What caused C. auris to emerge on several continents around the same time?
The earliest known strain of Candida auris dates back to 1996 in South Korea, according to the CDC. However, research suggests the fungal pathogen emerged independently in multiple regions of the world almost simultaneously between 2008 and 2009.
Infectious Disease News asked Stacey R. Rose, MD, associate program director of the internal medicine residency program and assistant professor of infectious diseases at Baylor College of Medicine, how and why C. auris emerged globally.
Candida auris was first described as a clinical pathogen in 2009, in Japan. Over the last few years, C. auris has been reported in an increasing number of countries and continents. In 2016, the CDC issued a warning concerning the emergence of this antifungal-resistant, virulent organism, with associated high mortality (approximately 60%).
The global distribution of C. auris has raised questions related to its origin. Genetic sequencing and phylogenetic studies have suggested that C. auris has emerged independently, and simultaneously, in multiple geographic regions across the globe.
There are several potential explanations for why C. auris has emerged on multiple continents over a short period of time. First, increased use of systemic antifungal agents may select for the development of C. auris, which carries a high rate of antifungal resistance. Second, the detection (and treatment/eradication) of C. auris may be delayed due to limitations of automated identification systems. Third, increasing antibiotic use in the affected geographic regions may perturb the bacterial microbiome, thus increasing the likelihood of colonization and/or infection with C. auris. Finally, since the organism appears to be hardy, it is plausible that the use of similar chemicals and protocols for decontamination in these regions may select for C. auris.
Regardless of the origin of this emerging and deadly pathogen, it is clear that the international community must act swiftly and aggressively in order to improve diagnosis and treatment for C. auris colonization and infection.
- CDC. Candida auris Questions and Answers. https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html. Accessed February 28, 2017.
Disclosure: Rose reports no relevant financial disclosures.