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Killer Fungi Detectives: Inside The Lab That May Be Fighting The Next Pandemic

The first tray of yellow-lidded specimen jars holds chunks of flesh – lung, perhaps, or muscle – some cerebrospinal fluid and another liquid, possibly from a brain abscess. The second holds a rainbow of colourful fungi, cultivated from those specimens.

One growth is green and fluffy, like something you would find in a sharehouse fridge – penicillium, maybe. Another is a dark grey or brown, like animal fur. There are bright white fuzzballs and blackish blobs. One growth leaches red into the medium it sits in.

Fungal pathogens come from all over Australia to this Adelaide laboratory, the National Mycological Reference Centre, for identification. Mycologists are on the lookout for new pathogens, which are starting to spread more because of climate change, and which can be deadly in the absence of effective antifungal drugs.

They work under biohazard signs, sorting specimens and growing colonies on petri dishes, to slice off and put under the microscope. There's a weird, wonderful library of mycology books, a DNA sequencer and a reference collection with boxes and boxes full of vials, from azole-resistant Aspergillus to Zygomycetes.

Dr Sarah Kidd is the centre's head. She was interested in Cryptococcus gattii, which live in eucalyptus trees and infect koalas, before she moved to Canada in 2006. And, serendipitously, there was a C gatti outbreak in Vancouver while she was there. It was a mystery how that fungus associated with Australia cropped up over there, but the theories are that it was something to do with changing global temperatures, perhaps some mutations.

Asked if those mutations scare her, Kidd says it's "certainly not a good thing … but it keeps things interesting".

Dr Sarah Kidd says 'very few people really appreciate that fungi cause life-threatening infections'. Photograph: University of Adelaide

The fascination with fungal pathogens has recently been piqued by the HBO series The Last of Us, which stars Pedro Pascal, Bella Ramsey and a host of humans turned into zombies by a parasitic fungal infection.

"The fungus in The Last of Us, Cordyceps, it certainly does cause infection and sort of zombifies, if you will, insects," Kidd says.

"But insects have a much cooler body temperature than humans … The vast majority of fungi cannot grow at 37C. So it's unlikely we'll see a human brain fungus zombification.

"Shows like The Last of Us have been really fantastic for drawing attention to mycology … Before that, I think people considered mycology to be about mushrooms, and foraging … or they knew that fungi can cause infections on skin, on toenails.

If they find themselves in a host who is susceptible, then they can kill

Dr Megan Lenardon

"But I think very few people, even now, really appreciate that fungi cause life-threatening infections."

There are hundreds of fungi that can affect humans.

Almost 4m global deaths a year are associated with fungal infections, according to research published earlier this year in the Lancet – and it's likely that this figure is massively underreported.

A pathogen of much more concern than Cordyceps at the moment is Candida auris.

It affects immunocompromised patients, people in intensive care and people with cancer or HIV/Aids.

Kidd says it can live on people, happily coexisting, until it finds its way into the bloodstream. It is resistant to many of the existing therapies and can spread easily from person to person – not unlike superbugs, bacterial infections that have grown resistant to antibiotics.

"They're calling this the first fungal superbug," Kidd says, "because it behaves like any of those resistant bacteria."

'A growing threat to human health': we are ill-equipped for the dangers of fungal infections

Another pathogen starting to crop up in Australia is Trichophyton indotineae. It's a superficial rash, but it never goes away. People try to self-treat it with ointments, but they don't work and its resistance grows.

"You can have whole families affected by these essentially incurable rashes," Kidd says. "We're starting to see those come into Australia as well."

Kidd returned to Australia from Canada to take over at the centre from emeritus mycologist David Ellis, a legend in the field. Ellis is quick to point to Kidd's impressive achievements, including a paper on fungal name changes that was listed in the Infectious Diseases Society of America's top 10 papers for the year, and the book Descriptions of Medical Fungi, on which she was the first author.

In 2022 the World Health Organization identified four fungal pathogens as "critical" among 19 fungi that pose the biggest threat to public health: Cryptococcus neoformans, Candida auris, Aspergillus fumigatus and Candida albicans.

The WHO emphasised the danger of having only a few antifungal medicines, the expansion of fungal diseases due to global warming and international travel and trade, and their increasing resistance to treatment.

Dr Megan Lenardon, a microbiologist at the University of New South Wales, warned just a few weeks ago that fungi had historically been overlooked in infectious disease research. She has been studying the Candida species, which cause thrush infections in tens of millions of people each year. While thrush itself – an overgrowth of Candida often in the mouth or genital area – is generally not dangerous, Candida can become invasive and spread through the organs and bloodstream.

Vials of fungus specimens at the National Mycological Reference Centre. Photograph: University of Adelaide

"We call them 'opportunistic invasive' fungal pathogens because they don't kill healthy people," Lenardon says.

"But if they find themselves in a host who is susceptible, then they can kill."

Lenardon warns that fungi may evolve to resist higher temperatures, meaning they can survive in human bodies but says the likelihood of a pandemic is "probably still relatively low".

Still, she says, there are no vaccines imminent and few preventive treatments in the pipeline.

At the centre in Adelaide they can screen for infections and implement extra precautions with infected patients. They are working on specialised tests and treatments, and hope they will have enough to tackle what comes.

Kidd says we "don't have a huge problem" with Candida auris in Australia – "yet".

This article was amended on 29 February 2024. A previous version incorrectly said The Last of Us was on Netflix.

Is Candida The New Epidemic?

by NAOMI COLEMAN, femail.Co.Uk

Most people associate candida with thrush or an itchy rash.

