600 cases of deadly fungus reported — two-thirds from New Jersey and New York City area

The New York City area and New Jersey have reported more than 400 cases over the last few years of an emerging fungus infection identified by federal health authorities as "a serious global health threat."

That amounts to two thirds of all cases reported in recent years throughout the United States.

The fungus — Candida auris, also referred to as C. auris — is resistant to some or all anti-fungal medicines, which makes it harder to treat. Found in hospitals and long-term care facilities, it can quickly lead to death in patients who have weakened immune systems or other underlying serious medical problems. More than one in three patients with an invasive infection of the fungus has died, the federal Centers for Disease Control said.

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By the end of February, New York had confirmed 309 cases over the past several years, more than any other state, according to the CDC. New Jersey has reported 132 confirmed cases and another 22 that are considered probable over the last four years, the state Department of Health said Tuesday.

"It's taken us all by surprise," said David S. Perlin, the chief scientific officer of the new Hackensack Meridian Health Center for Discovery and Innovation. A global authority on drug-resistant fungal infections, he published several studies in the last two years about diagnosing such infections, including C. auris. 

"We don’t really know why globally this bug has burst on the scene all over the world." he said. "We're seeing it in hospitals — we have a problem obviously in New York and New Jersey, but we see it in Spain, the United Kingdom,  South Africa, other places. How do you explain how this has happened all at once?"

C. auris spreads in hospitals and health care settings via surfaces, where it persists for days, and from person to person, he said. Those modes of transmission — and its persistence — are extremely unusual for fungal diseases.  

The federal agency first asked health facilities to start reporting infections of the fungus in June 2016. Some of the cases reported by the states predate that time, including most of those considered probable.

In all, the United States has had 617 confirmed cases, centered primarily in the New York City area, the Chicago area, and New Jersey, the CDC reported. 

 An additional 1,056 patients were "colonized" with the fungus, but did not show symptoms, the CDC said. They were identified through screenings in seven states where patients had become sick with the fungal infection.

What makes C. auris so deadly is that it is difficult to treat and often misidentified. It is resistant to many of the commonly used anti-fungal drugs. Unlike bacterial infections, for which doctors have many antibiotics, fungal infections are treated by three main classes of drugs. Some of the C. auris infections are resistant to all three.  

It's not known where the New Jersey and New York cases were identified. But a patient at Rochester General Hospital died in April 2017, and at that time 15 hospitals and a doctor's office in New York City had reported cases.

Patients who have been hospitalized for long periods, those with a central venous catheter or other lines or tubes into their body or have previously taken antibiotics or antifungal medications are the most vulnerable to the fungus.

Since Feb. 28, 104 cases of an emerging deadly fungus have been confirmed in New Jersey while another 309 cases have been confirmed in the New York City area.

C. auris was first identified in 2009 in an ear infection in a Japanese woman, but the earliest known strain dates back to 1996 in South Korea, according to the New Jersey Department of Health. Since then, it has spread to at least 20 other countries.

The CDC alerted doctors in June 2016, asking them to report cases. Two months later, the first seven cases in the United States were reported, six of them dating from before the CDC's notification. 

There is still much to be learned about the fungus and how it spreads. One concern is that doctors may be promoting its spread inadvertently when they prescribe anti-fungal medication as a preventive medication for patients who have received an organ transplant or who are undergoing chemotherapy.  

"It's hard to eradicate from hospitals," Perlin said. Most fungal pathogens die when they leave the body, but this one persists for days. It's also unclear how common the disease-causing fungus is in nursing homes, and what happens when patients go back and forth between nursing homes and hospitals.  

"A bulk of the work has to happen at the facilities," said Tina Tan, the state epidemiologist for New Jersey. "They have to be aggressive in trying to implement good infection control to stem the spread."

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She has worked with hospitals, nursing homes and other health care facilities for several years to increase awareness of the new fungal infection and how to identify it. 

The New Jersey Hospital Association also works with the state's 71 hospitals to avoid overuse of antibiotics, which contributes to drug resistance. Antibioitic stewardship, as it is known, is integral to quality improvement efforts at the state's hospitals, said Kerry McKean Kelly, the association's vice president. 

Physicians need to use "the right drug for the right bug," she said. "Make sure it’s an effective treatment for an illness so an organism doesn’t have an opportunity to gain resistance."