
Rise of Candida auris embodies a serious and growing public health threat - pseudolus
https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html
======
xoa
This seems like it ties into an article from The Atlantic last year [1] on the
under appreciated threat of increasing antifungal resistance. In particular,
there are lots of antifungal agents out there that are fit for use on plants,
but only a very small number triazole agents that are safe for humans. It
should be completely illegal worldwide to use triazoles in anything except
prescription treatments. This isn't even like antibiotics where there is
necessarily overlap between mammalian usage in agriculture vs humans, there
are non-triazole non-human safe agents that won't hurt plants one bit.

An important takeaway from that article was that it's not too late:
agricultural azole usage is actually a fairly recent thing in much of the
world and hasn't been in the US for example long. Quoting:

> _" Until recently, the United States was exempt from concerns about azole-
> resistant Aspergillus. Azole use here has historically been low, a small
> percentage of what happens in Europe—though the numbers that record it, kept
> by the U.S. Geological Survey, may be incorrect because submitting them is
> voluntary. Nevertheless, tebuconazole use in the United States rose five
> times over from 1995 to 2015; the crops that accounted for the most use were
> wheat and corn. Meanwhile, a Centers for Disease Control (CDC) poll of state
> health laboratories found no cases of resistance as recently as 2014. But
> last month, the CDC disclosed that 10 patients treated in the United States
> have been diagnosed with triazole-resistant Aspergillus bearing the
> mutations associated with agriculture. In a report in its weekly bulletin,
> the agency analyzed the records of seven of them. Four of them had never
> received azoles before they were diagnosed with the resistant strain. Three
> of the patients died."_

It's worth trying to stamp down on it legally ASAP. But it needs more public
attention and political pressure, which makes this report that health
authorities have been covering up the seriousness even worse.

\----

1: [https://www.theatlantic.com/science/archive/2018/11/when-
tul...](https://www.theatlantic.com/science/archive/2018/11/when-tulips-
kill/574489/)

~~~
Camillo
Ok, let's say I decide to make this my cause. What can I do, concretely?

~~~
Nzen
We have representatives at the national and state/providential level. Write
each of them letters about how they can represent you in this regard, maybe
seasonally. As @acct1771 suggested, share this concern with others in your
community. Encourage them to write a letter as well.

I follow Hank Green's advice [0] about how to do so. Be specific, be
respectful, demonstrate you checked hiso'er past, relevant votes.

[0]
[https://www.youtube.com/watch?v=mp4h-3vQafk](https://www.youtube.com/watch?v=mp4h-3vQafk)

------
hirundo
> Health officials say that disclosing outbreaks frightens patients about a
> situation they can do nothing about, particularly when the risks are
> unclear.

They could go to a hospital that isn't having an outbreak. Why isn't that an
option for most patients?

> Even the C.D.C., under its agreement with states, is not allowed to make
> public the location or name of hospitals involved in outbreaks.

This seems like an agreement against the interests of the populations that the
C.D.C. is supposed to protect, even if (temporarily) in the interest of
hospitals involved in outbreaks ... yet another example of regulatory capture.

On the one hand I can see that this policy would make hospitals more likely to
report potential outbreaks and cooperate with the C.D.C. On the other hand the
secrecy would result in dead patients who could have gone elsewhere and
survived. Or people that need hospital treatment avoiding all hospitals.

Can anyone point to a good argument that such secrecy -- even after the
infection has been verified -- is good policy?

~~~
rjf72
You indirectly mentioned it in passing (through the corollary), but it's a
very real issue: hospitals simply would not report anything. This would even
encourage hospitals to do things such as ensuring that things such as this are
_not_ detected. No need to report an outbreak if you don't/can't detect it!
This is a particularly great example of unforeseen consequences. Though in
this case (and many) these unforeseen consequences can actually be quite
foreseen if you just consider practical reactions to things.

And as a consequence of the above, the current system is also likely more
beneficial for patients as well because hospitals need not worry about
anything other than doing as optimal a job as possible. Something like this
sounds like it stands a good chance of eventually spreading everywhere. And so
would you be safer at a place that has or has not detected it? Obviously you'd
be better off in a place without it, but again once we introduce those
unforeseen consequences a place not detecting it is absolutely not the same as
a place not having it. By contrast the place that has it has indicated that
they are actively screening for it and presumably doing all they can to try to
manage it.

