Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it. For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that is undermining a pillar of modern medicine.
Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines. Yet even as world health leaders have pleaded for more restraint in prescribing antimicrobial drugs to combat bacteria and fungi — convening the United Nations General Assembly in to manage an emerging crisis — gluttonous overuse of them in hospitals, clinics and farming has continued.
Scientists say that unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier populations. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in , eclipsing the eight million expected to die that year from cancer.
Innate recognition of fungi by the immune system
In the United States, two million people contract resistant infections annually, and 23, die from them, according to the official C. That number was based on figures; more recent estimates from researchers at Washington University School of Medicine put the death toll at , Worldwide fatalities from resistant infections are estimated at , Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting.
Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans. Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy. With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.
All the while, the germs are easily spread — carried on hands and equipment inside hospitals; ferried on meat and manure-fertilized vegetables from farms; transported across borders by travelers and on exports and imports; and transferred by patients from nursing home to hospital and back. Other prominent strains of the fungus Candida — one of the most common causes of bloodstream infections in hospitals — have not developed significant resistance to drugs, but more than 90 percent of C.
Immune responses to fungal pathogens
Nearly half of patients who contract C. Tom Chiller, who heads the fungal branch at the C. The two countries have some of the highest case counts in the world. A distinct strain appeared in Pakistan as early as and in Delhi by The first documented outbreak in the Americas was from —13 at a medical center in Venezuela. Five of 18 infected patients died. A genetically distinct strain of Candida auris in South Africa infected at least patients from — A study of a Shenyang hospital found 15 samples from —17 that were misidentified as a different strain of fungus.
Candida auris is hard to identify and may unreported in other hospitals around the world.
Fungal Infections: Fighting Fungus
The first documented outbreak in the Americas was at a medical center in Venezuela from — Candida auris was discovered in in the infected ear of a year-old Japanese woman. In late , Dr. Rhodes said she was told. Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C.
They left the device going for a week. Rhodes said. It was spreading, but word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement. This hushed panic is playing out in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to publicize outbreaks of resistant infections, arguing there is no point in scaring patients — or prospective ones.
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Schelenz said. Days later the hospital finally acknowledged to a newspaper that it had a problem. There, unbeknown to the public or unaffected patients, people were colonized — meaning they had the germ on their body but were not sick with it — and 85 developed bloodstream infections. A paper in the journal Mycoses reported that 41 percent of the infected patients died within 30 days. A statement from the hospital said it was not necessarily C. As with Royal Brompton, the hospital in Spain did not make any public announcement.
It still has not. The secrecy infuriates patient advocates, who say people have a right to know if there is an outbreak so they can decide whether to go to a hospital, particularly when dealing with a nonurgent matter, like elective surgery. Health officials say that disclosing outbreaks frightens patients about a situation they can do nothing about, particularly when the risks are unclear.
Anna Yaffee, a former C. Officials in London did alert the C. And the C.
Blocking gene expression to combat deadly fungal infection
On June 24, , the C. In the United States, cases of people having contracted C. The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal. The earliest known case in the United States involved a woman who arrived at a New York hospital on May 6, , seeking care for respiratory failure.
She was 61 and from the United Arab Emirates, and she died a week later, after testing positive for the fungus. She carried a strain different from the South Asian one most common here. Rachel Miest says bacterial and fungal are the two most common infections. To avoid them, she says, don't be afraid to ask to make sure the spa cleans all equipment between customers. Williams: To reduce your risk, Dr.
Miest says don't shave 24 hours beforehand and don't have your cuticles cut. Miest: Ask that they only either leave your cuticles alone or gently push them back but not to aggressively push them back or clip them because that cuticle is a very, very important seal. Fungal nail infections are caused by various fungal organisms fungi. The most common cause is a type of fungus called dermatophyte. Yeast and molds also can cause nail infections. Fungal nail infection can develop in people at any age, but it's more common in older adults.
As the nail ages, it can become brittle and dry. The resulting cracks in the nails allow fungi to enter. Other factors — such as reduced blood circulation to the feet and a weakened immune system — also may play a role. Toenail fungal infection can start from athlete's foot foot fungus , and it can spread from one nail to another. But it is uncommon to get an infection from someone else. A severe case of nail fungus can be painful and may cause permanent damage to your nails.
And it may lead to other serious infections that spread beyond your feet if you have a suppressed immune system due to medication, diabetes or other conditions. If you have diabetes, you may have reduced blood circulation and nerve supply in your feet. You're also at greater risk of a bacterial skin infection cellulitis. So any relatively minor injury to your feet — including a nail fungal infection — can lead to a more serious complication.
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See your doctor if you have diabetes and think you're developing nail fungus. The following habits can help prevent nail fungus or reinfections and athlete's foot, which can lead to nail fungus:. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
This content does not have an English version. This content does not have an Arabic version. Nail fungus Nail fungus can cause the nail to become thick or ragged and appear yellow, green, brown or black. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. References Onychomycosis. Merck Manual Professional Version. Accessed May 15, Goldstein AO, et al.
Onychomycosis: Management. Toenail fungus. American Podiatric Medical Association.