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PLANT or Die
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
W
hen I read about antibi-
otic resistance and the
ongoing emergence
of new bacterial and
fungal enemies, I have
nightmares involving running out of bleach.
These started when Ebola re-emerged in the
Congo last year and gained new life when
I read Matt Richtel and Andrew Jacobs’ re-
porting in the April 6 th The New York Times
article, “Revenge of the Bacteria: Why We’re
Losing the War.” I envision armed gangs
at Big Lots holding the driver hostage as
they offload the semi into armored white
vans. The Clorox factories have Star Wars
heat shields and robot guards in tanks and
drones. In my dreams, I have only an empty
sponge to confront a wall of mold. It’s ugly
and it grows as I watch, until I wake up
yelling. center for lung and heart problems, had
acquired over three months this markedly
resistant fungus, the administrators finally
called the CDC. Seventy-two people end-
ed up infected, although no deaths were
directly attributed to invasive candidemia.
This resistant Candida has affected those
with immune systems weakened by chemo-
therapy and immune suppressive therapy
for transplants, who have often received
multiple courses of antibiotics. Case fatality
rates from countries around the world have
ranged from over 30% to more than 50%.
The accuracy of these figures has been ques-
tioned, since identifying the exact cause of
death in a weakened patient with infections
and multi-organ dysfunction is difficult.
dia, C. auris was isolated in 19/27 intensive
care units in a 2017 study. Whole-genome
sequencing showed that the United States
isolates indicated links to both the South
Asian and South American groups.
Isolates of this organism from various
countries have been submitted for genetic
analysis. A late 2017 article in the American The problem with translating whole
genome sequencing into clinical medicine
is in identifying the exact organism. As a
rule, hospital labs use other methods, and
many of these organisms can be misidenti-
fied and therefore treated, wrongly. Treating
the wrong isolate of Candida has potentially
disastrous results. Patients so treated expose
the organism in-vivo to drugs reserved for
invasive candidemia, thus fostering the
growth of resistance while failing to help
the patient. Dr. Smith et al. reanalyzed
multiple samples and found a case from
1996 and another from 2008, but the first
acknowledged identification was from the
In reality, we cannot inject intravenous
bleach against one of the newest and most
fearsome pathogens, Candida auris. I first
learned of it a couple of years ago in as-
sociation with an outbreak in the Royal
Brompton Hospital in Chelsea, London.
After at least 50 people in this hospital, a Society for Microbiology Journal (A.J. Smith
and multiple authors) noted the fungus has
shown nearly simultaneous emergence of
separate clades (genetic varieties) in dif-
ferent parts of the world. Different clonal
strains of this have different patterns of sus-
ceptibility to antifungal medicines. In In- ear of a Japanese woman in 2009, thus the
“auris.” Initially, the key ingredient in proper
identification is having the correct spectral
data loaded into the fungus-identifying ap-
paratus, called the “Maldi-TOF MS” mass
spectrometer database. Rapid identification
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