What Is a Candida Auris Fungus Infection? Symptoms, Spread, and Treatment

Candida auris (C. auris) is a yeast that can live on the human body. It is commonly referred to as a fungus, a category that includes both yeasts and molds.

In general, C. auris isn’t a danger to healthy people, says Mark Rupp, MD, chief, division of infectious diseases and professor of medicine at the University of Nebraska Medical Center in Omaha. But fungal infection (candidiasis) can be deadly for people with weakened immune systems and/or serious underlying medical conditions who are very sick and getting complicated treatment in a hospital or long-term care facility like a nursing home.

The Centers for Disease Control and Prevention (CDC) has called C. auris an urgent threat because it is often resistant to antifungal treatments, spreads easily in healthcare facilities, and can cause severe, potentially fatal infections.

Candida auris was first described in Japan in 2009, and it seems to be gathering steam as it spreads throughout the world, Dr. Rupp says.

The first U.S. case of candidiasis occurred in 2013 but was reported retrospectively in 2016.

A total of more than 3,000 clinical cases were reported in the United States through the end of 2021 — a 95 percent increase in cases compared with the year before. The number of drug-resistant cases in 2021 was about three times that in each of the previous two years.

“Now in the U.S., it’s been identified in most major metropolitan areas. And even in states where it hasn’t been reported, it likely exists,” says Rupp. The states reporting the highest number of infections include California, Nevada, Texas, Illinois, Florida, and New York.

Most recently, a Candida auris outbreak in January 2024 sickened 4 people in a Seattle hospital. It was the first known C. auris outbreak in Washington State.

C. auris mainly spreads through person-to-person contact in healthcare settings, where the fungus can easily be transmitted directly between patients and healthcare workers.

People can get the fungus on their skin and even in their body — for example, the digestive tract — without ever getting sick. That’s called being “colonized” with the fungus. Healthcare workers who are perfectly healthy who are colonized with C. auris may unknowingly transmit it to a patient if they don’t practice proper hand hygiene.

Candida auris can also spread from person to person via contaminated objects. The fungus can survive on surfaces and equipment for an extended period, which contributes to its staying power within healthcare environments. Shared patient-care equipment and inadequate infection control practices also play roles in transmission, says Rupp.

It’s possible for the fungus to remain on the surface of a patient’s skin without causing any issues. But if that person goes on to have surgery or an invasive medical procedure (involving a catheter or ventilator, for instance), the fungus could enter the body.

In that scenario, a bloodstream infection, ear infection, urinary tract infection (UTI), or a postoperative surgical site abscess could occur. “Patients with weakened immune systems, those who’ve had recent surgeries, and those with extended hospital stays are at a higher risk,” Rupp says.

On the skin, candidiasis can cause a rash, and sometimes small blisters, especially at the edges of the rash.

Besides the aforementioned rash, common symptoms of Candida auris infection include:

Fever
Chills
Sweats
Low blood pressure
Weakness

These symptoms can resemble those of infections caused by bacteria, complicating diagnosis, according to the CDC.

There are two types of tests that can determine if a person has been infected or colonized with C. auris:

Colonization Screening The skin is swabbed near the armpits and groin and sent to a lab for testing.
Clinical Specimen Testing If a person is showing symptoms of an infection of unknown cause, a healthcare provider may collect a clinical sample, such as blood or urine, to test for multiple potential microbes.

C. auris can be tricky to identify with basic lab tests, says Rupp. “Clinical laboratories need to be on their toes in order to pick this up,” he says. Specialized testing is often required to differentiate it from other Candida species.

The CDC recommends that healthcare facilities conduct ongoing surveillance to promptly detect and contain outbreaks.

Treatment plans are often individualized based on the patient’s health condition and the site of infection.

C. auris is often resistant to common antifungal medications, but most infections are treatable with a class of antifungal medicines called echinocandins, which target the fungal cell wall.

“In most instances, we are able to combine antifungal medications to treat it,” says Rupp.

The prognosis for someone who has C. auris depends on the severity of the infection. If the fungus remains on the skin, it’s likely to respond to treatment. If the fungus invades the bloodstream, it’s more dangerous.

In the U.S., it’s estimated that about 1 in 3 people with an invasive infection die from the disease.
Because many people who become sick with C. auris are already very ill and often in the hospital, it can be hard to know the exact cause of death.

Most prevention efforts in reducing the risks posed by Candida auris are on an institutional level.

Hospitals and long-term care settings must make sure that patient rooms, procedure rooms, and all reusable equipment are properly cleaned and disinfected.
All staff need to regularly wash or sanitize their hands.
If a patient is found to have C. auris, they need to be isolated to keep from spreading it to someone else.

If you or a loved one are in the hospital or a long-term care setting, being proactive in your care may help reduce transmission risk, says Rupp. “Healthcare providers should be washing their hands and/or using hand gel, and the room should be cleaned and disinfected appropriately — and you should be assertive if this isn’t happening,” he says.

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