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Inoue T, Watabe D, Tsunemi Y, Amano H. Outcome of fosravuconazole treatment for onychomycosis refractory to topical antifungal agents. J Dermatol 2023; 50:1014-1019. [PMID: 37157898 DOI: 10.1111/1346-8138.16824] [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: 02/17/2023] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
Fosravuconazole L-lysine ethanolate (F-RVCZ) is an oral antifungal agent approved in Japan for the treatment of onychomycosis. We treated 36 patients (mean age 77.6 years) with onychomycosis that had been refractory to long-term topical treatment. The patients took F-RVCZ (100 mg ravuconazole) once daily for a mean of 11.3 weeks, and were followed up for an average of 48 weeks (mean 48.3 ± 2.1 weeks). The mean rate of improvement of the affected nail area at 48 weeks was 59.4%, and 12 patients achieved complete cure. Patients with total dystrophic onychomycosis (TDO) showed a significantly lower improvement rate than those with distal and lateral subungual onychomycosis (DLSO), and those with an affected nail area of 76%-100% at the first visit showed a significantly lower improvement rate than those with an affected nail area of 0%-75%. Six patients had adverse events necessitating treatment discontinuation, but the symptoms and laboratory data improved without specific treatment in all of them. The data suggest that F-RVCZ would be effective in various age groups, including the elderly, and even in patients with onychomycosis refractory to long-term topical antifungal treatment. It was also suggested that its early use in mild cases might achieve a higher rate of complete cure. Furthermore, the average cost of oral F-RVCZ therapy was lower than that for topical antifungal agents. Therefore, F-RVCZ is considered to be much more cost-effective than topical antifungal agents.
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Affiliation(s)
- Tsuyoshi Inoue
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Daisuke Watabe
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Hiroo Amano
- Department of Dermatology, Iwate Medical University School of Medicine, Iwate, Japan
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First Terbinafine-Resistant Trichophyton indotineae Isolates with Phe 397Leu and/or Thr 414His Mutations in Turkey. Mycopathologia 2023; 188:2. [PMID: 36656402 DOI: 10.1007/s11046-023-00708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
Fungal infections of the skin, nails, and hair caused by dermatophyte species continue to be a worldwide concern. The increase in terbinafine-resistant superficial dermatophytosis has become a major concern over the last decade. In this report, we presented two cases of infection with terbinafine-resistant Trichophyton indotineae, the first diagnosis of this species in Turkey. One patient exhibited erythematous pruritic patches and plaques in the inguinal and gluteal regions, while the other patient showed annular erythematous scaly plaques in the bilateral posterior thigh and gluteal regions. One patient harbored a CD36 mutation. Both strains harbored the same amino acid substitution in the squalene epoxidase gene, whereas one isolate had another unknown mutation. Clinical improvement was observed with resveratrol treatment in the patient with the CD36 mutation but not in the other patient.
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Langfeldt A, Gold JAW, Chiller T. Emerging Fungal Infections: from the Fields to the Clinic, Resistant Aspergillus fumigatus and Dermatophyte Species: a One Health Perspective on an Urgent Public Health Problem. CURRENT CLINICAL MICROBIOLOGY REPORTS 2022; 9:46-51. [PMID: 36188157 PMCID: PMC9512973 DOI: 10.1007/s40588-022-00181-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review For this review, we use a One Health approach to examine two globally emerging public health threats related to antifungal drug resistance: triazole-resistant Aspergillus fumigatus infections, which can cause a life-threatening illness in immunocompromised hosts, and antifungal-resistant dermatophytosis, which is an aggressive skin infection caused by dermatophyte molds. We describe the state of current scientific knowledge and outline necessary public health actions to address each issue. Recent Findings Recent evidence has identified the agricultural use of triazole fungicides as an important driver of triazole-resistant A. fumigatus infections. Antifungal-resistant dermatophyte infections are likely driven by the inappropriate use of antifungal drugs and antibacterial and corticosteroid creams. Summary This review highlights the need for a One Health approach to address emerging antifungal resistant infections, emphasizing judicious antifungal use to preserve available treatments; strengthened laboratory capacity to identify antifungal resistance; and improved human, animal, and environmental surveillance to detect emerging resistance, monitor trends, and evaluate the effectiveness of efforts to decrease spread.
