South Africa is placed on alert for ‘superbug’ as drug-resistant yeast infections rise globally

The National Institute for Communicable Diseases has warned doctors and laboratories to be on the alert for cases of multidrug-resistant yeast infections. South Africa has already recorded cases of drug-resistant Candida auris in public and private hospitals, according to the institute’s medical officer, Magendhree Moodley.

The potentially deadly infection usually develops in the ear, throat or mouth but has only been known to cause severe infections in patients who have been hospitalised.

This “superbug” is thought to be transmitted from patient to patient in health facilities, or through contact with infected objects or the hands of healthcare workers, Moodley says.

The United States Centres for Disease Control and Prevention (CDC) notes that it is still not known exactly how the fungus is spread, but it may be present on surfaces in hospital rooms occupied by infected patients.

Patients who have recently been hospitalised, undergone surgery or used a catheter while at a healthcare facility are most at risk of contracting the fungal infection, Moodley says. Others at risk of picking up the bug while in hospital include patients with diabetes, chronic kidney disease and some forms of cancer.

Candida, or yeast, is normally present in small quantities on the skin and on certain types of membranes such as those that line the mouth, throat and reproductive tract, according to the CDC.

The drug-resistant yeast strain is related to, but is not the same as, the more commonly known Candida albicans that gives rise to vaginal thrush.

The National Institute for Communicable Diseases institute’s recent alert to clinicians comes on the heels of similar warnings by the CDC. Since initial cases were discovered in Gauteng in 2013, neighbouring provinces have also diagnosed cases of infection. Most have been reported in the private sector and have been largely discovered in samples of patients’ urine or on used catheters, Moodley says.

Although the condition does not respond to common antifungal treatments such as Fluconazole, the condition can be treated with a new class of antifungals called Echinocandin or Amphotericin B.

Echinocandins are available in private health facilities whereas Amphotericin B is used in the public sector. The length of treatment varies according to the patient but should not cost more than the standard treatments for common yeast infections, Moodley explains.

The institute advises hospital laboratories to send blood samples from suspected cases to its facilities for confirmation as part of routine surveillance.

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