Expert FAQs on Candida Fungus: Can "The Last of Us" Happen in Real Life?

stock.Adobe.com

The media has recently exploded with news about a fungus called Candida auris. Major news sources, including the Washington Post, BBC, Time, and CNN, have reported on the alarming spread of a highly drug-resistant and deadly fungus in long-term care hospitals for critically ill patients.

The number of fungal infections caused by the Candida auris yeast strain has tripled from 476 in 2019 to 1,471 in 2021 nationwide.¹ In the same period, cases of individuals carrying the fungus without infection have nearly quadrupled from 1,077 to 4,040. These numbers continue to increase.

What is this fungus? Is the news about Candida an exaggeration or a fact? What precautions should be taken? Is a new pandemic possible? And can “The Last of Us” happen in real life?

With the help of medical experts, we have prepared answers to the most common questions regarding this widely discussed fungus.

What Is Candida Fungus?

Kelly Johnson-Arbor, MD

Medical toxicology physician

“Candida auris is a recently discovered yeast (fungus) species that can cause serious human infections. It was initially discovered in 2009 in the ear of a patient hospitalized in Japan; since then, it has been detected in at least 5 continents. Because this yeast can easily spread from one individual to another, it is associated with outbreaks of infection that can occur in hospitals, nursing homes, or other medical facilities.”

Once the fungus enters a hospitalized patient, it gets into their bloodstream and causes severe symptoms of illness.

“Candida can affect the central nervous system (brain/spinal cord) and other internal organs, such as the liver.

Moreover, certain risk factors make a hospitalized patient more susceptible. These include patients with central venous catheters (tubes going into large veins in the body) or any other type of catheter, such as urine. Also, if a hospitalized patient has been receiving antifungal or antibiotic treatment, they can get Candida auris,” states Dr. Youni Abdul.

How Dangerous Is Candida? Does It Really Have “Deadly Potential”?

Rosmy Barrios, MD

Health Reporter Expert

“Candida auris is a dangerous infection affecting the bloodstream, heart, and brain. However, as previously mentioned, it poses a greater threat to medically fragile individuals already hospitalized and fighting other diseases. Healthy individuals with a robust immune system are more than capable of fighting off the infection.”

However, some experts are far more concerned.

“Candida auris does have deadly potential, especially for at-risk populations. The mortality rate for people infected with Candida auris can range from 30–70%, with infants and children being less likely to die from Candida auris infection than adults”, adds Kelly Johnson-Arbor, medical toxicology physician.

Treating Candida auris is a problematic experience, as this fungal infection displays resistance to conventional medications. However, with swift action from the healthcare industry, there is reason to remain hopeful.

“The antifungal drugs used to treat fungal infections come in 4 major categories – polyenes, azoles, allylamines, and echinocandins. However, Candida auris shows resistance to all 4, making it multi-drug resistant and complicating initial treatment and microbiologic analysis to determine susceptibility.

Although Candida resistance is still variable, some drugs within these categories may be effective based on susceptibility in the local geographic area where the patient and strain are found.

If drug discovery and development do not keep pace, we may soon run out of antifungals that work on Candida auris. The yeast mutates and develops resistance over the years, and the only thing that can help is the speed of our pharmaceutical industry,” says Dr. Youni Abdul.

Is the News About This Yeast an Exaggeration or a Fact?

“Some of the popular articles on this topic are exaggerated. For example, the Washington Post article headlined ‘Deadly fungal infection rapidly spreading in the US’ leans toward clickbait by suggesting a spread similar to the Covid-19 virus.²

However, it is a fact that fungal strains, such as Candida auris, have evolved to become resistant to different classes of antifungal drugs, posing a threat to medically vulnerable individuals in hospitals.

Although hospitals have long struggled with similar problems, such as bacteria developing immunity to antibiotics, headlines like ‘Resistant bacteria present a major threat in hospitals’ are easy to find,” as Dr. Rosmy Barrious points out.