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Affiliation(s)
- Antonia Langfeldt
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
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Gnat S, Łagowski D, Dyląg M, Nowakiewicz A. European Hedgehogs (Erinaceus europaeus L.) as a Reservoir of Dermatophytes in Poland. MICROBIAL ECOLOGY 2022; 84:363-375. [PMID: 34536095 PMCID: PMC9436838 DOI: 10.1007/s00248-021-01866-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 05/02/2023]
Abstract
The European hedgehog (Erinaceus europaeus Linnaeus) frequently colonises areas located close to human life in cities, as these are more suitable nest sites offering an abundance of food and allowing avoidance of predators. However, urbanisation has a significant impact on the epidemiology of infectious diseases, including dermatophytoses, the primary source of which are wild animals. In this study, we determined the spectrum of dermatophytes isolated from the European hedgehog and assessed their susceptibility profile to antifungal drugs. Symptomatic and asymptomatic dermatophyte infections were observed in 7.7% and 8% of the 182 examined free-living hedgehogs, respectively. In the pool of the isolated dermatophyte strains, Trichophyton erinacei was dominant (29.9%), followed by Trichophyton mentagrophytes (17.9%), Trichophyton benhamiae (13.4%), Nannizzia gypsea (11.9%), Microsporum canis (10.4%), Nannizzia nana (7.5%), Paraphyton cookei (6.0%), and Nannizzia fulva (3.0%). Susceptibility tests revealed the highest activity of luliconazole and the lowest of activity fluconazole among the azole drugs applied. Although terbinafine generally exhibited high efficacy, two Trichophyton mentagrophytes isolates showed resistance to this drug (MIC = 2 µg/ml) resulting from missense mutations in the SQLE gene corresponding to the amino acid substitution Leu393Phe. Summarising, our study has also revealed that such wildlife animals as hedgehogs can be a reservoir of pathogenic human dermatophytes, including harmful strains resistant to commonly used antifungal drugs.
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Affiliation(s)
- Sebastian Gnat
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Dominik Łagowski
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Faculty of Biological Sciences, University of Wroclaw, Wroclaw, Poland
| | - Aneta Nowakiewicz
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
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5
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A deletion mutation in the amino acid sequence of squalene epoxidase in terbinafine-resistant Trichophyton rubrum. J Infect Chemother 2022; 28:741-744. [DOI: 10.1016/j.jiac.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022]
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6
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Rogers TR, Verweij PE, Castanheira M, Dannaoui E, White PL, Arendrup MC. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:2053-2073. [PMID: 35703391 PMCID: PMC9333407 DOI: 10.1093/jac/dkac161] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The increasing incidence and changing epidemiology of invasive fungal infections continue to present many challenges to their effective management. The repertoire of antifungal drugs available for treatment is still limited although there are new antifungals on the horizon. Successful treatment of invasive mycoses is dependent on a mix of pathogen-, host- and antifungal drug-related factors. Laboratories need to be adept at detection of fungal pathogens in clinical samples in order to effectively guide treatment by identifying isolates with acquired drug resistance. While there are international guidelines on how to conduct in vitro antifungal susceptibility testing, these are not performed as widely as for bacterial pathogens. Furthermore, fungi generally are recovered in cultures more slowly than bacteria, and often cannot be cultured in the laboratory. Therefore, non-culture-based methods, including molecular tests, to detect fungi in clinical specimens are increasingly important in patient management and are becoming more reliable as technology improves. Molecular methods can also be used for detection of target gene mutations or other mechanisms that predict antifungal drug resistance. This review addresses acquired antifungal drug resistance in the principal human fungal pathogens and describes known resistance mechanisms and what in-house and commercial tools are available for their detection. It is emphasized that this approach should be complementary to culture-based susceptibility testing, given the range of mutations, resistance mechanisms and target genes that may be present in clinical isolates, but may not be included in current molecular assays.
