Are drug-resistant fungal infections spreading in Europe and Egypt (in hospitals)?

Bad news, however the case numbers seem to be small! 

Drug-resistant bacterial infections have a competitor? Caution: irony!

I bet, this is not limited to Europe and Egypt!

"European Hospitals’ Formidable Fungal Threat 

 

A drug-resistant fungal infection has gained a foothold in European hospitals, proliferating “from isolated cases to becoming widespread in some countries,” the European Centre for Disease Control warned in a report last week.  

 

Rapid rise: The fungus Candidozyma auris has only been detected within the last decade; but since 2013, 4,000+ people have been infected across 18 countries.  

1,346 cases were reported in 2023 alone—a 67% jump from the previous year. 

Deadly foe: C. auris thrives in health facilities, surviving on surfaces from windowsills to stethoscopes, and resists most disinfectants and antifungals.  

~60% of infected patients die within 90 days. ..."

From the abstract (unfortunately, a very technical abstract for subject specialists only):

"Candidozyma auris (formerly Candida auris) has emerged as a significant multidrug-resistant pathogen. Among 140 antifungal-resistant Candida spp. isolates, 120 were identified as C. auris using chromogenic agar, VITEK 2, and MALDI-TOF.

Most cases (60%) were males, and 59% were aged ≥ 60 years.

Bloodstream infections were predominant (60.8%), followed by respiratory (20.8%), urinary tract (15%), and other sites.

Liver transplantation (35.8%) was the most common underlying risk factor, followed by post-COVID-19 (30.8%) and cancer (25%).

All isolates exhibited thermotolerance, halotolerance, anaerobic blood hemolysis, and biofilm formation.

Significant association was observed between virulence enzymes activity and both specimen source and clinical conditions (P < 0.001), with strong activity linked to blood isolates, liver transplant, post-COVID-19, and lung cancer.

Among antifungal agents, voriconazole (MIC50/90: 0.125/0.5 µg/mL), posaconazole (0.03/0.125 µg/mL), and amphotericin B (0.5/1 µg/mL) showed consistently low MICs. Caspofungin (0.25/1 µg/mL) and micafungin (0.125/0.5 µg/mL) demonstrated favorable activity, with resistance rates of 3.3% and 4.2%, respectively.

Fluconazole resistance was observed among all isolates (MIC50/90: 32/32 µg/mL). Itraconazole and ketoconazole showed elevated MICs (MIC50/90: 1/4 and 16/64 µg/mL, respectively) and was inactive against all isolates.

Flucytosine (MIC50/90: 64/128 µg/mL) was inactive against 96.7%.

Agreement between VITEK 2 and CLSI BMD was strong for fluconazole, voriconazole, amphotericin B, caspofungin, and micafungin (Cohen’s kappa ≥ 0.8), but poor for flucytosine (0.35), indicating limited reliability.

This report provides crucial local data on antifungal susceptibility and virulence traits of C. auris, supporting infection control and treatment strategies in Egypt."

Global Health NOW: A Troubling Snapshot of Women’s Health; Europe's Fungal Threat; and Indigenous Ingredients Elevate School Lunch

Epidemiological and microbiological characterization of Candidozyma auris (Candida auris) isolates from a tertiary hospital in Cairo, Egypt: an 18-month study

Fig. 1 Workflow of the study

Engineering Immunity in Frogs to Fight Fungal Disease

Good news! However, this is about future progress!

"“Researchers at the University of Melbourne in partnership with the Colossal Foundation will advance conservation efforts to engineer immunity in amphibians, including Australia’s critically endangered Corroboree Frog, against a deadly fungal disease.

The Colossal Foundation, a non-profit organisation established by American de-extinction company Colossal Biosciences, have gifted US$3 million to the University of Melbourne over three years to help stop the spread of chytridiomycosis, a disease responsible for the extinction of 90 amphibian species to date and significant declines in 500 more. ..."

"... The amphibian chytrid fungus infects epidermal cells and kills frogs by disrupting their skin function. It was discovered by a University of Melbourne ... Professor ... in 1998. ..."

Engineering Immunity in Frogs to Fight Fungal Disease - Human Progress

Engineering immunity in frogs to fight fungal disease (original news release)

Corroboree Frog

WHO releases first-ever list of health-threatening fungi

Know thy enemy!

"WHO today published a report highlighting the first-ever list of fungal "priority pathogens" – a catalogue of the 19 fungi that represent the greatest threat to public health.  The WHO fungal priority pathogens list (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering the unmet research and development (R&D) needs and the perceived public health importance. ...

Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal medicines currently available, and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics and those that exist are not widely available or affordable globally.

The invasive forms of these fungal infections often affect severely ill patients and those with significant underlying immune system related conditions. Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection."

WHO releases first-ever list of health-threatening fungi

Royal Society: How to outsmart a cereal killer

This could be an interesting event! Unfortunately, famine and starvation are still very real and with us!

The ongoing Russian war of aggression against one of the major bread baskets of the world Ukraine has been a strong reminder how important wheat is to provide food to people all over the world.

"Imagine a world without wheat… No bread, no cakes, no pasta and no beer. With wheat providing over 20% of the calories and protein consumed globally each day ... the world’s wheat supplies are being ravaged by a dangerous epidemic. Professor Diane Saunders will introduce you to the notorious “polio of agriculture”, the wheat rusts, that throughout history has endangered the production of one of our oldest and most precious food crops.

Despite long-standing efforts by a global community to wrestle the wheat rusts into submission, new strains are constantly evolving that can overcome the barriers we create to inhibit infection, and once again leave the world’s wheat crops vulnerable. Professor Saunders will discuss how phenomenal recent scientific advances have created the tools and resources in our arsenal that now have the real potential to finally outsmart these cereal killers and safeguard a sustainable food supply for generations to come."

How to outsmart a cereal killer | Royal Society