CDI Scientist Colleagues Author Review of Global Burden of Fungus Candida auris

The fungal species Candida auris is spreading across the globe, and gaining in virulence, according to a new review by a Hackensack Meridian Center for Discovery and Innovation (CDI) scientist and colleagues.

But there are strategies available and underway to combat the invasive and drug resistant germ, according to the new review in the American Society of Microbiology journal Microbiology and Molecular Biology Reviews.

The paper summarizes and analyzes the latest developments - and needs - in mycology in 2025. Neeraj Chauhan, Ph.D., of the CDI is co-author with: Anuradha Chowdhary, Ph.D., of the Medical Mycology Unit at the Vallabhbhai Patel Chest Institute at the University of Delhi, who is a global leader in identifying and combating fungal threats, and was one of the first scientists to identify C. auris as a major public health threat in India in 2014. She is also a visiting researcher at the CDI; and Michail Lionakis. M.D., Sc.D., who is chief of the clinical mycology program at the National Institutes of Health, and a physician-scientist who is one of the foremost fungal immunologists globally.

Together, the trio find:

• Invasive fungal infections affect approximately 6.5 million people per year, with high mortality rates.
• C. auris was first identified as a distinct species in 2009 in a sample from an ear of a patient in Japan, and has been spreading ever since.
• Theories often contend that the appearance and spread of C. auris is driven, at least in part, by climate change.
• The cell wall of C. auris is a unique adaptation compared to other fungal cousins, and its sugar-dense structure gives it advantages in drug resistance and host interactions.
• C. auris has also developed wily cellular strategies to survive, including morphogenesis in its ability to switch from yeast growth to filament-driven spread, as well as forming multicellular aggregates, and also switching its phenotypic genetic expression in response to its changing environment.
• The fungus is also extremely successful in colonizing human skin, with the molecular evidence showing so far that the proteins of the cell wall attach like a kind of glue to mammalian cells - and even non-living surfaces.
• The host develops mechanisms to battle C. auris, but the science so far indicates the germ can develop proactive ways to evade the immune response. Yet new vaccination and treatment strategies are possible.
• Four classes of antifungal drugs are currently available, with varying degrees of efficacy since they were developed in the latter half of the 20th century.
• Three new drugs are currently in trials or newly approved and in the pipeline for treatments relatively soon.
• Diagnostics still remain a challenge, since most conventional lab tests lead to misidentification as other related yeasts, which delays and complicates treatment.
• But awareness of the burden of this relatively-new scourge is growing - and research is now proliferating to catch up to clinical needs.

“Taken together, these data underscore the need to develop novel antifungal agents with broad-spectrum activity against human fungal pathogens, to improve diagnostic tests, and to develop immune- and vaccine- based adjunct modalities for the treatment of high-risk patients,” they write. “In addition, future efforts should focus on raising awareness about fungal disease through developing better surveillance mechanisms, especially in resource-poor countries.

“All these developments should help improve the outcomes and prognosis of patients afflicted by opportunistic fungal infections,” the authors conclude.