After the first two cases confirmed in December 2020 in a hospital in Salvador de Bahia in two Covid patients hospitalized in the same intensive care unit, in the same hospital they were registered nine other cases of infection gives Candida auris, a microorganism known to many as a “super fungus” due to the speed with which it became resistant to drugs.
The first two cases were described in detail in a study published in the journal Journal of Fungi by a research team led by Arnaldo Colombo, head of the Mycology Laboratory at the Federal University of San Paolo, which highlighted the evolutionary characteristics of the pathogen responsible for infections. In particular, the microorganism isolated in the hospital of Salvador de Bahia showed “ less sensitivity “To fluconazole and echinocandins. “ The latter belong to a new class of drugs used for the treatment of invasive candidiasis – Colombo explained -. Although no other cases have been reported in Brazil at the moment, these are cause for concern as C. auris becomes rapidly resistant to multiple drugs and it is not very sensitive to disinfectants. As a result, it is able to persist in hospitals, where it colonizes healthcare workers and ends up infecting Covid patients and other critically ill in long-term care. ”.
The investigation revealed that the C. auris belongs to the South Asian clade. “ The restrictions applied to international travel during the Covid-19 pandemic and the absence of a history of travel outside Brazil in the two patients who first contracted the infection suggest that this species was introduced several months before identification of the first cases and / or emerged locally in the Salvador area ”The researchers pointed out.
Several factors can make Covid-19 patients particularly vulnerable to infection with C.auris, including long hospital stays, the use of urinary and venous catheters (which allow the pathogen to invade the bloodstream) as well as treatments with steroids and antibiotics (which destroy the intestinal microbiota). “ The virus can damage the intestinal mucosa of patients, making the patient himself particularly susceptible to candidemia – added Colombo -. Several countries have reported cases of C. auris during the pandemic, making the need to step up hospital-acquired infection control across Brazil even more urgent. Equally important it is the rational use of antimicrobial drugs in intensive care units. Since the start of the pandemic, azithromycin and other antibiotics have been prescribed more widely, mostly without genuine justification ”.
As mentioned, in some cases the pathogen can enter the bloodstream, causing a systemic infection (candidemia) similar to bacterial sespi. This results in an exacerbated immune system response that can cause damage to various organs and even lead to death. “ According to scientific data – indicate the scholars – mortality among patients with candidemia infected with C. auris can reach 60% “. As for the mechanism that allows this species to develop drug resistance, this is different from the “ enzymatic degradation, which occurs in the case of many bacteria resistant to antibiotics – Colombo specified -. The fungus develops structural changes in proteins which the drug binds to inhibit cell wall synthesis, which are the key to its survival. And this is the phenomenon we are witnessing here in Brazil ”.