But according to alternative experts, a growing number of women are being diagnosed with candida - a condition where sufferers complain of a variety of symptoms including constant tiredness, a bloated stomach and aching joints.

However, if you visit your GP with the same complaints, the chances are your doctor won't recognise your symptoms as candida.

So why is candida such a controversial condition and why is medical opinion so torn about how it manifests itself?

To find out the truth behind candida, femail.Co.Uk has investigated this hotly debated condition and finds out whether you are at risk. Here, we look at the alternative approach to treating candida. Click at the bottom of the page to read the conventional medical view and an expert's conclusion

CANDIDA: THE ALTERNATIVE VIEW

According to alternative practitioners one in three women suffer from candida albicans - a yeast overgrowth that can occur in our body. Alternative experts claim candida can live in our intestines and other parts of our body such as the skin and mucous membranes.

One theory currently being put forward is that candida is a symptom of an endocrine disorder - where there is an imbalance between oestrogen and progesterone in the body.

This happens when the activity of oestrogen receptors is altered by contraceptive drugs or mercury poisoning from fillings, claim practitioners. Even if candida doesn't result from this directly, once these conditions are established in the body it only needs something small - such as a course of antibiotics - to unbalance the body and trigger yeast overgrowth, they say.

It is believed that most of the time yeast is kept in check by 'friendly' bacteria which live alongside it in the gut. If this balance between yeast and bacteria is out of kilter, for instance by antibiotics which kill off the bacteria, or in periods of low immunity following virus or stress, candida can start to grow and spread out of control.

Once there is overgrowth in the gut, say practitioners, candida can leak through the intestine wall and enter the bloodstream leading to a variety of symptoms including abdominal bloating, fatigue, muscular aches, food allergies and migraines which can underlie conditions such as chronic fatigue syndrome, irritable bowel syndrome and sinusitus.

The alternative treatments:

If you visit a homeopath or naturopath about your condition, you may be offered a specific diet where you reduce - or cut out - yeast such as bread, soya sauce and alcohol from your diet.

The idea is to starve the candida of yeast, which in turn, halts its growth and kills it off. You may also be given herbs such as aloe vera and acidophilus to encourage friendly bacteria to grow in your gut. This is claimed to help create a balance of good and bad bacteria in your body.

Click on the link below to read about the conventional view of candida and an expert's verdict

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Seattle Reports Outbreak Of Rare, Drug-Resistant Fungal Infection: Here's What To Know

Topline

An outbreak of a multi-drug resistant fungal infection in Washington state was reported earlier this week, and although infection is rare, experts warn its high mortality rate, drug resistance and ability to easily spread in healthcare facilities may be cause for concern.

Optical microscope view of Candida auris.

BSIP/Universal Images Group via Getty Images Key Facts

The Seattle and King County public health department announced Tuesday it identified three confirmed cases of Candida auris infection last week, after an initial case was confirmed on January 10.

Candida auris is a type of fungus that grows as yeast, and though it's rare, it can cause severe illness and spread easily because it's typically resistant to antifungal medications, according to the Centers for Disease Control and Prevention.

All four people were patients of Kindred Hospital Seattle, and the first confirmed case was detected through a "proactive screening program" during admission to the hospital, according to the news release from King County officials.

The other three patients initially tested negative for the fungus when they were first admitted, though additional testing revealed they were positive, suggesting they were infected during their stay at the hospital.

Local officials still haven't identified the source of the outbreak, but they're working with Kindred Hospital to keep transmissions down by keeping infected patients isolated, and notifying facilities that admit patients who were previously at Kindred.

The CDC issued a warning in May 2023 about an uptick of Candida auris cases spreading in healthcare facilities, labeling it an "urgent antimicrobial resistant threat."

Big Number

2,377. That's how many Candida auris infections were reported in the U.S. In 2022—the year with the most up-to-date data—according to the CDC. Some 5,754 other people were found to have Candida auris somewhere on their body that same year, though they weren't sick or had an active infection.

Key Background

Candida auris was first identified in Japan in 2009, where it was spotted in a patient's ear secretion. The U.S. First began tracking infections in 2016, and it was discovered that cases dated back to 2013 in the country. Cases have since grown every year and have been reported in 36 states as of 2022, with the most drastic increase occurring during the Covid pandemic between 2020 and 2021, where the U.S. Saw a 94% increase, according to CDC data. Around 95% of cases occurred in five states between 2013 and 2020: New York (41%), Illinois (26%), New Jersey (14%), California (8%) and Florida (7%). Around 90% of Candida auris strains are resistant to at least one antifungal, while 30% are resistant to at least two. Part of the reason the infection spreads so quickly is because it's often misdiagnosed as a different fungus and not treated properly, and spreads easily through healthcare facilities. This is because the infection can live on surfaces for at least two weeks, according to a 2017 study published in the Journal of Clinical Microbiology. In comparison to Covid, the coronavirus can survive on surfaces for up to three days, researchers from the National Institute of Health found.

Tangent

Candida auris can cause severe infection and hospitalization in some patients. It's particularly deadly in healthcare patients with serious medical issues, as one in three people with an invasive Candida auris infection—which affects places like the heart, brain and blood—die. The fungus can cause infection in different parts of the body like an open wound or the lungs, the CDC reports, though bloodstream infection is the most common. There's not a specific set of symptoms, as it has similar symptoms to other fungal infections. Symptoms of fungal infections include fever, chills, soreness, rashes, low blood pressure, muscle aches, shortness of breath, a cough, joint pain, pain while eating, fatigue, headache or discolored, brittle nails.

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