Health experts are troubled by the recent increase in the U.S. of Candida auris, a potentially deadly yeast infection. According to the Centers for Disease Control and Prevention, C. auris outbreaks are occurring in hospitals—which is not typical of yeast infections—and now present “a serious global threat.” 

As of earlier this month, the CDC says, 243 cases have been reported in the U.S., across 10 states.

While that’s still a relatively small amount, the number has quadrupled from the 61 cases known about last spring. And between 2013 and 2016, there were only 13 known cases in the U.S. (This infection is thought to have first been seen in Japan in 2009 and has since spread to about 15 countries.)

In some cases, usually in people who are already quite ill, C. auris can cause a widespread, or invasive, bloodstream infection. What’s more, invasive Candida bloodstream infections are becoming increasingly unresponsive to the most commonly used antifungal medications.

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“We’re very alarmed because some strains of C. auris in other countries are resistant to all three major classes of antifungal drugs, which we’ve never seen before,” says Tom Chiller, M.D., chief of the CDC’s mycotic diseases branch. “We’re taking as proactive and aggressive an approach as possible to try to keep it in check in the United States.”

Around the world, some 60 percent of people who contracted C. auris have died. In the U.S., the CDC says, more than 30 percent of those with C. auris have died, but it’s unclear whether the deaths were the direct result of the fungal infection or an underlying health problem.

Compounding the problem is that C. auris can move from one person to another in hospitals, unlike other yeast infections. It can live on contaminated objects such as bed rails, chairs, catheters, and other equipment, and on the hands of healthcare providers.

“C. auris acts more like a type of bacteria called a nosocomial bacteria, which sticks to surfaces, so it can spread from patient to patient or from a healthcare provider to a patient,” says Cornelius Clancy, M.D., director of the mycology program at the University of Pittsburgh School of Medicine. “That makes it hard to get rid of, even in hospitals that have excellent infection-control methods.”

While scientists work to understand more about how C. auris spreads and how best to prevent, diagnose, and treat it, here’s what you need to know if someone you love is at risk.

Know Who Is at Risk

If you’re generally healthy, there’s no current cause for concern.

“We haven’t seen [C. auris] in the general community. It’s mainly a hospital-acquired infection,” says Peter Pappas, M.D., a professor of medicine in the division of infectious diseases at the University of Alabama and spokesman for the Infectious Diseases Society of America.

Thus far, this infection, like other invasive yeasts, has struck only “the sickest of the sick—people who are in and out of ICUs and also have central lines or immune-system-lowering conditions such as diabetes,” Chiller says.

Others at high risk include nursing home residents who have a central line (for the administration of medications) and people in the intensive care unit for an extended period of time, such as transplant recipients or cancer patients on intravenous antibiotics.

5 Protective Steps

If someone you love or care for is in a hospital, nursing home, or physical rehabilitation facility:

1. Wash your hands well whenever you enter his or her room—and insist that healthcare providers do the same. “One of the best ways to prevent the spread of dangerous germs like C. auris in healthcare settings is simply good hand hygiene,” Chiller says. The patient should also wash his or her hands regularly and well.

2. Speak up if others aren’t washing their hands correctly. (Healthcare providers do this less than half the time, according to the CDC.) You may need to remind nurses, doctors, and other healthcare professionals to scrub up not only when they come into the room but also after handling a patient’s open wound, blood, or bodily fluids—or even touching his or her skin. Anyone who is wearing medical gloves and removes them should still wash his or her hands.

3. Ask whether any patients in the facility have C. auris. If so, Chiller says, find out whether additional precautionary measures have been put in place. Infected patients should be in a single room, those who come in contact with them should wear gowns and gloves, and healthcare providers should use disposable patient-care equipment for them (such as some blood pressure cuffs) when possible.

4. Make sure the hospital is cleaning properly. There’s no research yet available on the best disinfectant for C. auris, but the CDC recommends the use of an Environmental Protection Agency-registered hospital-grade disinfectant that’s effective against Clostridium difficile spores. These tend to be the strongest disinfectants currently available, Chiller says.

5. If the person is put on IV antibiotics in the ICU, ask whether it’s really necessary. “Antibiotic therapy, specifically IV antibiotics, is a significant risk factor [for any invasive candida], both the number of different antibiotics and the length of therapy,” says David Denning, M.D., a professor of infectious diseases in global health at the University Hospital of South Manchester in the U.K.

According to Chiller, use of any antibiotic, particularly a broad-spectrum antibiotic, increases the risk of C. auris because it kills healthy bacteria in the gut.

“With less competition from other organisms, it can multiply and become more likely to spread through the body,” he notes. (Find more of our coverage on antibiotic overuse here.)

Diagnosis and Treatment Challenges

People who develop C. auris are often already very ill, so it may be difficult to distinguish its symptoms from those of other medical conditions.

The most common signs are fever and chills that don’t improve after antibiotic treatment for suspected bacterial infections, Chiller says. If you notice this, call it to the attention of a health professional on site.

Blood tests are usually used to diagnose invasive Candida infections. When C. auris is suspected, hospital staff members should use a special laboratory test called matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF).

If the test is positive for the fungal infection, the CDC recommends concurrent treatment with three antifungals: anidulafungin, caspofungin, and micafungin. Generally, C. auris infections in the U.S. have responded to the CDC protocol, Chiller says.

But because C. auris develops resistance quickly, it’s important for anyone with this fungal infection to be monitored to see whether treatment is working and to have follow-up cultures. And because C. auris can live on the skin (and other body sites, says the CDC) after treatment, continue protective practices—such as ensuring that healthcare workers wear gowns and gloves—until a doctor determines that it’s appropriate to stop them.