<i>Notes from the Field:</i> First Reported U.S. Cases of Tinea Caused by <i>Trichophyton indotineae —</i> New York City, December 2021–March 2023

Caplan, Arthur; Chaturvedi, Sudha; Zhu, YanChun; Todd, Gabrielle C.; Yin, Li; Lopez, Adriana; Travis, Lisa deMena; Smith, Dallas; Chiller, Tom; Lockhart, Shawn R.; Alroy, Karen A.; Greendyke, William; Gold, Jeremy A W

doi:10.15585/mmwr.mm7219a4

Cited by 28 publications

(30 citation statements)

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“…Although reports of resistance to these drugs were relatively rare in the early 2000s, reports from around the globe of resistance among Trichophyton species have since become increasingly common. Reported rates of Trichophyton resistance to these drugs in clinical isolates from patients with fungal infections including onychomycosis, published mostly between 2017 and 2023, are presented in Figure 2, highlighting both the global spread and regional variability in rates of antifungal resistance 7,9,19,21–41 …”

Section: Resistance To Common Oral Antifungal Agents Among Trichophyt...mentioning

confidence: 99%

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole—the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes—has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug–drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real‐world long‐term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.

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Section: Resistance To Common Oral Antifungal Agents Among Trichophyt...mentioning

confidence: 99%

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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“…2 The diagnosis is confirmed by genetic sequencing of the ITS region in specialized laboratories. 2 The current patient initiated treatment with itraconazole, 100 mg, twice daily. 1,4 On follow-up 3 weeks after presentation, he reported an improvement in the pruritus and scaling.…”

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confidence: 99%

“…Trichophyton indotineae , also known as Trichophyton mentagrophytes ITS genotype VIII, is a newly identified dermatophyte mold that has been associated with a near epidemic level of chronic, refractory, and severe dermatophyte infections in areas of South Asia . It is now reported globally . Infections can be followed by widespread, highly pruritic, scaly, and erythematous plaques of tinea corporis, cruris, or facei .…”

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confidence: 99%

“…As with the current patient, travel history should be gathered and suspicion raised when patients present with widespread, inflamed, or atypical appearing plaques of tinea, especially when they were refractory to first-line or second-line therapies. Morphologic overlap among dermatophytes leads to potential misidentification of T indotineae on culture results as T mentagrophytes or Trichophyton interdigitale . The diagnosis is confirmed by genetic sequencing of the ITS region in specialized laboratories …”

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confidence: 99%

“…Morphologic overlap among dermatophytes leads to potential misidentification of T indotineae on culture results as T mentagrophytes or Trichophyton interdigitale . The diagnosis is confirmed by genetic sequencing of the ITS region in specialized laboratories …”

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Trichophyton mentagrophytes Internal Transcribed Spacer Genotype VIII

2023

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Resistant Trichophyton indotineae Dermatophytosis—An Emerging Pandemic, Now in the US

Bui,

Katz

2024

JAMA Dermatol

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Fungus is finding 15 minutes of fame.A variant Ophiocordyceps unilateralis, a real-life fungus, took a fictional star turn in 2023 as the culprit behind a civilization-threatening zombie pandemic in HBO's blockbuster series, The Last of Us. Increasing infections with Candida auris-a fungus resistant to many antifungal medicines, often acquired in health care settings, and frequently fatal-have prompted the US Centers for Disease Control and Prevention (CDC) to label that fungus a "serious global health threat." 1 Psilocybin, the psychoactive substance found in magic mushrooms, is gaining attention for its potential to treat depression and other psychiatric conditions. 2 And now: Trichophyton indotineae. This dermatophyte is, almost literally, on steroids; experts have linked its emergence to inappropriate use of combination topical products containing antifungals and high-potenc y corticosteroids. [3][4][5] First described as a unique species in the past decade, 6 T indotineae (previously called Trichophyton mentagrophytes genotype VIII) has caused outbreaks of tinea-often extensive, pruritic, and frequently resistant to first-line antifungalsprimarily in South Asia but also in Europe, Canada, Australia, and Asia. 4,5 The first 3 cases of T indotineae dermatophytosis in the US were reported in 2023, 7,8 and a fourth casepossibly sexually transmitted-was reported in 2024. 9 A case series in this issue of JAMA Dermatology describes 11 more T indotineae infections in New York City from May 2022 to May 2023. 10 The case series included 5 female and 6 male patients, with a median (range) age of 39 (8-64) years. Only 1 was immunocompromised and had untreated lymphoma. Nine had traveled to Bangladesh within 2 years prior to rash onset; 4 of those patients also had contact with a family member or partner with T indotineae infection. One patient had neither traveled internationally nor had contact with an infected person, to their knowledge. Epidemiologic exposures were not available for 1 patient.All patients experienced widespread rash, most commonly involving the trunk, extremities, groin, and buttocks; 2 patients had facial involvement. Nine patients reported pruritus.Delays in diagnosis were substantial, with a median (range) of 10 (3-42) months. Prior to diagnosis, 6 patients were treated with topical corticosteroids, including 2 with combination antifungal-corticosteroid topicals. All patients unsuccessfully tried treatment with at least 1 topical antifungal medicine. Except for 1 patient who was initially treated with itraconazole, all patients were unsuccessfully treated with at least

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Notes from the Field: First Reported U.S. Cases of Tinea Caused by Trichophyton indotineae — New York City, December 2021–March 2023

Cited by 28 publications

References 5 publications

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Trichophyton mentagrophytes Internal Transcribed Spacer Genotype VIII

Resistant Trichophyton indotineae Dermatophytosis—An Emerging Pandemic, Now in the US

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