However, some experts have different opinions.

“The recent story in the Washington Post and other large media is not an exaggeration. Candida auris outbreaks can be challenging to prevent or control for several reasons, and this allows the fungus to spread at an alarming rate across healthcare facilities.

Candida auris is resistant to quaternary ammonium disinfectants, standard cleaning products used in healthcare facilities across the United States.

This means that standard cleaning processes utilized by medical facilities may not effectively kill Candida auris.

In addition, Candida survives on surfaces, including cell phones, hospital beds, furniture, and windows, for weeks”, Dr. Kelly Johnson-Arbor claims.

Is a New Fungal Pandemic Possible?

Rosmy Barrios, MD

Health Reporter Expert

“The transmission of Candida auris differs from that of Covid-19, as it spreads from one patient to another in healthcare settings, such as hospitals and nursing homes, and is not airborne like Covid-19. Therefore, the transmission rate of Candida auris is significantly slower, and it is not expected to spread at the same rate as Covid-19.”

What Precautions Should Be Taken to Avoid Сandida Infection?

“Hospitals have many procedures to prevent the spread of Candida auris to other patients. However, for ordinary people visiting patients, the most important precaution is to wash their hands after visiting”, says Rosmy Barrios.

If a loved one is infected with Candida auris, Rosmy suggests thoroughly cleaning any reusable medical equipment (like blood pressure cuffs, stethoscopes, and temperature probes) with a disinfectant approved by the EPA.

What New Challenges Will This Fungus Bring to the Healthcare Industry?

“The healthcare industry may need to develop new antifungal drugs capable of eliminating existing Candida auris strains as well as those that evolve and adapt to current drugs. It is, therefore, a challenge for the industry to stay one step ahead of the fungus,” says Rosmy Barrios.

Dr. Zeeshan Afzal adds that we will need improved diagnostic tests. Additionally, Candida auris can lead to longer hospital stays and higher patient healthcare costs.

“Some studies suggest that ibrexafungerp may be effective in treating patients with Candida auris infections that are resistant to other drugs, but more research is needed to confirm this.

In addition, since Candida auris is not adequately killed by common disinfectants like quaternary ammonium compounds (e.g., benzalkonium chloride), hospitals may need to revise their cleaning protocols”, says Kelly Johnson-Arbor, MD.

Can “The Last of Us” Happen in Real Life?

Zeeshan Afzal, MD

Dermatologist

“The Last of Us” is a work of fiction and should not be taken as a representation of Candida’s potential impact. Although this fungus is severe and potentially deadly, it is not capable of causing a global pandemic or transforming humans into zombie-like creatures. Nevertheless, the spread of any infectious disease should be taken seriously by healthcare professionals and the general public.”

Rosmy Barrios adds that it’s important to recognize that Candida auris and cordyceps are not similar. The human body has a high internal temperature unsuitable for the fungus to thrive. Human bodies are much more complex than insects, so it is unlikely that cordyceps would affect humans in the same way.

However, some experts disagree. Kelly Johnson-Arbor notes that Candida auris is a tricky fungus that can form sticky films (called “biofilms”) that enhance its transmission across surfaces and can adapt its structure to survive in different environments. While “The Last of Us” is fictional, the threat of Candida auris is concerning, given the fungus’s ability to evolve.

Conclusion

Experts agree that Candida auris is a dangerous infection that primarily affects medically vulnerable people in hospitals fighting other diseases. Yet, individuals with strong immune systems can generally fend it off.

Although some experts believe public concern may be exaggerated, the transmission rate of Candida auris is much slower than Covid-19, and it is not expected to spread at the same pace. It is also not similar to cordyceps from “Last of Us,” so there is no possibility of a zombie outbreak.

However, the medical industry must be proactive and stay one step ahead of the fungus to avoid repeating the mistakes we learned from Covid-19.