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Tamimi P, Fattahi M, Ghaderi A, Firooz A, Shirvani F, Alkhen A, Zamani S. Terbinafine-resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid-related tinea incognita patients. J Dtsch Dermatol Ges 2024; 22:922-934. [PMID: 38924688 DOI: 10.1111/ddg.15440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/26/2024] [Indexed: 06/28/2024]
Abstract
Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug-resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine-resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)-associated resistance mechanisms are evaluated. Lesions caused by terbinafine-resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high-level resistance. L393S was seen in isolates with low-resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics-based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
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Affiliation(s)
- Pegah Tamimi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Fattahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ghaderi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shayan Zamani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Liang C, Li J, Chen Y, Ke L, Zhu J, Zheng L, Li XP, Zhang S, Li H, Zhong GJ, Xu H. Self-Charging, Breathable, and Antibacterial Poly(lactic acid) Nanofibrous Air Filters by Surface Engineering of Ultrasmall Electroactive Nanohybrids. ACS APPLIED MATERIALS & INTERFACES 2023. [PMID: 38048182 DOI: 10.1021/acsami.3c13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Despite the great promise in the development of biodegradable and ecofriendly air filters by electrospinning of poly(lactic acid) (PLA) nanofibrous membranes (NFMs), the as-electrospun PLA nanofibers are generally characterized by poor electroactivity and smooth surface, challenging the exploitation of electrostatic adsorption and physical interception that are in need for efficient removal of pathogens and particulate matters (PMs). Herein, a combined "electrospinning-electrospray" strategy was disclosed to functionalize the PLA nanofibers by direct anchoring of highly dielectric BaTiO3@ZIF-8 nanohybrids (BTO@ZIF-8), conferring simultaneous promotion of surface roughness, electret properties (surface potential as high as 7.5 kV), and self-charging capability (∼190% increase in tribo-output voltage compared to that of pure PLA). Benefiting from the well-tailored morphology and increased electroactivity, the electrospun-electrosprayed PLA/BTO@ZIF-8 exhibited excellent PM-capturing performance (up to 96.54% for PM0.3 and 99.49% for PM2.5) while providing desirable air resistance (only 87 Pa at 32 L/min) due primarily to the slip flow of air molecules over the nanohybrid protrusions. This was accompanied by excellent antibacterial properties (99.9% inhibition against both Staphylococcus aureus and Escherichia coli), arising presumably from the synergistic effects of enhanced reactive oxygen species (ROS) generation, plentiful ion release, and surface charges. Our proposed strategy opens up pathways to afford exceptional combination of high-efficiency and low-resistance filtration, excellent antibacterial performance, and mechanical robustness without sacrificing the biodegradation profiles of PLA NFMs, holding potential implications for efficient and long-term healthcare.
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Affiliation(s)
- Chenyu Liang
- School of Safety Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Jiaqi Li
- School of Safety Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Yuyang Chen
- School of Safety Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Lv Ke
- School of Materials Science and Physics, China University of Mining and Technology, Xuzhou 221116, China
| | - Jintuo Zhu
- School of Safety Engineering, China University of Mining and Technology, Xuzhou 221116, China
- Jiangsu Engineering Research Center of Dust Control and Occupational Protection, Xuzhou 221008, China
| | - Lina Zheng
- School of Safety Engineering, China University of Mining and Technology, Xuzhou 221116, China
- Jiangsu Engineering Research Center of Dust Control and Occupational Protection, Xuzhou 221008, China
| | - Xiao-Peng Li
- State Key Laboratory of NBC Protection for Civilian, Institute of Chemical Defense, Beijing 100191, China
| | - Shenghui Zhang
- School of Materials Science and Physics, China University of Mining and Technology, Xuzhou 221116, China
| | - Heguo Li
- State Key Laboratory of NBC Protection for Civilian, Institute of Chemical Defense, Beijing 100191, China
| | - Gan-Ji Zhong
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Chengdu 610065, China
| | - Huan Xu
- School of Materials Science and Physics, China University of Mining and Technology, Xuzhou 221116, China
- Jiangsu Engineering Research Center of Dust Control and Occupational Protection, Xuzhou 221008, China
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Chengdu 610065, China
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Nenoff P, Stahl M, Schaller M, Burmester A, Monod M, Ebert A, Uhrlaß S. [Recurrent tinea corporis generalisata due to Terbinafine-resistant Trichophyton rubrum strain : Long-term treatment with super bioavailability itraconazole]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:864-873. [PMID: 37823916 DOI: 10.1007/s00105-023-05232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
For more than 30 years, an 82-year-old man has been suffering from tinea corporis generalisata in the sense of Trichophyton rubrum syndrome. The patient received long-term treatment with terbinafine. Fluconazole had no effect. There was an increase in liver enzymes with itraconazole. Super bioavailability (SUBA) itraconazole was initially not tolerated. A therapy attempt with voriconazole was successful, but was stopped due to side effects. The Trichophyton (T.) rubrum strain isolated from skin scales was tested for terbinafine resistance using the breakpoint method and found to be (still) sensitive. Sequencing of the squalene epoxidase (SQLE) gene revealed a previously unknown point mutation of the codon for isoleucine ATC→ACC with amino acid substitution I479T (isoleucine479 threonine). Long-term therapy with terbinafine 250 mg had been given every 3 days since 2018. In addition, bifonazole cream, ciclopirox solution, and occasionally terbinafine cream were used. The skin condition was stable until an exacerbation of the dermatophytosis in 2021. There were erythematosquamous, partly atrophic, centrifugal, scaly, confluent plaques on the integument and the extremities. Fingernails and toenails had white to yellow-brown discoloration, and were hyperkeratotic and totally dystrophic. T. rubrum was cultured from skin scales from the integument, from the feet, from nail shavings from the fingernails and also toenails and detected by PCR. In the breakpoint test, the T. rubrum isolates from tinea corporis and nail samples showed a minimum inhibitory concentration (MIC) of 0.5 µg ml-1 (terbinafine resistance in vitro). Sequencing of the SQLE gene of the T. rubrum isolate revealed evidence of a further point mutation that led to amino acid substitution I479V (isoleucine 479 valine). Long-term therapy was started with SUBA itraconazole: 14 days 2 × 1 capsule daily, then twice weekly administration of 2 × 50 mg. During breaks in therapy, the mycosis regularly flared up again. Finally, 50 mg SUBA itraconazole was given 5 days a week, which completely suppressed the dermatophytosis. Topically, ciclopirox and miconazole cream were used alternately. In conclusion, in the case of recurrent and therapy-refractory dermatophytoses caused by T. rubrum, terbinafine resistance must also be considered in individual cases. An in vitro resistance test and point mutation analysis of the squalene epoxidase gene confirms the diagnosis. Itraconazole, also in the form of SUBA itraconazole, is the drug of choice for the oral antifungal treatment of these patients.
