By Julie Washington

Candida auris, a drug-resistant fungal infection that spreads easily in hospitals and nursing homes, and can lead to death, is on the rise in Ohio.

Cases of Candida auris tripled from 2019 to 2021, and treatment-resistant cases also are rising, according to national surveillance data.

The Centers for Disease Control through the end of 2022 reported 79 cases in Ohio of Candida auris — also called C. auris. But since then, more recent data from the Ohio Department of Health shows a sharp increase, with 416 cases through mid-March.

Looking at Cuyahoga County and surrounding areas, 101 cases were counted in Cuyahoga County, four in Summit County and four in Lorain County. Other Greater Cleveland counties recorded no cases of this fungal infection, according to state health data.

Through December, there were more than 8,000 cases across the United States.

Because it can linger on surfaces, spread through touch and is difficult to treat and detect, the U.S. Centers for Disease Control and Prevention recently rated Candida auris as an urgent threat, the agency’s highest level of concern.

“In Ohio, even though we don’t have a lot of it now, it could spread very quickly,” said Mahmoud Ghannoum, professor of dermatology and pathology at the Case Western Reserve University School of Medicine and director of the Center for Medical Mycology at University Hospitals.

“It is very difficult to diagnose this organism,” Ghannoum said. “It could be there and people won’t even know it.”

State health officials recommend that people wash their hands frequently when visiting loved ones in a healthcare facility, postpone visiting if they are sick, and ask healthcare providers to perform hand hygiene (hand washing or using hand sanitizer) when they come into the room.

Candida auris mainly impacts people who have other medical conditions, particularly those who have frequent hospital stays or live in nursing homes, according to the Ohio Department of Health.

The fungus can be contracted through contact with contaminated surfaces or medical equipment or spread person-to-person. It can live on surfaces for up to two weeks.

There is a 30% to 60% mortality rate, although many of those infected had comorbidities or other illnesses that increased their risk of death, according to federal health officials.

“In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections,” the CDC said. “Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.”

Other risk factors include recent diabetes, recent surgery, and the use of antibiotics and antifungal drugs. Infections have been found in patients of all ages, from preterm infants to the elderly, according to federal health data.

“If you have an underlying disease, then it becomes a big issue,” Ghannoum said.

That fact that Candida auris does not respond to many antifungal drugs makes it difficult to treat, Ghannoum said.

The Ohio Department of Health works closely with local health departments and healthcare facilities where Candida auris has been identified, putting in place enhanced cleaning and screenings to identify asymptomatic people, the agency said.

Ghannoum and a research team recently received a $3 million grant from the National Institutes of Health to investigate ways to treat and prevent Candida auris infections.

The five-year grant allows a team, led by the Case Western Reserve School of Medicine and University Hospitals, to evaluate an antifungal drug developed by a New Jersey-based biotech company.

Ghannoum is the study’s principal investigator. Thomas McCormick, an associate professor of dermatology at the Case Western Reserve University School of Medicine and in the Department of Dermatology at University Hospitals, also leads the investigation team.

Candida auris was first detected in the United States in 2016, and it has since been identified in at least 25 states. The number of cases began rising in 2021, possibly due to the COVID-19′s disruption of the health care system, according to the CDC.

When it was first detected, cases appeared to be imported from abroad. But more recently, healthcare transmission is responsible “for most, if not all, cases,” the CDC said in a recent paper.

Candida auris is harder to identify than other, more common types of fungus. Special laboratory blood tests are needed to identify it. People can have this fungus on their skin but not have symptoms of an infection.

Both Candida auris and C. diff — also known as Clostridioides difficile — can spread easily in healthcare facilities and contaminate commonly touched surfaces. But the two infections are caused by different organisms and have different treatments, health experts said.