How dangerous is Candida auris. What makes C. auris different from other yeast infections. Why is C. auris considered an emerging global health threat. How is C. auris diagnosed and treated. Who is most at risk for C. auris infection.

The Emergence of Candida auris: A Deadly Yeast Infection

Candida auris, first identified in Japan in 2009, has rapidly become a significant concern in healthcare settings worldwide. This fungal pathogen has garnered attention due to its ability to cause severe infections, particularly in hospitalized patients. Unlike common yeast infections, C. auris poses a serious threat to human health, potentially leading to life-threatening conditions.

The earliest known strain of C. auris dates back to 1996 in South Korea, but it wasn’t until recent years that its prevalence and impact became apparent. Since its discovery, C. auris infections have been reported in over 30 countries, including the United States, indicating its global spread and increasing significance as an emerging pathogen.

Why is Candida auris a Major Concern for Healthcare Professionals?

Healthcare facilities and medical professionals are particularly concerned about C. auris for several reasons:

• Multidrug resistance: C. auris often exhibits resistance to multiple antifungal drugs commonly used to treat Candida infections, making treatment challenging.
• Difficult identification: Standard laboratory methods struggle to accurately identify C. auris, leading to potential misidentification and inappropriate management.
• Outbreak potential: C. auris has caused outbreaks in healthcare settings, necessitating quick identification and special precautions to prevent its spread.

These factors contribute to the growing concern surrounding C. auris and its potential impact on patient health and healthcare systems.

Understanding the Types of Infections Caused by Candida auris

C. auris can cause a variety of infections throughout the body, some of which can be life-threatening. The most common types of infections associated with C. auris include:

1. Bloodstream infections
2. Wound infections
3. Ear infections

Additionally, C. auris has been isolated from respiratory and urine specimens, although its role in causing infections in the lungs or bladder remains unclear. The ability of C. auris to infect multiple body sites underscores its versatility as a pathogen and the challenges it presents in clinical settings.

Diagnosing Candida auris: Challenges and Specialized Techniques

Diagnosing C. auris infections presents unique challenges due to the organism’s characteristics. How are C. auris infections typically diagnosed? Like other Candida infections, C. auris is usually identified through culture of blood or other body fluids. However, the process is not straightforward.

C. auris is notably harder to identify from cultures than other, more common types of Candida. It can be easily confused with other yeast species, particularly Candida haemulonii. This similarity to other yeasts can lead to misidentification and subsequent inappropriate treatment.

To accurately diagnose C. auris, specialized laboratory tests are required. These tests employ advanced techniques that can definitively distinguish C. auris from other Candida species. The need for these specialized methods highlights the importance of laboratory expertise in managing C. auris infections effectively.

Who is at Risk? Identifying Vulnerable Populations for Candida auris Infections

Understanding who is most susceptible to C. auris infections is crucial for prevention and early intervention. While anyone can potentially contract a C. auris infection, certain groups are at higher risk:

• Patients in long-term care facilities or nursing homes
• Individuals with medical devices such as breathing tubes, feeding tubes, or central venous catheters
• People who have recently undergone surgery
• Diabetic patients
• Those who have received broad-spectrum antibiotics or antifungal medications

It’s important to note that C. auris infections have been found in patients of all ages, from preterm infants to the elderly. The common thread among high-risk individuals is often prolonged hospitalization or the presence of invasive medical devices, which provide potential entry points for the fungus.

The Global Spread of Candida auris: Tracking an Emerging Threat

The rapid spread of C. auris across the globe has alarmed public health officials and researchers alike. How has this pathogen managed to disseminate so widely in a relatively short period? To answer this question, the Centers for Disease Control and Prevention (CDC) conducted whole genome sequencing of C. auris specimens from various regions, including eastern Asia, southern Asia, southern Africa, and South America.

Whole genome sequencing produces detailed DNA fingerprints of organisms, allowing scientists to track the genetic similarities and differences between strains found in different parts of the world. This genetic analysis has provided valuable insights into the origins and spread of C. auris.