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Affiliation(s)
- Pietro Nenoff
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
| | - Maren Stahl
- Hautärztin Dr. med. Maren Stahl, Osterode am Harz, Deutschland
| | | | - Anke Burmester
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Deutschland
| | - Michel Monod
- Dermatology Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Schweiz
| | - Andreas Ebert
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
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Blanchard G, Amarov B, Fratti M, Salamin K, Bontems O, Chang YT, Sabou AM, Künzle N, Monod M, Guenova E. Reliable and rapid identification of terbinafine resistance in dermatophytic nail and skin infections. J Eur Acad Dermatol Venereol 2023; 37:2080-2089. [PMID: 37319111 DOI: 10.1111/jdv.19253] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fungal infections are the most frequent dermatoses. The gold standard treatment for dermatophytosis is the squalene epoxidase (SQLE) inhibitor terbinafine. Pathogenic dermatophytes resistant to terbinafine are an emerging global threat. Here, we determine the proportion of resistant fungal skin infections, analyse the molecular mechanisms of terbinafine resistance, and validate a method for its reliable rapid identification. METHODS Between 2013 and 2021, we screened 5634 consecutively isolated Trichophyton for antifungal resistance determined by hyphal growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine. All Trichophyton isolates with preserved growth capacity in the presence of terbinafine underwent SQLE sequencing. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method. RESULTS Over an 8-year period, the proportion of fungal skin infections resistant to terbinafine increased from 0.63% in 2013 to 1.3% in 2021. Our routine phenotypic in vitro screening analysis identified 0.83% (n = 47/5634) of Trichophyton strains with in vitro terbinafine resistance. Molecular screening detected a mutation in the SQLE in all cases. Mutations L393F, L393S, F397L, F397I, F397V, Q408K, F415I, F415S, F415V, H440Y, or A398 A399 G400 deletion were detected in Trichophyton rubrum. Mutations L393F and F397L were the most frequent. In contrast, all mutations detected in T. mentagrophytes/T. interdigitale complex strains were F397L, except for one strain with L393S. All 47 strains featured significantly higher MICs than terbinafine-sensitive controls. The mutation-related range of MICs varied between 0.004 and 16.0 μg/mL, with MIC as low as 0.015 μg/mL conferring clinical resistance to standard terbinafine dosing. CONCLUSIONS Based on our data, we propose MIC of 0.015 μg/mL as a minimum breakpoint for predicting clinically relevant terbinafine treatment failure to standard oral dosing for dermatophyte infections. We further propose growth on Sabouraud dextrose agar medium containing 0.2 μg/mL terbinafine and SQLE sequencing as fungal sporulation-independent methods for rapid and reliable detection of terbinafine resistance.
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Affiliation(s)
- Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Boyko Amarov
- Institute of Statistics and Econometrics, Sofia University "St. Kliment Ohridski," Faculty of Economics and Business Administration, Sofia, Bulgaria
| | - Marina Fratti
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Karine Salamin
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Olympia Bontems
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Alina Marcela Sabou
- Laboratoire de Parasitologie et Mycologie Médicale, Plateau Technique de Microbiologie, University Hospital of Strasbourg, Strasbourg, France
| | | | - Michel Monod
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Dermatology, Hospital 12 de octubre, Medical School, University Complutense, Madrid, Spain
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Noguchi H, Matsumoto T, Kubo M, Kimura U, Hiruma M, Yaguchi T, Yamada T, Kano R. Dermatophytoma caused by terbinafine‐resistant
Trichophyton rubrum
treated with fosravuconazole. J Dermatol 2022; 49:e407-e408. [DOI: 10.1111/1346-8138.16480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Hiromitsu Noguchi
- Noguchi Dermatology Clinic Kumamoto Japan
- Ochanomizu Institute for Medical Mycology and Allergology Tokyo Japan
| | - Tadahiko Matsumoto
- Noguchi Dermatology Clinic Kumamoto Japan
- Ochanomizu Institute for Medical Mycology and Allergology Tokyo Japan
| | | | - Utako Kimura
- Department of Dermatology and Allergology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Masataro Hiruma
- Ochanomizu Institute for Medical Mycology and Allergology Tokyo Japan
| | - Takashi Yaguchi
- Division of Bio‐resources, Medical Mycology Research Center Chiba University Chiba Japan
| | - Tsuyoshi Yamada
- Teikyo University Institute of Medical Mycology (TIMM) Tokyo Japan
| | - Rui Kano
- Teikyo University Institute of Medical Mycology (TIMM) Tokyo Japan
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