This article was written by Rachel Tay for Business Insider Malaysia.

A dangerous, emerging fungus that is resistant to anti-fungal drugs is becoming an increasing health concern around the world.

The fungus, called Candida auris, is constantly evolving its defences to survive modern medicines, and has also proven to be deadly. According to The New York Times, Candida auris is a fungus that can cause life-threatening infections when it enters a person’s bloodstream.

Here’s what we know about the super fungus:

90 per cent of infections are resistant to one anti-fungal drug.

The most worrying characteristic about Candida auris is its resistance to major anti-fungal drugs, which are typically used to treat such infections. According to the Centers for Disease Control and Prevention (CDC) in the US, 90 per cent of Candida auris infections are resistant to at least one such anti-fungal drug, while 30 per cent are resistant to two or more major drugs.

The germ, which is most commonly found in hospitals and nursing homes, is also difficult to eradicate once it is present in a facility. Some hospitals needed special cleaning equipment and even had to rip out some of the ceiling and floor tiles to eradicate the fungus, The New York Times reported.

According to the Times, people with compromised or weakened immune systems – including elderly people, people who are already sick, and newborns – are the most vulnerable.

First Reported in Japan

According to a report published in 2016 by the Center for Infectious Disease Research and Policy at the University of Minnesota, scientists first discovered the fungus in a patient who had an ear infection in Japan in the year 2009.

Since then, 587 cases of Candida auris have been reported in the United States, the centre said, citing the CDC. Most of the cases were reported in New York, New Jersey and Illinois.

Globally, Candida auris has been reported in eight other countries, including two with more than 30 patients each, the 2016 report added.

3 Imported Cases in Singapore

According to a report published by Annals Academy of Medicine Singapore in July 2018, the first case of Candida auris was detected in Singapore in 2012 and involved a 52-year-old locally-born Chinese woman.

The report, written by Dr Yen Ee Tan and Dr Ai Ling Tan from the Department of Microbiology, Division of Pathology at the Singapore General Hospital, said that the woman was transferred to Singapore from India following a road traffic accident.

After the woman’s wound had gotten infected, multiple organisms – including Candida auris, started to grow. The doctors prescribed antibiotics and antifungal medication, but fluconazole was discontinued after a week when the fungus was tested to be resistant to it, the report said. According to the authors, the patient was discharged four months later with her “wounds healing well”.

Two other cases were later reported in 2016. The first involved a 24-year-old Bangladeshi male who flew to Singapore to seek medical treatment, while the second involved a 69-year-old US male citizen who was suffering from a lung disease.

In both cases, the infections seemed to be imported from overseas as there were no reports of a Candida auris outbreak from Singapore, the report said.

Silence Surrounding Outbreaks

There has been little coverage on this global outbreak, mostly because many hospitals and governments are reluctant to disclose such outbreaks for fear of being seen as infection hubs, The New York Times reported.

The New York Times also cited a case that took place in 2015, where Dr Johanna Rhodes, an infectious disease expert, was told by the Royal Brompton Hospital in Britain that Candida auris had taken root there a few months earlier.

Royal Brompton Hospital alerted the British government and infected patients when the fungus could not be removed, but made no public announcement to warn the public about the outbreak, The New York Times said. Members of the public remained in the dark until a scientific paper reported that there was “an ongoing outbreak of 50 C. auris cases” in July 2016.

Some hospitals and medical professionals have argued that since precautions are being taken to prevent the spread of such outbreaks, publicising an outbreak would scare people unnecessarily, The New York Times said.