The findings suggest that C. auris emerged independently in multiple regions around the same time, rather than spreading from a single point of origin. This simultaneous emergence in different parts of the world is unusual and has contributed to the rapid global dissemination of C. auris.

Treatment Challenges: Combating Multidrug-Resistant Candida auris

One of the most concerning aspects of C. auris is its resistance to multiple antifungal drugs. This multidrug resistance poses significant challenges in treating infections effectively. Why is C. auris so difficult to treat?

The fungus has shown resistance to the three main classes of antifungal drugs:

1. Azoles
2. Echinocandins
3. Polyenes

In some cases, C. auris has demonstrated resistance to all three classes, leaving healthcare providers with limited treatment options. This high level of drug resistance is unusual for Candida species and contributes to the severity of C. auris infections.

Treatment of C. auris infections often requires a combination of antifungal medications, careful monitoring, and in some cases, the use of experimental therapies. The difficulty in treating these infections underscores the importance of prevention and early detection in managing the spread of C. auris.

Prevention Strategies: Controlling the Spread of Candida auris in Healthcare Settings

Given the challenges in treating C. auris infections, prevention becomes paramount in controlling its spread, especially in healthcare environments. What measures can be taken to prevent C. auris transmission?

• Enhanced cleaning and disinfection protocols: C. auris can persist on surfaces for long periods, necessitating thorough cleaning with appropriate disinfectants.
• Strict hand hygiene practices: Healthcare workers and visitors should adhere to rigorous hand washing and sanitizing procedures.
• Patient isolation: Infected or colonized patients should be placed in single rooms with contact precautions.
• Screening high-risk patients: Proactive screening of patients from high-risk areas or with a history of prolonged hospitalization can help identify cases early.
• Antimicrobial stewardship: Judicious use of antibiotics and antifungals can help prevent the development of drug-resistant strains.

Implementing these strategies requires a coordinated effort from healthcare facilities, staff, and public health agencies. The goal is to create a barrier against the spread of C. auris and protect vulnerable patient populations.

The Role of Surveillance in Combating Candida auris

Effective surveillance is crucial in managing the C. auris threat. Healthcare facilities and public health departments must work together to monitor for new cases, track the spread of existing infections, and identify potential outbreaks quickly. This surveillance includes:

• Regular testing of high-risk patients
• Prompt reporting of confirmed cases to health authorities
• Genetic analysis of isolates to track strain evolution and spread
• International collaboration to share data and best practices

By maintaining vigilant surveillance, healthcare systems can respond rapidly to new C. auris cases and implement targeted interventions to prevent further spread.

Research and Development: The Future of Candida auris Management

As C. auris continues to pose challenges to global health, ongoing research and development efforts are crucial. What areas of research are scientists focusing on to combat C. auris?

• New antifungal drugs: Researchers are working to develop novel antifungal agents that can overcome the multidrug resistance of C. auris.
• Improved diagnostic tools: Efforts are underway to create faster, more accurate diagnostic tests that can quickly identify C. auris infections.
• Vaccine development: While challenging, the possibility of a vaccine against C. auris is being explored as a long-term prevention strategy.
• Environmental control measures: Studies are investigating more effective ways to eliminate C. auris from healthcare environments.

These research initiatives offer hope for better management and control of C. auris in the future. As our understanding of this pathogen grows, so too will our ability to combat its spread and treat infections effectively.

The Economic Impact of Candida auris Infections

Beyond the immediate health concerns, C. auris infections can have significant economic implications for healthcare systems and society at large. How does C. auris affect healthcare costs?

• Increased length of hospital stays
• Higher treatment costs due to the need for expensive antifungal medications
• Additional expenses for isolation precautions and specialized cleaning
• Potential loss of revenue for healthcare facilities during outbreaks

These economic factors underscore the importance of effective prevention and control measures. By investing in prevention, healthcare systems can potentially save substantial costs associated with treating and managing C. auris infections.

Public Awareness and Education: Key Components in Controlling Candida auris

Raising public awareness about C. auris is crucial in controlling its spread and ensuring early detection of infections. What role does public education play in managing the C. auris threat?

