INFECTIONS - Kills almost half of those infected in the first 30 days
The spread of the resistant super fungus 'Candida auris' in operating rooms around the world becomes a new headache for scientists due to its high mortality.

More than 35,000 deaths annually in Spain due to 'superbugs'

An outbreak of candidiasis with 40 affected in the La Fe hospital

A threat to the health of humans, animals and crops has been growing silently over the past decades. Each of the large families of fungi - Cryptococcus, Pneumocystis, Aspergillus and Candida - causes hundreds of thousands of deaths a year, up to a total of 1.6 million worldwide, according to figures from the Global Action Fund for Fungal Infections. (GAFFI). Almost as many as tuberculosis, the deadliest bacterial infection today. And the appearance of new strains, resistant to one or more antifungal drugs, further complicates the future of the fight against these diseases.
"The scale of the problem has been little recognized and underestimated, but the risk it poses to human health and food safety is serious and immediate," says Matthew Fisher, Professor of Public Health at Imperial College London and first author of a study on the increasing presence of multi-resistant fungi in patients and cultures, appeared in a special edition of the journal Nature. "The threat posed by antimicrobial resistance is well established in bacteria, but has been largely neglected in fungi."

This is the case of Candida auris, a super fungus discovered in 2009 and which has already caused victims on four continents. And Spain has been one of the most affected countries: more than half of the cases registered in Europe have occurred in our country. The largest outbreak in Spain occurred between 2016 and 2017 at the Hospital Universitari i Politècnic La Fe in Valencia: more than 40 patients developed infections in a period of only 10 months. A year later the doctors of the Valencian center analyzed the episode in a scientific article published in the specialized magazine Mycoses. In it they describe a fungus that attacks patients who already suffered from serious ailments and that has significant resistance to antibiotics; two elements that explain its high mortality rate (41% in the first 30 days). It is estimated that there are around 1.5 million species of fungi, although most have not yet been cataloged by scientists. Only a few hundred have the ability to survive in the human body. By placing our body at 37 degrees, evolution has protected us from most of them. The rest, under normal conditions, are blocked by our immune system. "Many fungi, like some species of the genus Candida, are part of our natural microbiota, on the skin or in the mucous membranes of the intestinal tract", explains Óscar Zaragoza, researcher at the Carlos III Health Institute and author of the book Microscopic fungi: ¿ friends or enemies ?, (Ed. Las Cataratas).

THE DISEASE OF THE SICK
"But when our defenses are lowered, they have the opportunity to replicate, spread throughout the body and invade our organs." Fungal infections are, in a way, the diseases of the sick. That is why it is common for outbreaks to occur in medical centers. "Most of them are opportunistic, they affect patients who already have some risk factor, mainly defects in the immune system," says the researcher.

In addition, mycoses and bacterial infections can manifest with similar symptoms, which makes it difficult to diagnose, a circumstance that leads some authors to suspect that their incidence worldwide is even higher than is assumed. It could be controlled and no patient has developed an infection over the last year, but in other regions of the world the cases are increasing. In the United States, C. Auris has caused almost 600 victims in the last five years. The New York Times this spring published a series of articles accusing hospitals in Europe and the United States of creating "a climate of denial and secrecy." The North American newspaper maintained that these centers - including La Fe - had done everything possible to keep the problem hidden from the public, since "they were concerned about the image of the hospital."

From the Levantine center they deny that there was any will to keep the outbreak hidden and they assure that “the usual protocol was applied in these cases and it was communicated to the general direction of Public Health of the Department of Universal Health and Public Health of the Generalitat Valenciana. They also point out that "all the media that were interested in the issue, including The New York Times, were informed" and that if a similar case were to occur in the future they would apply exactly the same procedure.