~~~
panarky
_> This would even encourage hospitals to do things such as ensuring that
things such as this are not detected_

Trial lawyers in New York created an organization [0] that systematically maps
sidewalks and streets to identify cracks and holes that cause slip-and-fall
accidents.

They provide these maps and supporting data to the city for free, and in the
process they can prove that the city had constructive knowledge of the risk.

That way the city can't avoid liability by claiming they didn't know.

It seems that a similar "service" could alert hospital managers to the risk of
C. auris, and thereby neutralize intentional ignorance as a defense.

[0]
[https://en.wikipedia.org/wiki/Big_Apple_Pothole_and_Sidewalk...](https://en.wikipedia.org/wiki/Big_Apple_Pothole_and_Sidewalk_Protection_Committee)

~~~
rincebrain
City streets and sidewalks are readily publicly viewable, though, while
medical facilities go to great lengths to not let people see whether they've
screwed up.

I agree it'd be extremely useful, but it's a harder problem to get visibility
into.

~~~
vageli
Mandate the visibility and let's see how hard it is.

------
clord
It is so incredibly stupid on so many levels to be spraying antifungals into
the environment. Not least because of the resistance problem. There are many
ways that fungus interacts with plants and animals. Destabilizing the base of
some critical food chain to get 10% better crop yields seems like a bad idea
for us to do.

~~~
dleslie
Don't worry too much, the spraying is imperfect and is creating an environment
conducive to creating fungicide resistance. The fungi will bounce back.

We, on the other hand, will pay for our collective misdeeds.

~~~
jcoffland
That's what I think when I hear people say, "save the planet." The planet will
be fine. It's humans that need saving.

~~~
Fricken
Generally they're referring to the thin veneer of blue and green on the
surface of the planet. Things would have to get pretty heinous for humans to
go extinct, but many species are already threatened.

~~~
dleslie
We're well past threatened. We're already in the midst of one of the major
extinctions.

~~~
jcoffland
Hardly, our population is still growing at an exorbitant rate.

------
samat
Welcome to the beginning of the new dark age, with doctors scared to care for
patients with certain diseases. Were higher crop yields really worth it? When
do we finally start taxing (even retroactively) externalities?

~~~
samat
So people think twice before doing stupid things for their own local gains?

~~~
coldtea
That was supposed to be the "great engine" of capitalism dogma.

That self-interest, and doing things for one's local gains, ends up to the
benefit of everybody.

It started with Adam Smith: ""It is not from the benevolence of the butcher,
the brewer, or the baker, that we expect our dinner, but from their regard to
their own interest. We address ourselves, not to their humanity, but to their
self-love, and never talk to them of our own necessities but of their
advantages"."

and ended up in ever increased praises of self-interest (Ayn Rand, etc) over
communal values and morality.

~~~
gerbilly
Some say Adam Smith was the last virtue ethicist.

I find it amusing that so many people read his "Wealth of Nations" and founded
edifices on it, while conveniently ignoring his other book: "The Theory of
Moral Sentiments"¹

1: Relevant quote: “How selfish soever man may be supposed, there are
evidently some principles in his nature, which interest him in the fortune of
others, and render their happiness necessary to him, though he derives nothing
from it, except the pleasure of seeing it.”

------
doitLP
> rampant use of fungicides on crops is contributing to the surge in drug-
> resistant fungi infecting humans

Another looming side effect of mono-cropping — planting huge fields of a
single, highly specialized cultivar with very low genetic diversity.

