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Spokane, Washington  Est. May 19, 1883
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Major cities are grappling with a drug-resistant fungal infection, but will it travel to Spokane?

The mild weather brought out strollers in light jackets to Riverfront Park Monday, Mar. 18, 2019 in downtown Spokane. (Jesse Tinsley / The Spokesman-Review)
The mild weather brought out strollers in light jackets to Riverfront Park Monday, Mar. 18, 2019 in downtown Spokane. (Jesse Tinsley / The Spokesman-Review)

Though Spokane has never dealt with a case of candidiasis caused by Candida auris, a drug-resistant fungus, an outbreak is only a plane ride away, Rockwood Multicare infection control manager Sharyl Bergerund said.

“Things are very, very close to coming into any community at any time,” Bergerund said. “You need to watch these things every time. It’s not something we need to be panicked about per se, but it’s something that we definitely keep a vigilant watch on.”

Mark Springer, Spokane Regional Health epidemiologist, also agrees this infection has a travel risk.

“I think with society being clearly global nowadays, it’s not unreasonable for something to move to another part of the country,” Springer said. “ … it’s not unreasonable to say that we could see this at some point in the future. I don’t think this organism is going away.”

In fact, many of those infected in the U.S. have reported receiving medical care in other countries, according to the Centers for Disease Control and Prevention. Infections have been found in patients who visited health care facilities in India, Kenya, Kuwait, Pakistan, South Africa, the United Arab Emirates and Venezuela. Many other countries have reported cases of the infection.

“This is not an uncommon thing when people have hospitalizations outside of the U.S.,” Bergerund said. “This isn’t the only infection of concern that might affect somebody coming back to the U.S., so having to have health care in other countries can be a risk factor for a number of things, not just Candida auris.”

Candidiasis is one of the most common types of fungal infections, but when it is detected in a “sterile body site” – such as blood or spinal fluid – the hospital sends the fluid to a lab to determine the strain. If the hospital’s lab doesn’t identify it as a common form, the sample is then sent to the reference laboratory.

“That includes Candida auris, in addition to a number of others,” Bergerund said. “If they identify it as Candida auris, we would hear about it immediately, and then we would go on from there.”

Part of the risk of Candida auris is that it is multidrug resistant, meaning it cannot be treated using the antifungal drugs commonly usually used to treat candida, according to the CDC. Since Candida auris can cause infections in the ear, the fungus takes its name for the Latin word for ear, auris. Despite this, Candida auris can also infect the blood and wounds.

Since it is such a specialized organism, even one case would be considered an outbreak, which would trigger reporting to the health district, Bergerund said. The hospital would also conduct a thorough investigation to ensure that the fungus isn’t present in any other patients or any of the hospital’s environment.

Much of the protocol to isolate an outbreak falls under basic practices, such as thorough hand-washing. Other safety measures include isolating patients and monitoring that staff members are disinfecting surfaces correctly.

Springer said Spokane can use the cases across the country as a learning experience, comparing it to the measles outbreak in Washington.

“We’re in a fortunate circumstance of not having any cases and being able to learn from other areas’ experience,” Springer said. “ … What happened with the measles outbreak in Clark County led to a lot of lessons, a lot of development of materials and education for providers.”

The most widespread outbreaks have occurred in New York City, New Jersey and Chicago, which have each reported more than 100 cases. California, Connecticut, Florida, Indiana, Maryland, Massachusetts, Oklahoma, Texas and Virginia have also reported cases of infection caused by Candida auris.

As with many infections, the most susceptible are vulnerable people: those with weak immune systems or health problems.

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