-derived and that have an antifungal component. HERE is my post on making your own antifungal hand sanitizer. It is important to always be vigilant both inside your home and outside of it for bacteria and for fungi that can pose a threat to your health. I clean our home with non-toxic cleaning agents that have a proven fungal component. For us, that means first cleaning with a “soap and water” application and then treating and wiping or cleaning with something, like high-heat steam, an EC3 product, Borax, or hydrogen peroxide. It is important to note that many bacteria and yeasts also produce biofilm, much like Candida auris. The only products that have been proven effective against biofilm in the long-term have been steam and natural anitfungals.
  • Eat a low sugar, low carbohydrate diet. Not only will this type of diet help to combat inflammation and type-2 diabetes (a precursor for Candida auris in hospital settings), it will prevent Candida and other opportunistic yeasts from flourishing in your gut. If you already have Candida, this weakens your immune system, making you even more prone to other disease and chronic illness.
  • Make sure the air you are breathing is not a hidden source of illness and inflammation. This includes testing often for indoor mold, using air purification and filtration systems in your home, avoiding the use of toxic chemicals in your home, and employing some general mold maintenance, like frequent HEPA vacuuming and use of EC3 Products to maintain indoor air quality and homeostasis. The air you breathe is 90% more important to your overall health than your genetics. Take control of your health by securing that the air you are breathing is clean and safe.
Action Steps After Possible Exposure:

Only a few short years ago, I was frequently in the hospital for major gastrointestinal problems and distress. I stayed overnight on most of my visits. Every time, I was hooked up to an IV, where I received antibiotic medications, nutrition, and fluids. I don’t like recalling those days of sickness and confusion, but to write this section, I made myself really go back there, knowing what I know now to answer this question. In other words, knowing about fungus in general, and now about the threat of Candida auris, here is what I would do to help prevent acquiring such an infection when in a hospital setting:

In the hospital:
  • If you are being given antibiotics for your condition, ask that your doctor also put you on a high-dose probiotic and an antifungal. You could also bring some CitriDrops Dietary Supplement with you to the hospital to use 2-3 times per day, mixed in water. This will help to prevent yeast overgrowth in your gut and will help to combat oral thrush.
  • Bring Mold Wipes and Antifungal Hand Sanitizer with you and use them often in your room and on the things around your room. Also make sure that any family members visiting employ good hand washing and hygiene practices to prevent the spread of infection.
  • Ask to be put on a diabetic or low-sugar, gluten-free meal plan. Hospital food tends to be full of sugar and sodium and is definitely not whole-foods centered. Since food is medicine, I am still in disbelief that this aspect of medical care has not caught up with acute care, but it is severely lacking. As much as possible, try to take charge of what is going into your mouth, as it can make or break your recovery. This is not always easily controlled, but sometimes letting your doctor know that it is a concern alerts them to the fact that attention does need to be made to your diet.
When you get home:

Take matters into your own hands and do what works well to support your body. As you gain your strength back, you can do things like the following:

  • Throw out or carefully clean anything you wore in the hospital with an oxygen-based cleaning detergent and EC3 Laundry Additive to kill any bacteria or fungi that you may have picked up.
  • Do a yeast cleanse, with a product like Candida Rid to remove yeast and fungal “bugs” from your body.
  • Continue to support your immune system with a healthy diet made up of whole foods and nutrient-dense meals.
  • Take a full-spectrum vitamin and mineral supplement to replace deficiencies that could cause immunosuppression. I like Complete Thymic Formula.
  • Continue using probiotics to help regain a strong gut microbiome and CitriDrops Dietary Supplement to address yeast and pathogens.
  • Try to get outside in the fresh air as much as possible. Breathing recycled indoor air and staying only in confined spaces does not help your health or recovery. Pathogens exist more readily indoors, because they can survive easier without threat.
  • Continue cleaning your environment frequently with non-toxic products proven against fungus. You need to prevent exposure as much as possible, especially in the early days when your immune system is still weak after leaving the hospital.
  • Monitor your symptoms and let your doctor know immediately if there are any negative changes in your health. The earlier you catch a potential infection, the better.
Please write to me at catherine@moldfreeliving.com or comment below with any questions or input on this subject.

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