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Candida Auris

Candida auris a fungal infection of current public health concern due to the emergence of multidrug-resistant (MDR) strains

Candida auris (C. auris), is a fungal infection of current public health concern due to the emergence of multidrug-resistant (MDR) strains. This was first isolated from the external ear of a patient in Japan in 2009 and has since spread worldwide. The first case of MDR Candida auris infection in Hong Kong occurred at the end of June 2019, and sporadic cases have appeared since then.  Most of the cases involved carriers and had no symptoms. However, once Candida auris enters the blood, it can cause invasive , life-threatening infection, with a crude mortality rate from 30% up to 72%. The multidrug-resistant characteristic of C. auris also makes infection control considerably more difficult. 


Risk factors for Candida auris infection 

  • Candida auris is a type of fungal (or “yeast”) infection.  It is generally no different from infections caused by other Candida species (notably C. albicans), but it is relatively rare and can cause serious infections. The following conditions contribute to the spread of this infection: Poor personal and environmental hygiene 
  • Long-standing implanted devices such as endotracheal tubes/artificial airways, and urinary catheters, and use of contaminated, improperly disinfected endoscopes Immunocompromised patients such as diabetics, patients on chemotherapy and immunosuppresants (e.g. transplant patients) and long-term hospital admissions 
  • Patients who recently underwent major surgery and is on broad spectrum antibiotics and antifungals 


Candida auris vs. Candia spp.   


Candida Auris 


Preferred environment 

humid environments and dry environments such as plastic surfaces for several weeks. 

Can survive in humid environments. 

Areas of the body usually isolated from 

Can survive anywhere in the body, including urine, sputum and human mucous membranes. 

Mostly survive in human mucous membranes including the mouth, vagina and intestines. 


Carriers are asymptomatic 

Symptoms vary depending on the location of the infection 

Pathologic manifestation 

It may enter the bloodstream through the urinary  tract, central venous catheter, etc., causing invasive infection and symptoms such as dizziness, fever, and low blood pressure. People with poor immunity may develop sepsis. 

It usually causes inflammation of the vagina (vaginitis), urethra (urethritis); may cause sepsis in the severely immunocompromised.  

Drug resistance 

About 90% are resistant to the antifungal drug "fluconazole", about 30% are resistant to the antifungal drug "amphotericin B", and less than 5% are resistant to the novel antifungal drug class "echinocandins". 

Prescription antifungal medications and (adjuvant) probiotic vaginal suppositories can be effective treatments. 


Symptoms and signs of Candida auris infection 

Immuno-competent individuals harboring Candida auris may remain asymptomatic. However, at-risk patients may have wound, ear or catheter-related infections which can enter the bloodstream causing invasive infection that can spread throughout the body, causing symptoms and signs such as: 

  • Dizziness 
  • fever 
  • pain 
  • fatigue 
  • low blood pressure 
  • Elevated heart rate 

 Fungal sepsis is a serious, life-threatening complication of C. auris infection.Generally, judging from the symptoms alone is difficult, and the diagnosis must be confirmed through testing. 


Diagnostic methods for candida auris 

Candida auris is difficult to identify using standard laboratory methods and must be identified using a "protein spectrometer". 

The Hospital Authority has formulated infection control guidelines since 2018. Patients who have been admitted to hospitals overseas and are admitted to high-risk wards in Hong Kong, such as the intensive care unit, clinical oncology department, hematology department and bone marrow department, are required to undergo admission screening. 

  • The instrument used for testing is a protein spectrometer, which tests combined swab samples from the patient's nasal cavity, armpit and groin; if the result is positive, the hospital will isolate the confirmed patient. 
  • Conduct contact tracing investigations based on infection control guidelines and individual risk assessments 
  • All confirmed cases need to be reported to the Office of the Chief Infection Control Officer of the Hospital Authority 
  • If Candida is found in clinical samples or an outbreak occurs, the Center for Health Protection will be notified immediately 


Candida auris prevention methods 

  • Maintain good personal and environmental hygiene 
  • Proper hand-washing 
  • Rational use of antibiotics and antifungal medications 
  • Hospital staff should use protective equipment appropriately 
  • Disinfect the environment with bleach (sodium hypochlorite solution) 1000 ppm 


OT&P Healthcare Advice 

Candida auris is the same as the more common Candida species (albicans), but the multi-drug resistant nature of C. auris can cause serious infections. Generally, Candida auris is difficult to diagnose based on symptoms alone, and a diagnosis must be confirmed through high clinical suspicion and testing.

Please note that all medical articles featured on our website have been reviewed by qualified healthcare doctors. The articles are for general information only and are not medical opinions nor should the contents be used to replace the need for a personal consultation with a qualified medical professional on the reader's medical condition.

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