Many of these cultivars are reliant on huge amounts of fertilizer, insecticide
and fungicide. They produce high yields when times are good, but come with
massive vulnerabilities and large negative externalities.

There has been some movement in recent decades away from typical industrial
agriculture toward more diverse planting and sustainable and scientific
farming, which in the long run produce healthier soil, crops and environment.
Sadly this is still fairly niche and not applied to the millions of acres of
single crop areas around the globe, mostly because it’s still super cheap to
pump fields for all their worth with cash crops.

Unless we adopt a more difficult path, we’ll be paying for our cheap calories
in more ways than just algae blooms and drug-resistant fungus. But I guess the
same could be said about everything, climate change et al.

~~~
snargggg
I think a different term needs to be adopted by now, since climate change is
perhaps only half the story.

Yes, the greenhouse gases from converted fossil fuels used for transportation
and the release of energy to do work, all of which leads to global warming, is
of great concern, and in terms of survival of our species, matters very much.

But there are a number of looming adjacent narratives that go hand-in-hand
with climate change, but are not necessarily of climate change alone, while
human activity beyond the use of fossil fuels is certainly at the heart of the
matter.

Fish dying off, colony collapse disorder, birds disappearing, general insect
volume depletion throughout zones of historically higher activity,
radiological contamination of the ocean by at least one major nuclear
incident, the pacific garbage patch and microplastics in general, chemical
pollution of waterways, disruptive hydroelectric dams, fracking, slag lagoons
(ruptured and unruptured), superfund sites like the gowanus canal as a
particular expample of a failure to clean up even one hazardous zone in a
major city, pesticides in general (even ignoring insect populations as
keystone species and colony collapse). The list goes on.

Beyond just climate change, the grand scope of human activity has some serious
detrimental side effects, with deep ramifications for the world around us. Yes
it's getting hotter, and the weather patterns are strange, but taken together
with other issues, the big picture is that The Anthropocene as a period of
time represents itself a challenge of challenges.

That we now can safely call this The Anthropocene is enough to say we have a
problem, as we become a force of nature unto itself. This being The
Anthropocene is akin to us being the asteroid that killed the dinosaurs.
Terrible lizards though they were, we are worse.

We are the asteroid. Don't call is merely climate change. Call it The
Anthropocene, and understand that the full scope of human activity is the full
scope of the problem.

------
DanBC
Here's the Public Health England page for C. Auris. It's hit a few hospitals,
and some really struggled to cope with it.

[https://www.gov.uk/government/publications/candida-auris-
eme...](https://www.gov.uk/government/publications/candida-auris-emergence-in-
england/candida-auris-within-the-united-kingdom-updated-guidance-published)

------
maze-le
Could also be related to the growing prevalence of chronic inflammatory
gastrointestinal conditions.

[0]:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163673/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163673/)

------
api
It's amazing to me how little (if ever) they bring up massive antibiotic
overuse in agriculture. High density farms for pigs, cattle, chickens, etc.
are goal directed evolution experiments for antibiotic resistance.

------
eecc
Why are we still tolerating dousing intensive livestock farming with
antibiotics?

This has to be outlawed.

~~~
darpa_escapee
80% of the antibiotics consumed in the US are used in animal agriculture[1].
2/3 of infectious diseases in humans have animal origins. Along with
horizontal gene transfer, antibiotic misuse in agriculture is overwhelmingly
responsible for antibiotic resistance in the US.

As someone who often gets secondary bacterial infections from initial viral
infections, I often have to fight with well-intentioned prescribers in order
to get adequate treatment so I don't end up in the hospital a few days later.

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/)

~~~
acct1771
Not disbelief, but requesting your source for ⅔.

~~~
darpa_escapee
From the CDC[1]:

> _In fact, as many as 60% of all communicable diseases and 75% of emerging
> infectious diseases of people originated with animals_.

