Earlier this year, the U.S. Centers for Disease Control and Prevention (CDC) issued a warning about Candida auris, a fungus that causes serious infections of the bloodstream, heart or brain and can be fatal. Sometimes, C. auris is resistant to all three major classes of antifungal medications—azoles, echinocandins and polyenes—used to treat Candida infections, making this hospital-acquired infection extremely difficult to treat.
While the CDC has declared C. auris a global health threat, it has not yet affected any children in the U.S. Still, children’s hospitals should be on the lookout for it, says Tina Tan, M.D., attending, Division of Infectious Diseases; medical director, International Patient Services Program at Ann & Robert H. Lurie Children’s Hospital of Chicago; and professor of pediatrics, Northwestern University Feinberg School of Medicine.
“Children’s hospitals need to be aware it can cause infections in children, it just has not been identified,” says Tan. “And children’s hospitals need to implement other methods of identifying Candida in a patient who does not seem to be responding to the treatment they are receiving.”
How to identify C. auris
C. auris can be misidentified, which can lead to the wrong treatment. Tan says the recommended way to identify this organism is through matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF), which most children’s hospitals have. This test was first approved by the U.S. Food and Drug Administration (FDA) in 2013 and can provide results in less than an hour, while conventional methods of species identification usually take 24 to 48 hours.
“If children’s hospitals have a patient who doesn’t seem to be improving—a patient who has a Candida infection—it may be this particular organism,” Tan says.
Where this superbug started
Tan says C. auris was first identified in Japan 10 years ago, in a child with an ear infection. There have been nearly 700 confirmed and probable cases across 12 states as of April 2019, according to CDC data. Illinois is one of the affected states, which has seen 178 confirmed and four probable cases from late May 2016 through early June 2019. Those cases have been adults—mostly those who are critically ill with an underlying condition and are in the hospital or long-term care settings, Tan says.
Where children could be affected
Tan adds if children were to be affected by C. auris, it would likely happen in a pediatric or neonatal intensive care unit setting. And the proper precautions for this organism are the same as any other.
“It will be the same precautions as with any infection,” Tan says. “So, there is no specific precaution taken because you’re afraid it’s this particular organism.”
What to watch for
According to the CDC, the most common symptoms of C. auris are fever and chills that don't improve after antibiotic treatment for a suspected bacterial infection. “The way this organism presents is no different than the way other serious Candida infections can present,” says Tan.
Because of that, children’s hospitals—and families—should be on the lookout for infection in patients due to C. auris in the same way they would look for any other infection, according to Tan.
How to prevent the spread of C. auris
C. auris can spread through contact with affected patients and contaminated surfaces or equipment. Good hand hygiene and cleaning in health care facilities is important because C. auris can live on surfaces for several weeks, according to the CDC.