• Informing the public about the risks and symptoms of C. auris infections
• Educating patients and families about prevention measures in healthcare settings
• Promoting proper hygiene practices in the community
• Encouraging open communication between patients and healthcare providers about infection risks

By increasing public knowledge about C. auris, we can create a more informed and vigilant population that can actively participate in preventing the spread of this dangerous pathogen.

The Global Response to Candida auris: Collaborative Efforts and Challenges

Addressing the threat of C. auris requires a coordinated global response. How are countries and international organizations working together to combat this pathogen?

• Sharing of surveillance data and research findings
• Collaborative development of guidelines and best practices
• International training programs for healthcare workers and laboratory staff
• Coordinated efforts to track and respond to outbreaks across borders

Despite these efforts, challenges remain, including disparities in healthcare infrastructure and resources between countries. Overcoming these challenges will be crucial in developing a truly effective global strategy against C. auris.

The Future Outlook: Predicting the Impact of Candida auris

As we look to the future, what can we expect regarding the impact of C. auris on global health? While predictions are challenging, several factors will likely influence the trajectory of C. auris:

• The continued evolution of antifungal resistance
• Advances in diagnostic and treatment technologies
• Changes in global travel and healthcare practices
• The effectiveness of ongoing prevention and control measures

Monitoring these factors will be crucial in anticipating and responding to future challenges posed by C. auris. As our understanding of this pathogen grows, so too will our ability to mitigate its impact on human health and healthcare systems worldwide.

General Information about Candida auris | Candida auris | Fungal Diseases

Healthcare facilities in several countries have reported that a type of yeast called Candida auris has been causing severe illness in hospitalized patients. In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections. This yeast often does not respond to commonly used antifungal drugs, making infections difficult to treat. Patients who have been hospitalized in a healthcare facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.

Specialized laboratory methods are needed to accurately identify C. auris. Conventional laboratory techniques could lead to misidentification and inappropriate management, making it difficult to control the spread of C. auris in healthcare settings.

Because of these factors, CDC is alerting U.S. healthcare facilities to be on the lookout for C. auris in their patients.

CDC and partners continue to work closely; click here for the latest information on Candida auris. To learn more about Candida auris, read the Q&A below and:

• Fact sheet on Candida auris – Download pdf icon[PDF – 2 Pages]
• Recommendations for Laboratorians and Health Professionals
• Information for Patients and Family Members
• Questions and Answers for Healthcare Personnel

Why is CDC concerned about

C. auris infections?

CDC is concerned about C. auris for three main reasons:

1. It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections.
2. It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
3. It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

What types of infections can

C. auris cause?

C. auris has caused bloodstream infections, wound infections, and ear infections. It also has been isolated from respiratory and urine specimens, but it is unclear if it causes infections in the lung or bladder.

How is

C. auris infection diagnosed?

Like other Candida infections, C. auris infections are usually diagnosed by culture of blood or other body fluids. However, C. auris is harder to identify from cultures than other, more common types of Candida. For example, it can be confused with other types of yeasts, particularly Candida haemulonii. Special laboratory tests are needed to identify C. auris. For more information, please see the Recommendations for Laboratorians and Health Professionals.

Who is at risk for infection from

C. auris?

People who have recently spent time in nursing homes and have lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters), seem to be at highest risk for C. auris infection. Limited data suggest that the risk factors for Candida auris infections are generally similar to risk factors for other types of Candida infections. These risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use. Infections have been found in patients of all ages, from preterm infants to the elderly. Further study is needed to learn more about risk factors for C. auris infection.

When was

C. auris first reported?

C. auris was first identified in 2009 in Japan. Retrospective review of Candida strain collections found that the earliest known strain of C. auris dates to 1996 in South Korea. CDC considers C. auris an emerging pathogen because increasing numbers of infections have been identified in multiple countries since it was recognized.

How did

C. auris get its name?

Auris is the Latin word for ear. Despite its name, C. auris can also affect many other regions of the body and can cause invasive infections, including bloodstream infections and wound infections.

Where have

C. auris infections occurred globally?

C. auris infections have been reported from over 30 countries, including the United States. Because identification of C. auris requires specialized laboratory methods, infections likely have occurred in other countries but have not been identified or reported. Click here for a map of countries with reported cases.

