The more antimicrobial medications we use to save lives, the deadlier microbes seem to become, morphing into “superbugs” that resist treatment. While you may be relatively familiar with the concept of superbugs that flourish in spite of antibiotics and antibacterial sanitizers, a feature published in the New York Times over the weekend highlighted the frightening long-term health predicament that society faces due to the contemporary overuse of prescription and over-the-counter antifungals. Antifungal medications are lifesaving for people afflicted with serious yeast infections, but they are being overused in the same way that antibiotics have been in recent years.
This misuse allows deadly “super fungi” to become an existential threat to the most vulnerable patients in the world. The super fungi in question is Candida auris, a poorly understood and relatively unidentifiable yeast that leads to bloodstream, urinary tract, and wound infections, difficult to treat with the tools we currently have access to in modern medicine. Previously treatable with antifungal cream, pills, powders, and even body wash, Candida has since expressed the capacity to grow resistant. People with compromised immune systems — the elderly, the young, smokers, diabetics, cancer patients, and those who suffer from autoimmune conditions — are at risk for these deadly yeast infections.
To me, perhaps the most frightening aspect of this fungus is that it has demonstrated the ability to resist environmental disinfection in clinical settings. “It is a creature from the black lagoon,” a CDC leader explained to the Times. “It bubbled up and now it is everywhere.” C. auris recently took the life of a patient in a New York City hospital, killing him within 90 days of hospitalization. (According to figures cited by the publication, about half of all patients who are infected by the fungus die within that timeline.) After this particular individual’s death, researchers found that the fungus had so thoroughly infected his hospital room that some of the ceiling and floor had to be removed, destroyed, and replaced. This microbial intransigence may ultimately end up killing more people than cancer by 2050, suggesting the urgent need to take action now in order to protect public health.
While people with healthy immune systems currently may have the option to treat their Candida through holistic approaches like making dietary changes or first experimenting with herbal alternatives over pharmaceuticals, our individual choices are likely eclipsed by the use of antifungals in the agricultural sector; industrial agriculture uses large quantities of fungicides called azoles, which may make it the biggest contributor to fungal drug-resistance in the United States. Newsweek cited a statistic that said that specifically azoles constitute a quarter of all fungicides used in agriculture.
The Times feature is certainly not the first to bring up the issue of C. auris, but it confirms that the fungus has not disappeared into the annals of medical history as experts may have hoped. Last year, a study covering food security and individual health covered drug-resistant fungi that are leading to the obsolescence of antifungals, possibly setting up society for bigger problems than antibiotic resistance. “The emergence of resistance [to fungi] is leading to a deterioration in our ability to defend our crops against fungal pathogen,” said the lead author of the 2018 study. “The annual losses for food production have serious implications for food security on a global scale.”
As of now, modern medicine has not developed viable alternative to azole treatment of individual or agricultural infections, and this may ultimately lead to individual infections as well as large-scale food shortages that threaten individual and public health.