Candida

Question 1

Where were the 4 major clonal lineages of C.auris identified?

Answer 1

• South Africa
• South America
• East Asia
• South Asia

Question 2

Sporadic introductions still occur, mainly associated with patients who have direct travel links or healthcare stays in which “endemic” areas?

Answer 2

• India
• Pakistan
• Oman
• Kuwait
• Qatar
• Kenya

Question 3

Where have the vast majority of the approximately 270 isolates of C. auris detected in the UK been recovered from?

Answer 3

Patients in the South of England (metropolitan London and surrounding areas), with no cases reported from Northern Ireland or Scotland.

Question 4

What are the main methods of C.auris detection?

Answer 4

• Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) for yeast identification using the Bruker platform
• A novel chromogenic agar (CHROMagar Candida Plus) was developed specifically to facilitate detection and identification of C. auris. It permits C. auris to be differentiated from over 50 other yeast species in Candida and related genera.
• Vitek MS platform was still unable to reliably identify C. auris isolates

Question 5

Why was C. auris is the first human pathogenic fungus to be subject to international health alerts?

Answer 5

Its propensity to colonize skin, persist in the hospital environment, cause nosocomial outbreaks, and cause severe disease.

The ability of C. auris to colonize patients to extremely high levels is certainly novel among known Candida spp.

Question 6

Describe UK Public Health responses to C. auris

Answer 6

• A national incident management team (IMT) was convened by PHE in order to develop a consistent national response to this emerging nosocomial pathogen
• A multitiered system for reporting novel C. auris detections was developed, which included individual laboratories reporting directly into a national infectious diseases surveillance system, local health protection teams confronted by new incidents informing the IMT of new acquisitions, and the MRL feeding details of all isolates confirmed at the laboratory and especially those that represented new centers in real time directly to the IMT
• Finally, several whole genome sequencing (WGS initiatives were instituted, involving collections of isolates from all 3 English hospitals with extensive ongoing outbreaks.

Question 7

How does COVID-19 dappear to offer the perfect conditions for widespread novel outbreaks of C. auris?

Answer 7

• Because previous studies have independently identified mechanical ventilation and stays in ventilator-assisted long-term acute hospitals as significant predictors of C. auris colonization/infection the ongoing SARS-CoV-2 worldwide pandemic would appear to offer the perfect conditions for .widespread novel outbreaks of C. auris.

Severe COVID-19 disease is associated with acute respiratory distress syndrome requiring ICU admission, mechanical ventilation or extracorporeal membrane oxygenation, protracted hospital stays, and significant mortality. Reports from several of the most seriously affected countries to date have indicated that cases of infection with SARS-CoV-2 have overwhelmed existing ICU capacity, with affected patients being managed in makeshift wards and hospitals where conventional infection control measures are challenging. Because previous studies have independently identified mechanical ventilation and stays in ventilator-assisted long-term acute hospitals as significant predictors of C. auris colonization/infection