Fully occupied intensive care unit (ICU). Healthcare workers who are physically and mentally tired. Chaotic and overcrowded hospital. These and similar issues caused by the COVID-19 pandemic in Brazil Candida aurisMicroorganisms called “superfungi” because of the rate at which drug resistance develops.
The first two cases were confirmed in a hospital in Salvador (Bahia, northeastern Brazil) in December 2020. Fungal journal By a group of researchers led by Arnaldo Colombo, Director of the Institute of Special Mycology at the Federal University of Sao Paulo (UNIFESP).The study was supported by Sao Paulo Research Foundation – FAPESP..
“The other nine Candida auris Since then, patients have been diagnosed in the same hospital and some have been colonized. [with the fungus in their organism but not doing harm] Others have been infected, “Colombo said. “No other cases have been reported in Brazil, but there are reasons for concern. We are monitoring the evolutionary characteristics of Candida auris Samples that have been isolated from patients in Salvador hospitals and have reduced susceptibility to fluconazole and echinocandin have already been found. The latter belongs to a major class of drugs used in the treatment of invasive candidiasis. “
except Candida auris, Genus fungi Candida Is part of the human gut flora and causes problems only when the organism is imbalanced, Colombo explained. These include infections such as candida vaginal inflammation and thrush (oral candidiasis), which are often caused by Candida albicans.
However, in some cases, the fungus enters the bloodstream and, like bacterial sepsis, causes a systemic infection known as candidiasis, the most common form of invasive candidiasis. Invasion of the bloodstream and worsening of the immune system’s response to pathogens can damage some organs and even lead to death.Mortality in infected candidaemia patients, according to scientific evidence Candida auris Can reach 60%.
“This species quickly becomes resistant to multiple drugs and is less sensitive to disinfectants used in hospitals and clinics,” Colombo said. “As a result, they can survive in hospitals, where they colonize healthcare professionals and eventually infect severely ill COVID-19 and other critical patients with long-term stays.”
Patients infected with SARS-CoV-2 due to several factors Candida aurisIncludes long-term hospitalization, urinary and central venous catheters (which allow entry into the bloodstream), steroids and antibiotics (which destroy the gut microbiota).
“The virus can damage the intestinal mucosa of severe COVID-19 patients [facilitating invasion of the bloodstream by pathogens] To make patients vulnerable to candidaemia, “Colombo said.
Some countries Candida auris During the COVID-19 pandemic, he added, further urgent need to strengthen control of nosocomial infections throughout Brazil. Reasonable use of antibiotics in the ICU is just as important. Azithromycin and other antibiotics have been more widely prescribed since the beginning of the pandemic, but in most cases there is no true justification.
Candida auris Was first isolated in Japan in 2009, but little attention was paid to the scientific community until a few years later, when the outbreak of superfungal candidaemia occurred in Asia and Europe. 2016, article by UNIFES P group Journal of Infection Reported that the species arrived in the Americas via Venezuela. Immediately detected in Colombia, Panama and Chile.
“In 2017, we participated in a task force convened by the Ministry of Health and ANVISA. [Brazil’s health surveillance authority] I wrote a technical standard [Risk Notice 01/2017] Warn medical services that precautions need to be taken to monitor potential arrivals Candida auris In Brazil, which was confirmed only at the end of last year, “Colombo said.
Since then, the UNIFESP team has undetected and monitored the emergence of novel fungal pathogens in bloodstream infections documented by medical centers throughout Brazil. Candida auris until now.
5 clades or lines Candida auris So far, it has been explained in the world. According to Colombo, the Salvador-isolated clade is more similar to the Asian original than the variants found in Venezuela and other South American countries, suggesting the second independent arrival of the superfungus on the continent. ..
“Or, there may be a local source of the environment, as none of the Brazilian patients infected with the fungus have traveled abroad or been infected with relatives,” Colombo said.
From December to monthly, researchers received samples of isolated clades at Salvador’s hospital to test their susceptibility to antifungal drugs in the lab.
“In these tests, exposure to gradual concentrations of antifungal agents is used to determine the lowest dose that can inactivate cultured microorganisms. Candida auris For example, if present in a sample recently isolated with salvador, the dose should be 4-5 times the dose used to inactivate the isolates cultured in December 2020. ” Says.
The UNIFESP group, in collaboration with a Dutch colleague, has a gene that confer drug resistance. Candida auris Mutated during the period.
“Like many bacteria that are resistant to antibiotics, the mechanism that allows a species to develop drug resistance is not enzymatic degradation,” Colombo said. “Funges cause structural changes in the proteins that the drug binds to, inhibiting cell wall synthesis. [glucan synthase in the case of echinocandins], That is the key to its survival. This phenomenon is happening here in Brazil. “
In addition to dual hygiene care, he added that surveillance efforts to detect suspicious pathogens need to be strengthened.Confirm the existence of Candida auris Working with samples is not an easy task and requires specific equipment. The most widely used technique is matrix-assisted laser desorption / ionization time-of-flight (MALDI-TOF) mass spectrometry. This is fairly common in the Institute of Microbiology, but it is not always available in Brazilian hospitals.
“When performing an analysis using traditional automated methods, Candida auris Can be confused with other species such as: C. haemulonii Or C. lusitaniae.. Ideally Candida Those showing drug resistance must be sent to a reference laboratory for analysis, “Colombo said.