60% and not 2/3, but that's memory for you.

[1]
[https://wwwnc.cdc.gov/eid/page/zoonoses-2018](https://wwwnc.cdc.gov/eid/page/zoonoses-2018)

------
eternalban
I was wondering why they didn't just irradiate the infected room and did a
preliminary online search. I'm not a specialists and the following are not
specific to Candida Auris, but it seems some of these organisms actually
thrive under radiation. Reminded me of The Andromeda Syndrome.

[https://www.ncbi.nlm.nih.gov/pubmed/15907555](https://www.ncbi.nlm.nih.gov/pubmed/15907555)

[https://mbio.asm.org/content/7/6/e01483-16](https://mbio.asm.org/content/7/6/e01483-16)

[https://www.scientificamerican.com/article/radiation-
helps-f...](https://www.scientificamerican.com/article/radiation-helps-fungi-
grow/)

------
porknubbins
Interesting and scary how much of it is in the New York area. I wonder if its
similar to the AIDS epidemic in that a combination of immigration and local
social patterns make big cities much more susceptible to these things than
elsewhere.

------
spraak
It's not just antibiotics, but some types of vaccines are creating
evolutionary pressure and new strains of the pathogen. E.g. for pertussis

> it is thought that B. pertussis is adapting under acellular vaccine mediated
> immune selection pressure, towards vaccine escape [1]

> an increase in asymptomatic infection with concomitant increases in
> transmission and increased selection pressure for Bordetellapertussis
> variants that are better able to evade vaccine-mediated immunity than older
> isolates [2]

[1]
[https://academic.oup.com/femspd/article/73/8/ftv064/2467598](https://academic.oup.com/femspd/article/73/8/ftv064/2467598)

[2]
[https://www.sciencedirect.com/science/article/pii/S156713481...](https://www.sciencedirect.com/science/article/pii/S1567134816300636)

------
peteradio
What are the symptoms?

~~~
cimmanom
[https://en.wikipedia.org/wiki/Candidiasis](https://en.wikipedia.org/wiki/Candidiasis)

(via
[https://en.wikipedia.org/wiki/Candida_auris](https://en.wikipedia.org/wiki/Candida_auris))

------
msds
A non-trivial amount of what I work on is better diagnostics for C. auris.
It's remarkably nasty stuff, especially the multi-drug resistant strains! One
of those projects where I'm glad I'm on the analysis side of things, and not
growing out collections of "interesting" isolates.

------
ohiovr
This should spread fast as yeast cysts ride on the wind.

------
HNLurker2
Wow i have to pay article for health information.

------
sodosopa
I read this earlier today and have been mulling it over and over in my head.
Think of how many fungi we encounter on a daily basis. We know that
breadmakers' sourdough will contain customized microbes based on the
breadmaker. What if candida auris was on the skin of the breadmaker? Shit....

------
passive
For about 7 years, I've been battling undiagnosed Candidiasis. Cutting down
wheat and sugar dramatically has mostly eliminated my symptoms, though when I
get careless it comes back.

I've talked to three doctors about my symptoms, and done various tests, which
don't show anything. None of them seemed to accept the idea that it could be
caused by Candida. It's interesting to see it getting some media attention,
though certainly this particular report makes me a bit nervous.

~~~
avip
Data is missing. How can you know you've had an undiagnosed condition for 7
years?

~~~
asveikau
Sounds like they have been convinced of it by their own symptoms but it has
not had a proper diagnosis.

In my own life experience this is common. People bounce around the medical
system with varying diagnoses for many ailments, at various levels of
confirmation, and sometimes the doctors aren't sure either.

~~~
avip
There is some distinction to be made between the verbs "convinced of" and
"diagnosed with". Not to downplay anyone's medical conditions, but there's
lots of FUD surrounding candida, too much money on the table, and we should
all be careful with terms.

~~~
asveikau
I take it that distinction is why they said "undiagnosed".

