(Reuters) – Potentially deadly fungal infections with Candida auris are spreading rapidly in U.S. healthcare facilities, with cases nearly doubling between 2020 and 2021, the Centers for Disease Control and Prevention said.

The number of cases rose by 44% to 476 in 2019, up from 330 in 2018, and subsequently 59% to 756 in 2020 and by an additional 95% to 1,471 in 2021, the agency’s researchers reported on Monday in Annals of Internal Medicine.

Also concerning was a tripling in 2021 of the number of cases that were resistant to echinocandins, the class of drugs most often recommended for treatment of the disease.

A high fever with chills that does not get better after taking antibiotics may be a sign of Candida auris infection.

People who are very sick, have invasive medical devices such as mechanical ventilators, or have long or frequent hospital stays are at particular risk for the infections, the report said.

“The rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control,” study leader Dr. Meghan Lyman said in a statement.

The CDC noted that spread of the infections in 2021 may have been exacerbated as the healthcare system was hit by pandemic-related stressors, such as staff and equipment shortages.

The report did not include data from 2022, but the CDC’s website shows 2,377 cases of confirmed Candida auris infections in the U.S. last year, a sharp increase from 53 in 2016, the year in which cases were first reported in the country.

Although it was initially limited primarily to the New York City and Chicago metropolitan areas, Candida auris has now been detected in more than half of U.S. states, with recent cases mostly reflecting local transmission of the disease, according to the report.

Other countries have also reported increased spread of the fungus, the researchers said.

(Reporting by Leroy Leo in Bengaluru; editing by Caroline Humer, Nancy Lapid and Jonathan Oatis)

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