How did

C. auris infection spread globally?

CDC conducted whole genome sequencing of C. auris specimens from countries in the regions of eastern Asia, southern Asia, southern Africa, and South America. Whole genome sequencing produces detailed DNA fingerprints of organisms. CDC found that isolates within each region are quite similar to one another, but are relatively different across regions. These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time.

Would someone be likely to get a

C. auris infection if they travel to any of these countries?

It is unlikely that routine travel to countries with documented C. auris infections would increase the chance of someone getting sick from C. auris. Infections have occurred primarily in patients who were already in the hospital for other reasons. People who travel to these countries to seek medical care or who are hospitalized there for a long time may have an increased risk for C. auris infection. 

Have

C. auris infections occurred in the United States?

Cases of C. auris infections have been reported in the United States. As laboratories continue to look for this fungus, it is likely that more cases will be reported. Click here for a map of cases in the United States.

What should someone do if they suspect they have a

C. auris infection?

CDC recommends that anyone who believes they have any fungal infection or healthcare-associated infection see a healthcare provider.

Are

C. auris infections treatable?

Most C. auris infections are treatable with a class of antifungal drugs called echinocandins. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection. Treatment decisions should be made in consultation with a healthcare provider experienced in treating patients with fungal infections.

Can a person die from infection with

C. auris?

Yes. Invasive infections with any Candida species can be fatal. We don’t know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30–60% of people with C. auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death.

How does

C. auris spread?

C. auris can spread in healthcare settings through contact with contaminated environmental surfaces or equipment, or from person to person. More work is needed to further understand how it spreads.

How can the spread of

C. auris be prevented?

Please see the Recommendations for Laboratorians and Health Professionals.

What is CDC doing to address

C. auris?

CDC is providing guidance for clinicians and infection control personnel. For more information, please see the Recommendations for Laboratorians and Health Professionals. CDC also is working with state and local health agencies, healthcare facilities, and clinical microbiology laboratories to ensure that laboratories are using proper methods to detect C. auris and know the limitations of certain tests for detecting C. auris.

 Top of Page

Why It Should Be Diagnosed and Treated

Without treatment, a yeast infection could become more serious. There’s a chance that it could resolve on its own, but it could also worsen.

A vaginal yeast infection (vaginal candidiasis) is a relatively common fungal infection that causes thick, white discharge along with irritation, itchiness, and swelling of the vulva and vagina.

Keep reading to learn more about the downsides of ignoring yeast infections.

If left untreated, vaginal candidiasis will most likely get worse, causing itching, redness, and inflammation in the area surrounding your vagina. This may lead to a skin infection if the inflamed area becomes cracked, or if continual scratching creates open or raw areas.

Uncommon side effects of an untreated yeast infection include:

• fatigue
• oral thrush
• gastrointestinal problems

Invasive candidiasis

Invasive candidiasis occurs when the yeast infection affects other parts of the body, such as the:

• blood
• heart
• brain
• bones
• eyes

Invasive candidiasis is usually associated with an open sore that’s exposed to a yeast infection. It isn’t typically related to vaginal yeast infections. It can cause serious health complications if not promptly treated.

Candidemia

According to the Centers for Disease Control and Prevention (CDC), candidemia is one of the most common forms of invasive candidiasis in the United States. It’s also one of the most common bloodstream infections in the country.

Yeast infections are common during pregnancy due to fluctuating hormones. If you’re pregnant and think you may have a yeast infection, see a doctor so that you can get the right diagnosis and treatment.

Topical antifungals are safe to use during pregnancy, but you won’t be able to take oral antifungal medications.

According to the Food and Drug Administration (FDA), oral fluconazole (Diflucan) taken during the first trimester of pregnancy may cause birth defects. A 2016 study also linked the use of oral fluconazole taken during pregnancy with an increased risk of miscarriage.

A mild yeast infection is expected to clear up in a few days to a week. Moderate to severe infections may take 2 to 3 weeks.

Can yeast infections go away on their own?

There’s a possibility that a yeast infection can go away on its own. The probability varies from person to person.

