In the universe of scary drug-resistant pathogens that can kill, Candida auris is having a moment. The freaky fungus, which is behaving in ways scientists didn’t think fungi could act, has been garnering headlines because of its uncanny ability to resist multiple antifungal drugs and settle into hospital rooms so persistently it can take renovations to get rid of it.
But while concern about the superbug has grown exponentially in recent years, funding for research to stop it has not. Scientists who work in mycology — the study of fungi — say there is precious little money available to study Candida auris.
“Traditionally, mycology has been the ugly duckling of infectious diseases,” said Dr. Luis Ostrosky, professor of infectious diseases at McGovern Medical School at the University of Texas Health Science Center at Houston and director of its laboratory of mycology research.
Ostrosky’s specialties — he’s an infectious disease epidemiologist and a mycologist — make him especially well-equipped to study Candida auris. He has treated some patients who’ve acquired it, consulted on others, and worked in the laboratory trying to decipher some of its mysteries. But most of his funding comes from the pharmaceutical industry. Unsettling news articles about untreatable fungal infections have piqued pharma’s interest.
“I’ve been funded … almost exclusively by industry in the development of new antifungals for the past 20 years. I have had some federal funding here and there but nowhere to the level where our bacteriology colleagues have received,” Ostrosky told STAT.
The head of mycotic diseases at the Centers for Disease Control and Prevention acknowledged his field hasn’t attracted the same kind of research dollars as other pathogens.
“Unfortunately fungal research is not a well-funded field,” Dr. Tom Chiller said, ruefully. “We like to say sometimes we’re so neglected that we’re even neglected by the tropical disease people.”
Candida is a large family of yeasts; in fact, there are hundreds of species in the family. Many live on or in our bodies. Often they cause no problems. Occasionally, though, the balance of organisms in the sites where they live get out of whack and a type of Candida will grow out of control. Thrush or vaginal yeast infections are common such occurrences.
Typically these problems can be treated with an antifungal drug. But to the surprise of the field, outbreaks of infections caused by highly resistant Candida auris have popped up multiple parts of the world since the fungus was first identified in Japan in 2009.
On a few occasions, U.S. doctors have seen C. auris infections caused by versions of the fungus that can fend off all existing antifungal drugs — so called pan-resistant strains.
C. auris still hasn’t been found anywhere in nature other than on or in humans — one of several features of this organism that puzzles scientists. It tends to infect people who are already very sick, whose immune systems are compromised and unable to fight off the infection. A high proportion of people who have been diagnosed with C. auris have died — the CDC estimates it’s between 30% and 60% — but it can be hard to tease out whether the infection caused their death, or contributed to it.
The first known C. auris infection in the United States dates back to May 2013, in a patient in New York state who had been hospitalized previously in the Middle East. That case, however, was only spotted retrospectively, when the CDC asked state health departments in 2016 to be on the lookout for and to report C. auris infections.
Of the 684 cases that have been identified in the United States, most have occurred in New York, New Jersey, and Illinois, according to the CDC.
Even when it can be treated, Candida auris is a nightmare when it finds its way into a hospital setting. Standard hospital cleaning doesn’t budge it. In 2016, Royal Brompton Hospital in London — battling a major C. auris outbreak and with infection control staff at their wits end — temporarily closed its intensive care unit to try to stop spread of the fungus.
British researchers working on fungi scrambled to figure out how hospitals could cope with C. auris during the Royal Brompton outbreak. There was no money for the work, said Johanna Rhodes, an epidemiologist at Imperial College London. People called in favors and worked for free trying to come up with answers.
In the aftermath of the outbreak, the funding situation has improved for fungal research in Britain, Rhodes said.
“The MRC — the Medical Research Council — and the Wellcome Trust seem to be very keen to support work on this,” she said. “It’s trendy. People are interested in it — which is good for us.”
But C. auris research in the United States hasn’t yet hit that spot. Getting funding for this work here is still “extremely hard,” said Tejas Bouklas, an assistant professor in the department of biomedical sciences at Long Island University, Post, campus.
Bouklas’ lab has been studying C. auris samples she obtained from the CDC. The fungus grows at an incredible rate, she and her students reported in a poster presented at last month’s annual conference of the American Society of Microbiology. It also appears to be undaunted by exposure to antifungal drugs.
In the last fiscal year, $98 million was allocated for fungal research, Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, said in an interview. Of that, about a third was spent on the study of fungi in the Candida family.
How much, specifically, was spent on the study of Candida auris? There’s no way to say, Fauci said.
“It’s very tough to determine the precise amount that would be to auris versus others, because much of the studying that you do on Candida is really applicable to multiple species, including auris,” he said.
NIAID spent between $280 million and $300 million on influenza research in 2018 and nearly $3 billion on HIV.
“There’s a lot of attention on it and it’s a bit scary, because it’s tough to get rid of and also it is also resistant to a lot of antifungals. But the magnitude of the problem right now is not great,” said Fauci.
“But it’s something that we’re concerned about it growing. Because big problems start off as little problems and then they become big problems. So we want to make sure we don’t fall behind on this,” he said.
If NIAID gets additional funding in the budget process, C. auris study should get some of that. But Fauci cautioned the increase would be modest.
“They’re not going to get a lot of money,” he warned. “But I am almost certain that when they redistribute, they’re not just going to be redistributing it pro rata. They’re going to distribute it on need. And since Candida is a growing problem …” Fauci said. He then trailed off, leaving the conclusion to be assumed.
The type of funding NIAID provides is critical, though, if laboratories like the ones Bouklas or Ostrosky run are to come up with ways to prevent and control C. auris infections and outbreaks. That’s because pharmaceutical companies are interested in “applied research” — in other words, research that leads to things that can be sold.
So funding for science aimed at finding tools to better diagnose C. auris and new antifungals to treat it? Yes, there’s some pharma money for that, Ostrosky said. But science that shows how to avert these hugely difficult infections doesn’t generate sales.
“There is some federal funding being allocated for this,” said Ostrosky, “but perhaps not to the level that we would need to tackle this very quickly.”