Last May, an elderly man was admitted to the Brooklyn branch of the Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.
The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and was root in India, Pakistan and South Africa.
Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs considered "urgent threats."
Everything was positive ̵1; the walls, the bed, the doors, the curtains, the phones, the drain, the whiteboard, the poles, the pump.
– Dr. Scott Lorin, on C. auris
The man at Mount Sinai died after 90 days in.
– Dr. Scott Lorin, on C. auris
The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. The test showed it was everywhere in his room, so it was invasive that the hospital needed special cleaning equipment and had to rid some of the ceiling and floor tiles to eradicate it.
"Everything was positive – the walls, the bed, the doors , the curtains, the phones, the sink, the whiteboard, the poles, the pump, "said Dr. Scott Lorin, the hospital's president. "The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive."
C. Auris is so tenacious, partly because it is impervious to major antifungal medications, making it a new example of one of the world's most intractable health threats: the rise of drug-resistant infections.
For decades, public health experts have It was warned that the overuse of antibiotics was to reduce the effectiveness of drugs that have prolonged life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well, adding a new and frightening dimension to a phenomenon that undermines a pillar of modern medicine.
"It's a huge problem," said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review of the emergence of resistant fungi. "
A new breed of fungi
Simply put, fungi, just like bacteria, are developing defenses to survive modern medicines.
Even as world health Leaders have pleaded for more restraint in prescribing antimicrobial drugs to fight bacteria and fungi – convening the General Assembly of the United Nations in 2016 to manage emerging crises – their gluttonous overuse in hospitals, clinics and farming continued.
Resistant bacteria are often called "superbugs," but this is simplistic because they do not usually kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress body defenses.
Cancer versus superbug
Scientists say that Unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, the risk will spread to more healthy populations. A study by the British government funded projects that if policies are not put in place to slow the rise in drug resistance, 1050,000 people could die in the world of all such infections in 2050, eclipsing the eight million expected to die that year from cancer.  In the United States, two million people contract resistant infections annually, and 23,000 die from them, according to the official CDC estimate. That number was based on 2010 figures; more recent estimates from researchers at the Washington University School of Medicine put the death toll at 162,000. Worldwide, fatalities from resistant infections are estimated at 700,000.
Antibiotics and antifungals are both essential to prevent infections in humans, but antibiotics are also widely used to prevent disease in farm animals, and anti-fungal drugs are also used to prevent agricultural plants from rotting. Some scientists have cited evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.
Yet as the problem grows, it's little understood by the public – partly because of the very existence of resistant infections Is often cloaked in secrecy.
With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infectious hubs. Even the CDC, under its agreement with the states, is not permitted to make public the location or name of the hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they had cases.
All the while, the germs are easily spread – carried on hands and equipment inside hospitals; ferried on meat and manure-fertilized vegetables from farms; transported across borders by travelers and on exports and imports; and transferred by patients from nursing home to hospital and back.
C. Auris, which infected the man at Mount Sinai, is one of the dozens of dangerous bacteria and fungi that have developed resistance. Yet, like most of them, it is a threat that is practically unknown to the public.
The issue at hand
Other prominent strains of the fungus Candida – one of the most common causes of bloodstream infections in hospitals – has The drug CDC said.
Dr Lynn Sosa, Connecticut's deputy (s). State epidemiologist, she now saw C. auris as the "top" threat among resistant infections. "It's pretty much unbeatable and difficult to identity," she said.
Nearly half of the patients who contracted C. auris die within 90 days, according to the CDC. "It's a creature from the black lagoon," Dr. said.
"It's a creature from the black lagoon," Dr. Tom Chiller, who heads the fungal branch at C.D.C., which is leading a global detective effort to find treatments and stop the spread. "It bubbled up and now it is everywhere."
'No need' to tell the public
In late 2015, Dr. Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical center outside London. C. auris had taken root there months earlier, and the hospital could not clear it.
"We have no idea where it comes from. We've never heard of it. It's just spread like wildfire, '' Dr. Rhodes said she was told.
Under her direction, the hospital staff used a special device to spray aerosolized hydrogen peroxide around a room used by a patient with C. auris, the theory being that the vapor would scour every nook and cranny. They left the device going for a week. Then they put a "sett plate" in the middle of the room with a gel at the bottom, which would serve as a place for any surviving microbes to grow, Dr. Rhodes said.
Only one organism grew back. C. auris.
It was spreading, but the word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but did not make public announcements.
"There was no need to put out a news release during the outbreak, "said Oliver Wilkinson, a spokesman for the hospital.
This hushed panic is playing out in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to publicize outbreaks of resistant infections, arguing there is no point in scaring patients – or prospective ones.
Dr. Silke Schelenz, Royal Brompton's infectious disease specialist, found the urgency of the government and hospital in the early stages of the outbreak "very, very frustrating."
"They obviously did not want to lose reputation," Dr. Schelenz said "It had no impact on our surgical outcomes."
By the end of June 2016, a scientific paper reported "an ongoing outbreak of 50 cases of C. auris cases" at Royal Brompton, and the hospital took an extraordinary step: it shut down its ICU for 11 days, moving intensive care patients to another floor, again with no announcement.
Days later the hospital finally admitted to a newspaper that it had a problem. A headline in The Daily Telegraph warned that "Intensive Care Unit Closed After Deadly New Superbug Emerges in the UK" (Later research said there were ultimately 72 total cases, although some patients were only carriers and were not infected by the fungus.)  Yet the issue remained little internationally, while even more severe outbreaks were started in Valencia, Spain, at the 992-bed Hospital Universitari i Politècnic La Fe. There, unbeknown to the public or unaffected patients, 372 people were colonized – meaning they had a germ in their body but were not sick with it – and 85 developed bloodstream infections. A paper in the journal Mycoses reported that 41 percent of the infected patients died within 30 days.
A statement from the hospital said that it was not necessarily C. auris that killed them. "It is very difficult to discern whether patients die from a pathogen or with it, since they are patients with many underlying diseases and in very serious general conditions," the statement said.
As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not.
One author of the article in Mycoses, a doctor at the hospital, said in an email that the hospital did not want him to speak to journalists because she "is concerned about the public image of the hospital. "
The secret is infuriating patient advocates, who say that people have a right to know if there is an outbreak, so they can decide whether to go to a hospital, especially when dealing with a nonorgent matter, such as elective surgery.
" "Said Dr Kevin Kavanagh, a Kentucky physician and chair of Health Watch USA, a nonprofit patient advocacy group.
Health officials say that disclosing outbreaks frightens patients about a situation they can not do nothing about, especially when the risks are unclear.
"It's hard "It's enough with these organisms for health care providers to wrap their heads around it," said Dr. Anna Yaffee, a former C.D.C. The outbreak investigator who dealt with resistant infections in Kentucky in which the hospitals were not publicly disclosed. "It's really impossible to message to the public."
Officials in London did alert the CDC to the Royal Brompton outbreak while it was occurring. And the C.D.C. realized it needed to get the word to American hospitals. On June 24, 2016, the C.D.C. blasted a nationwide warning to hospitals and medical groups and set up an email address, firstname.lastname@example.org, to field queries. Dr. Snigdha Vallabhanen, a key member of the fungal team, is expected to get a trickle – "maybe a message every month."
Instead, within weeks, her inbox exploded.
Coming to America
In the United States , 587 cases of people having contracted C. auris have been reported, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the CDC.
The symptoms – fever, aches and drowsiness – are seemingly ordinary, but when a person gets infected, especially someone is already unhealthy, such commonplace symptoms can be fatal.