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Forbes
Forbes
Technology
Steve Brozak, Contributor

C. Auris, The Deadly Fungus CDC Says It’s ‘Still Trying To Figure Out’

When someone says that a disease will kill one out of three people and they are not sure of where it is or how it spreads it’s bad.  When the Centers for Disease Control, CDC is saying it and it’s the fungus, Candida auris (C. auris), it should be a wake-up call.  And today with the release of the 2019 AR Threats Report, it is a wake-up call six years in the making. 

In today’s report, the CDC detailed the 2019 list of killer pathogens and C. auris got the silver medal as the second most urgent pathogen threat in the U.S.  What should give people pause is not just the dedication to the 48,700 families that lose a loved one each year to antibiotic resistance or the chilling admonishment to “stop referring to a coming post-antibiotic era—it’s already here.” The pause-making issue is the absence of “new” details about the C. auris threat and can be crystallized by the CDC statement they are “still trying to figure out how the pathogen emerged simultaneously in four locations across the world.”

U.S. Map: Clinical cases of Candida auris reported by U.S. states, as of August 31, 2019

A Comparison and Contrast Between The CDC and The State of New York on C. auris

When it comes to details about the spread of C. auris, information sources are upside down. The CDC, with all its resources monitoring the Electronic Health Records EHR in 700 hospitals across the US, reports relatively little data as shown by the above chart, while New York State in a report of a week ago has extensive data about the infective agent being in virtually every healthcare facility in the New York metropolitan region.

In keeping with this in NYC area, 171 medical facilities were known to have cared for a person infected, colonized, or possibly colonized with C. auris between January 1, 2016 and June 28, 2019. However, the New York State Department of Health reports that surveillance for C. auris cases is likely to be incomplete because cases are found so in many health care facilities throughout the NYC area and because the resource-intensive nature of patient tracking makes it incomplete. Therefore, there is a very high statistical probability that facilities exist which have cared for affected patients who were not included on the lists the state provided.

The CDC’s inability to explain how the pathogen emerged in several locations distant from each other at the same time, may be somewhat disingenuous as well. Statistically speaking and using the most reasonable analysis, if a disease is discovered simultaneously in four distant locations it is highly probable that it is widespread and exists throughout the world. The real reason it hasn’t been detected yet is because no one was looking for it. Now that everyone is looking for it, our conclusion is that verification of the pathogen will be both that it is well colonized and ubiquitous. 

Even scant data back in 2013 showed four of the first seven C. auris patients identified in the U.S. died. They lived in four states: New York, Illinois, Maryland and New Jersey.  All of the patients had serious underlying medical conditions and had been hospitalized an average of 18 days when C. auris was identified. Two patients had been treated in the same hospital or long-term-care facility and had nearly identical fungal strains, thus suggesting C. auris in be spread in healthcare settings.

By November 2016, there were 13 identified cases and the CDC announced, “We need to act now to better understand, contain and stop the spread of this drug-resistant fungus,”…“This is an emerging threat, and we need to protect vulnerable patients and others.” By 2018, the U.S. recorded 323 clinical cases of C. auris infections. By August of 2019, there were 806 confirmed cases and 30 probable cases in 12 states, with New York representing nearly half. As such it is almost certain that C. auris is a pathogen that is now proverbially playing in Peoria, but no one knows it is there. 

Question: Are There Answers to The C. auris Threat?

No Easy Answers, but Two Bright Spots

The Biomedical Advanced Research and Development Authority (BARDA) is an agency that has been at the forefront of funding technology to identify and counteract public health threats, including infectious disease threats such as the anthrax attacks of 2001, the avian influenza scare of 2006, the swine flu pandemic of 2009 and the continuing Ebola menace. And during the BARDA Industry day last month, the agency showcased two companies that it has funded with the aim of advancing their respective anti-microbial platforms:

The first: T2 Biosystems Inc, (TTOO):

The methodology used to detect C. auris today is culturing, which can take up to 3 weeks to get a positive identification if at all. By that time, the patient is already cured or mortally ill. Length of time to treatment has a financial component as well as a medical component. Faster targeted treatment has been shown to save up to $30,000 of hospital costs per patient. 

This is where the T2Candida auris™ Panel validated by the Centers for Disease Control and Prevention (CDC) and available for research use only (RUO) provides direct detection of C. auris in patient skin, patient blood, and hospital environmental samples, with findings published in Mycoses. Unlike any other diagnostic for C. auris, the T2Candida auris™ Panel a fully automated, sample-to-answer, and detects with high accuracy. These attributes position the test ideally for patient surveillance and diagnosis. 

While not specifically for C. auris, BARDA signed a $69 million contract with TTOO, a pioneer in rapid diagnosis of infectious pathogens using magnetic resonance technology. The T2 device and customized diagnostic cartridges can identify a specific antibiotic threat in three to five hours, compared to two to five days from culture identification. The company, with support from CARB-X, a BARDA funded organization, has developed a cartridge that can identify resistant pathogens and this can be a critical step in identifying the spread of C. auris.

The second: Argentum Medical, LLC

An effective first step in treating deadly infections like C. auris is a targeted treatment that can eradicate the pathogen using an oral approach, but specific wounds are a close second. And while several large and small pharmaceutical companies have been working on a targeted drugs for C. auris an interesting approach might also be external approach. 

In keeping with specific wounds, last month BARDA also awarded a contract to privately held Argentum Medical, LLC valued up to $16.5 million  to develop its Silverlon® burn and wound trauma dressings for use in mass casualty incidents involving radiation or chemical exposure. Using science literally verified for over a century, Silverlon technology, impregnates metallic silver into nylon bandages and other materials to prevent and control infections. 

After proving previous eradication of Methicillin-resistant Staphylococcus aureus (MRSA), Silverlon was then evaluated in an independent lab study against C. auris using both a Kill-Time and Kirby-Bauer test. The study was undertaken to determine if a total kill of C. auris could be achieved after a 3 hour and 24 hour contact period with Silverlon dressings. The findings proved that a greater than 99.999% kill was observed at both 3 hour and 24 hour periods.

So what do these approaches have in common? Two things, the first challenging the status quo of current healthcare when healthcare lags behind real world needs. The second is the need for money, in this case, both companies were recipients of funding from BARDA. What happens next? Well in healthcare like everything else, follow the money, and if we are serious about understanding this global threat, we should hear about funding. If not, well just prepare to hear about the “new” infection at a hospital, acute care facility or nursing home near you.

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