San Diego County sees increasing cases of fungal infection that CDC calls a growing concern

San Diego County has recorded 20 cases so far this year of candida auris, an antibiotic-resistant yeast that the U.S. Centers for Disease Control and Prevention warned this week is spreading “at an alarming rate in U.S. health care facilities.”

Locally, the number of cases reported has jumped from three in 2020 to nine in 2021 and 60 in 2022, according to the county health department. The 20 cases reported from January through March this year set a pace to exceed last year’s total.

Nationwide infections, first reported in 2016, grew from 476 in 2019 to 1,471 in 2021, according to the CDC. The agency said it continued to see an increase in cases in 2022, though it did not state a number.

Dr. John Bradley, medical director of the Division of Infectious Diseases at Rady Children’s Hospital-San Diego, said this threat is not nearly as wide-reaching as the COVID-19 coronavirus has been during the pandemic.

Healthy people, whether adults or children, can fight off infection with few long-term consequences, he said. It is those with compromised immune systems, and especially those who have been treated recently with antibiotics, who are at risk.

Candida auris, he said, colonizes the surfaces of mucous membranes in the body and generally only invades the bloodstream, causing a potentially deadly infection in patients with diseases, such as cancer, known to hurt the body’s ability to fight off infection.

The yeast cells are naturally present on mucous membranes, and bacteria are generally very good at killing them. But antibiotic treatment kills bacteria, opening a niche for auris to fill.

Unlike the coronavirus, sharing air with an infected person isn’t enough for auris to spread, Bradley said.

“It’s not airborne, you can’t get it just by talking to someone. You have to touch a surface and touch a mucous membrane, so health care workers can potentially spread this from one patient to another if they don’t wash their hands,” he said.

Dr. Cameron Kaiser, a deputy public health officer for San Diego County, said it is difficult to know for sure what to make of the increase in detections of candida auris in the region. It could be that this particular strain is being found more often because health care providers are looking for it more often. And it could be that other similar types of yeast were actually auris but testing didn’t differentiate them from their cousins.

“It’s entirely possible that it has been there all along but we’re just starting to notice it more now,” Kaiser said.

It wasn’t clear this week how many local auris infections have been fatal, though the CDC indicates that based on limited information, 30 percent to 60 percent of people who are infected die.

Kaiser said it is reasonable to assume that some who have been confirmed to have a candida auris infection died, but each also would have been battling other serious health problems.

The risk is not confined to hospitals, he added.

“It’s also going to be acute rehab facilities ... long-term care ... skilled nursing facilities,” Kaiser said. “All of those places are also likely to have the kinds of people that candida auris would be a threat to.”

The county routinely investigates reports of such infections, but Kaiser declined to say whether those investigations have turned up evidence of lax infection control practices. Generally, he said, if any evidence of severe infection control lapses were found, they would be forwarded to the state for possible regulatory action.

On the front lines, doctors are moving into a more aggressive mode of treatment.

Because candida auris is resistant to first-line antibiotics, Bradley said the main take-away for medical providers is that they should look for possible bloodstream infections in at-risk patients and move to more aggressive medications — which cause more severe side effects — more quickly.

“It’s a big concern, and we’re taking it seriously,” Bradley said.

Rady hasn’t yet had a candida auris case, he said, but the hospital plans to test incoming patients, especially those who are transferring from other medical facilities, to see if their mucous membranes have been colonized.

Bradley said auris may cause a red patch of inflammation on mucous membranes such as those in the mouth. Penetration into the bloodstream generally causes an unexplained fever.

— La Jolla Light staff contributed to this report. ◆