If you decide not to treat the infection, however, it might get worse. There’s also the possibility that you’ve misdiagnosed your condition, and what you thought was candidiasis was a more serious problem.

According to the Mayo Clinic, 75 percent of women will experience a vaginal yeast infection at some point in their lifetime.

The Department of Health and Human Services (HHS) indicates that about 5 percent of women will experience recurrent vulvovaginal candidiasis (RVVC). This is defined as four or more vaginal yeast infections in 1 year.

RVVC can occur in healthy women, but it’s more common in women with diabetes or weak immune systems from conditions such as HIV.

According to the HHS, about 66 percent of women who buy yeast infection medicine don’t actually have a yeast infection.

The symptoms may be caused by an allergic reaction or irritation due to sensitivity to tampons, soaps, powders, or perfume. Or they may have another vaginal infection, such as:

• bacterial vaginosis
• chlamydia
• gonorrhea
• trichomoniasis
• herpes

You should see a doctor if you’re not 100 percent sure that you have a yeast infection. They may diagnose you with a yeast infection, or they may discover a more serious condition.

If you’re treating what you think is a yeast infection without doctor diagnosis and it doesn’t clear up in a week or two, see a doctor. The medication you’re using may not be strong enough, or you may not have a yeast infection.

You should also visit a doctor if the infection returns in a couple of months. Having more than one yeast infection in a year could be an indication of an underlying medical condition.

Don’t put off seeing a doctor if your symptoms include:

• fever
• foul-smelling or yellow discharge
• bloody discharge
• back or stomach pain
• vomiting
• increased urination

Vaginal yeast infection should be properly diagnosed and treated. If left untreated, a yeast infection may lead to health problems, such as:

• skin infections
• fatigue
• oral thrush
• gastrointestinal problems
• invasive candidiasis

Diagnosis is a critical step, as the symptoms of a yeast infection are similar to more serious conditions, such as:

• bacterial vaginosis
• chlamydia
• gonorrhea

Doctor Myasnikov warned about the mortal danger of candidiasis

July 06, 2021
12:08

She is familiar to most women, they think they know how to recognize her, and are treated for thrush on their own. In children, it is called a jam and is also harassed with folk remedies. Meanwhile, a disease caused by a seemingly harmless fungal infection can become an insidious killer. This was discussed today in the program “About the Most Important” on the channel “Russia 1”.

Candidiasis is an infection caused by microscopic yeast-like fungi of the genus Candida. Their varieties – more than two hundred, of which 30 can cause problems in humans. Alexander Myasnikov spoke about the forms and causes of the development of pathology in the program “About the Most Important” on the channel “Russia 1”.

Half of the people have Candida in their gastrointestinal or genital tract, oral cavity, and this saprophyte does not manifest itself in any way. Until one of the triggers works – illness, stress, pregnancy, taking antibiotics. And then the fungal infection reveals itself.

Most women experience it in the urogenital form. Symptoms of vaginosis (the so-called thrush) are inflammation of the vagina, swelling, itching, pain, white discharge. At the same time, candidiasis is not classified as a sexually transmitted disease (virgins also suffer from it), and it is not required to treat a partner if he does not have symptoms.

Wearers of dentures experience constant dry mouth, children are faced with oral candidiasis, which is characterized by a white coating on the mucous membranes. In people with weakened immunity for various reasons, candidiasis can descend into the esophagus, cause pain, swallowing disorder.

However, candidiasis becomes really life-threatening in intensive care units of hospitals. There are often people with microflora, “scorched” by antibiotics, and at the same time with catheters. These devices become foci of infection. Therefore, each time the catheter is changed, its tip is cut off and sent to the laboratory for culture. Hospital candidiasis can affect the liver and kidneys. In this case, he turns into a killer, which is very difficult to deal with. The chances of dying from drugs against such candidiasis are 50 to 50.

In addition, a few years ago, Japanese scientists discovered candida aureus: it is resistant to all drugs and causes severe damage to internal organs. And if in 2016 the pathogen was found in only a few patients in Japan, now it is found in patients in more than 80 countries.

