Dangerous Fungal Infections in ICU

A newborn in a Dhaka hospital tragically died within days of birth due to a severe fungal infection contracted in the hospital. The child’s mother, who had recently delivered a healthy baby, fell ill, requiring the newborn to remain in the hospital for a few days—a period during which the infection proved fatal.

Despite doctors’ best efforts, the newborn could not be saved. The hospital beds, especially in intensive care units (ICUs), were found to be a source of such lethal fungal infections—an outcome beyond prior expectation. Moreover, Bangladeshi hospitals currently lack the capacity to detect fungal infections effectively, particularly in ICUs where the infection rate is highest and contributes significantly to patient mortality.

For the first time in the country, researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) are investigating hospital-acquired severe fungal infections. This study has been ongoing since July 2022 in the critical care units of two major hospitals in Dhaka.

• Study sample: 992 patients identified at risk of fungal infections.
• Findings: High incidence of lethal fungal infections among newborns, children, and adults in ICU settings.

A major concern is the lack of systematic surveillance for systemic fungal infections, which has historically made early detection impossible. ICUs have been identified as high-risk zones, with Candida auris and Candida blankii emerging as drug-resistant fungal strains.

Treatment Challenges

• Resistant fungal strains are losing susceptibility to conventional antifungal drugs, including fluconazole and voriconazole.
• Some costly and less accessible medications, such as caspofungin and micafungin, remain effective.

Prevalence in Bangladesh

Globally, fungal infections affect approximately 6.5 million people annually, causing 3.8 million deaths, of which 2.5 million are directly attributed to fungal infections.

Researchers emphasise the need for:

• Microbiologically guided antifungal therapy to preserve drug efficacy.
• Rational use of antibiotics, as overuse increases susceptibility to fungal infections.
• Prompt diagnosis and treatment, particularly in ICUs, to prevent fatal outcomes.

Dr. Tanzir Ahmed Shuvo, Senior Research Investigator at icddr,b, stated:
“Previously, no systematic research was conducted on fungal infections in Bangladesh. We now see that fungi, like bacteria, can develop drug resistance. Standard antifungal drugs and disinfectants are insufficient against these pathogens. Urgent infection control measures must be strengthened to prevent severe and potentially fatal infections.”

Fungi are multicellular microorganisms capable of causing diseases in humans, animals, and plants.

• Common superficial infections: Thrush, ringworm, onychomycosis.
• Invasive/systemic infections:
  • Cryptococcal meningitis
  • Chronic pulmonary aspergillosis
  • Pneumocystis pneumonia
  • Bloodstream infections (Candida auris, Candida blankii)

Key ICU observation: The bloodstream infection rate in ICU patients is highest. Many infections remain undiagnosed or detected late, resulting in preventable deaths. Candida auris infections in particular have 80–100% mortality rates among affected patients, highlighting the critical need for rapid diagnosis and effective antifungal therapy.

This research underscores the emerging threat of drug-resistant fungi in Bangladesh, particularly in ICUs, and the urgent need for enhanced surveillance, early detection, and effective treatment protocols to save lives.