Healthcare professionals are alerted to the emergence of highly contagious fungal infections, such as ringworm and eczema, with two recent studies highlighting cases resistant to standard treatments. The first study reports a sexually transmitted fungal infection, TMVII, which has been difficult to treat and slow to resolve, but responds to typical antifungal medications. The second study focuses on a different fungus, T. indotineae, which is often resistant to conventional treatments but has shown some responsiveness to an alternative drug, itraconazole, despite its potential side effects. Researchers emphasize the importance of recognizing atypical presentations of these infections to avoid misdiagnosis and inadequate treatment.
Healthcare professionals are alerted to emerging and highly contagious fungal infections, including sexually transmitted and drug-resistant strains, which may be misdiagnosed due to their atypical presentation.
Health care providers should be vigilant for emerging and highly infectious types of ringworm and itch, which pose a potential public health risk according to two reports.
In the first of the studies, experts from NYU Langone Health, who focus on the spread of contagious rashes, document the first reported case in the United States of a sexually transmitted fungal infection that can take months to clear even with a treatment. In the second report, NYU Langone doctors teamed up with officials from the New York State Department of Health to describe the nation’s largest group of patients with a similar fungal strain that is resistant to standard therapies.
Characteristics of fungal infections
Both
” data-gt-translate-attributes=”({“attribute”:”data-cmtooltip”, “format”:”html”})” tabindex=”0″ role=”link”>species Fungi are part of a group that causes skin rashes, or ringworm, that spread easily to the face and limbs (ringworm), groin (itch), and feet (athlete’s foot). However, the ringworm explored in the new reports may be very different from the clear, regular circles seen in most forms of ringworm. They can instead be confused with lesions caused by
” data-gt-translate-attributes=”({“attribute”:”data-cmtooltip”, “format”:”html”})” tabindex=”0″ role=”link”>eczema and therefore can go without appropriate treatment for months.
The first report, published online June 5 in the journal JAMA Dermatology, describes a man in his thirties who developed ringworm on his penis, buttocks, and limbs after returning to New York from a trip to England, Greece, and California. Genetic testing of fungal samples taken from the patient’s rashes revealed that the infection was caused by the species Trichophyton mentagrophytes type VII (TMVII). This form of sexually transmitted ringworm is increasingly being diagnosed across Europe, with 13 cases reported in France in 2023, mostly in men who have sex with men. Notably, the man participating in the current study reported having sex with several male partners during his travels, none of whom reported similar skin problems.
Advice from healthcare experts
“Healthcare providers should be aware that Trichophyton mentagrophytes type VII is the latest in a group of serious skin infections to reach the United States,” said lead study author and dermatologist Avrom Caplan. , MD. Caplan is an assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine.
“As patients are often reluctant to discuss genital issues, doctors should directly ask about rashes around the groin and buttocks, especially for those who are sexually active, have recently traveled abroad and report itchy areas elsewhere on the body,” the study leader added. author John Zampella, MD.
Zampella, an associate professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman, says that although infections caused by TMVII are difficult to treat and can take months to resolve, they so far appear to respond to standard antifungal therapies such as terbinafine.
Meanwhile, Caplan says the new skin condition explored in his other new report presents a greater challenge for dermatologists. The study results, published online in May in JAMA Dermatology, focuses on Trichophyton indotineae (T. indotineae), which is widespread in India and is now reported worldwide. First confirmed in the United States last year, the infection causes itchy, contagious rashes similar to TMVII, but is often resistant to treatment with terbinafine.
Results of drug resistance study
To better understand how T. indotineae can evade antifungal medications, researchers collected clinical and laboratory data from 11 men and women treated for ringworm in New York City hospitals between May 2022 and May 2023. It Their ringworm was confirmed to be caused by T. indotinaceae. Seven of the patients had received standard doses of terbinafine for a period ranging from 14 days (the usual duration for most forms of ringworm) to 42 days, but their rashes did not improve.
Analyze fungal samples
” data-gt-translate-attributes=”({“attribute”:”data-cmtooltip”, “format”:”html”})” tabindex=”0″ role=”link”>DNA, the team reported several variations in the genetic code (mutations) that prevent terbinafine from latching onto fungal cells and punching holes in their protective membranes. According to the study authors, these mutations could explain why treatment often fails in some cases to fight infections.
The results also showed that when seven patients were treated with another antifungal drug called itraconazole, three recovered completely and two improved. However, according to Caplan, the problem with this therapy is that, while effective, the drug can interfere with many medications and cause nausea, diarrhea and other side effects that make it difficult to use for long periods of time.
“These results offer new insights into how certain fungal skin infections spreading from South Asia may evade our therapies of choice,” Caplan said. “Beyond learning to recognize their misleading signs, doctors will need to ensure that their treatment meets the quality of life needs of each patient.”
Caplan adds that he plans to work with leading mushroom experts in the United States and internationally in the coming months to expand research efforts and track emerging cases.
Researchers caution that while dermatologists should be alert for signs of TMVII and T. indotineae in their patients, rates so far remain low in the United States.
References: “Potential Sexual Transmission of Tinea Pubogenitalis From TMVII” by Avrom S. Caplan, Michelle Sikora, Arianna Strome, Christine C. Akoh, Caitlin Otto, Sudha Chaturvedi and John G. Zampella, June 5, 2024, JAMA Dermatology.
DOI: 10.1001/jamadermatol.2024.1430
“Clinical course, antifungal susceptibility, and genomic sequencing of Trichophyton indotineae” by Avrom S. Caplan, Gabrielle C. Todd, YanChun Zhu, Michelle Sikora, Christine C. Akoh, Jeannette Jakus, Shari R. Lipner, Kayla Babbush, Karen P. Acker, Ayana E. Morales, Rebecca M. Marrero Rolón, Lars F. Westblade, Maira Fonseca, Abigail Cline, Jeremy AW Gold, Shawn R. Lockhart, Dallas J. Smith, Tom Chiller, William G. Greendyke, Swati R. Manjari , Nilesh K. Banavali and Sudha Chaturvedi, May 15, 2024, JAMA Dermatology.
DOI: 10.1001/jamadermatol.2024.1126
Funding for the study was provided by NYU Langone.