A burn patient in ICU develops Candida bloodstream infection. Species identification by MALDI-TOF mass spectrometry identifies Candida auris. Which feature of C. auris makes this infection particularly challenging to manage compared to C. albicans?
- A C. auris is exclusively resistant to echinocandins, making azoles the only reliable treatment option
- B C. auris frequently shows resistance to multiple antifungal classes including fluconazole (azoles), and misidentification as C. haemulonii on conventional biochemical systems ✓
- C C. auris produces germ tubes (Reynolds-Braude phenomenon) that resist azole penetration unlike C. albicans
- D C. auris biofilms produce thick polysaccharide capsule similar to Cryptococcus, preventing antifungal access
Explanation
Candida auris, first described in 2009 (Japan, ear infection), is a globally emerging multidrug-resistant pathogen. Key features: (1) Frequent azole resistance (>90% of isolates) via ERG11 gene mutations; variable echinocandin and amphotericin B resistance; ~5% of isolates are pan-drug-resistant; (2) Critical diagnostic challenge — conventional identification systems (Vitek 2, API 20C AUX) misidentify C. auris as C. haemulonii, C. famata, or C. duobushaemulonii; MALDI-TOF and ITS2 sequencing are required for accurate identification; (3) Hospital environment persistence — survives on surfaces for prolonged periods causing nosocomial outbreaks; (4) High mortality in invasive infection (35–60%). Echinocandins are currently the first-line treatment for C. auris bloodstream infections.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.