Risk factors for candidiasis

One of the main ones is diabetes and even just elevated blood glucose levels. The rest are:

– Childhood, adolescence and old age
– Strong stress
– Taking certain medications (antibiotics, estrogens, corticosteroids)
– Increased sweating due to hot weather and synthetic clothing
– Excessive use of intimate hygiene products
– Intrauterine devices
– Pregnancy
– Immunodeficiency
– Obesity
– Oncological diseases

And if candidiasis occurs four or more times a year, you can suspect a genetic predisposition to it.

Dr. Myasnikov warned women against self-treatment: the symptoms of thrush are such that it is easy to confuse it with other ailments, and studies have shown that only 11 out of 600 women have correctly diagnosed themselves. So do not rush to run to the pharmacy for candles – it is better to go to the doctor.

Even more interesting news – in our Instagram (banned in Russia) and Telegram channel @smotrim_ru .

health
Russia 1
candidiasis/thrush
society
news
medicine
Alexander Myasnikov
About health: programs and films

Scientists: thrush can cause schizophrenia and memory problems 05/04/2016

Scientists: thrush can cause schizophrenia and memory problems

Infection with the sexual or oral form of thrush may be associated with an increased chance of developing schizophrenia and manic-depressive psychosis, as well as lead to the development of memory problems.

2016-05-04T17:59

2016-05-04T17:59

2016-05-04T18:11

/html/head/meta[@name=’og:title’]/@content 90 003

/html/head/meta[@name=’og:description’]/@content

2 RIA Novosti

1

5

4. 7

96

P MIA “Russia Today”

https://xn--c1acbl2abdlkab1og.xn--p1ai/awards/

2016

RIA Novosti

1

5

4.7

96

[email protected]

7 495 645-6601

Rossiya Segodnya

https://xn--c1acbl2abdlkab1og.xn--p1ai/awards/

News

en-RU

https://ria.ru/docs/about/copyright.html

https://xn--c1acbl2abdlkab1og.xn--p1ai/

RIA Novosti

1

5

4.7

96

[email protected]

7 495 645-6601 90 Russia Today 3

96

[email protected]

7 495 645-6601

Rossiya Segodnya

https://xn--c1acbl2abdlkab1og.xn--p1ai/awards/

RIA Novosti

1

5

4.7

96

[email protected]

7 495 645-6601 90 Russia Today 0002 MOSCOW, May 4 – RIA Novosti. Infection with the sexual or oral form of thrush may be associated with an increased chance of developing schizophrenia and manic-depressive psychosis, as well as lead to the development of memory problems, say doctors who published an article in the journal npj Schizophrenia.

“Of course, it is too early to say that Candida can actually cause mental health problems, and vice versa. However, since these infections can be easily removed from the body, and therefore psychotherapists and psychiatrists should pay attention to whether their patients suffer from thrush,” said Emily Severance of John University and Hopkins in Baltimore (USA).

Severance and her colleagues uncovered this unusual connection between fungi and mental problems by studying several unusual cases of schizophrenia in which patients complained of sudden mental health problems after they contracted a particularly aggressive form of thrush.

These cases led scientists to the idea that infection with various fungi and microbes can lead to the development of a number of problems with the functioning of the brain and other components of the nervous system. They tested this hypothesis by comparing blood, microflora, and mucous membrane samples from several hundred healthy people and psychiatric patients suffering from schizophrenia or manic-depressive disorder.

Toxoplasma parasite can provoke suicide attempts – scientists

August 17, 2012, 13:58

Initially, scientists failed to establish links between Candida fungi and mental disorders, but when the authors of the article began to compare data only for men and women, the picture changed radically.

In particular, men were about twice as likely to suffer from this infection when they were schizophrenics. A similar picture, although less pronounced, was observed for carriers of manic-depressive psychosis.

Scientists: toxoplasmosis causes irreversible changes in brain function

September 19, 2013, 01:00

They forgot new information faster than other participants in the experiment who did not become infected with Candida.

Does this relationship really exist? As the authors of the article themselves believe, based on the recently discovered effects that the Toxoplasma parasite causes in the brain of humans and rodents, it really has a right to exist.