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Affiliation(s)
| | | | | | | | | | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Dellière S, Joannard B, Benderdouche M, Mingui A, Gits-Muselli M, Hamane S, Alanio A, Petit A, Gabison G, Bagot M, Bretagne S. Emergence of Difficult-to-Treat Tinea Corporis Caused by Trichophyton mentagrophytes Complex Isolates, Paris, France. Emerg Infect Dis 2022; 28:224-228. [PMID: 34932462 PMCID: PMC8714205 DOI: 10.3201/eid2801.210810] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We describe 7 cases of extensive tinea corporis since 2018 in a hospital in Paris, France, after failure to cure with terbinafine. Molecular analysis indicated Trichophyton mentagrophytes internal transcribed spacer type VIII (T. indotineae). This strain, which has mutations in the squalene epoxidase gene, is spreading on the Indian subcontinent.
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Affiliation(s)
| | | | - Mazouz Benderdouche
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Anselme Mingui
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Maud Gits-Muselli
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Samia Hamane
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Alexandre Alanio
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Antoine Petit
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Germaine Gabison
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Martine Bagot
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
| | - Stéphane Bretagne
- Hôpital Saint Louis Laboratoire de Parasitologie-Mycologie, Assistance Publique des Hôpitaux de Paris, Paris, France (S. Dellière, B. Joannard, M. Benderdouche, A. Mingui, M. Gits-Muselli, S. Hamane, A. Alanio, S. Bretagne)
- Université de Paris, Paris (S. Dellière, M. Gits-Muselli, A. Alanio, M. Bagot, S. Bretagne)
- Centre National de Référence Mycoses Invasives et Antifongiques Unité de Mycologie Moléculaire, Paris (A. Alanio, S. Bretagne)
- Hôpital Saint-Louis Service de Dermatologie, Assistance Publique des Hôpitaux de Paris, Paris (A. Petit, G. Gabison, M. Bagot); INSERM U976 (M. Bagot)
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Sacheli R, Hayette MP. Antifungal Resistance in Dermatophytes: Genetic Considerations, Clinical Presentations and Alternative Therapies. J Fungi (Basel) 2021; 7:jof7110983. [PMID: 34829270 PMCID: PMC8622014 DOI: 10.3390/jof7110983] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 01/05/2023] Open
Abstract
Numerous reports describe the emergence of resistance in dermatophytes, especially in T. rubrum and T. mentagrophytes/indotineae strains. We here present a review of the current status of resistance in dermatophytes worldwide. Resistance to terbinafine is mainly discussed, with different mutations found in the squalene epoxidase gene also considered. Resistance to azoles is also approached. Clinical presentations caused by resistant dermatophytes are presented, together with alternative therapies that help to better manage these kind of infections.
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Checkerboard Analysis To Evaluate Synergistic Combinations of Existing Antifungal Drugs and Propylene Glycol Monocaprylate in Isolates from Recalcitrant Tinea Corporis and Cruris Patients Harboring Squalene Epoxidase Gene Mutation. Antimicrob Agents Chemother 2021; 65:e0032121. [PMID: 34097482 DOI: 10.1128/aac.00321-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recalcitrant dermatophytic infections of the glabrous skin (tinea corporis/cruris/faciei) pose a huge challenge to health care systems. Combinations of oral and topical drugs may potentially improve cure rates, but the same has never been objectively assessed for this condition in laboratory or clinical studies. The present study was undertaken with the aim of identifying synergistic combinations of oral and topical antifungals by testing clinical isolates obtained from patients with recalcitrant tinea corporis/cruris. Forty-two patients with tinea corporis/cruris who had failed oral antifungals or had relapsed within 4 weeks of apparent clinical cure were recruited. Twenty-one isolates were identified by sequencing (all belonging to the Trichophyton mentagrophytes/T. interdigitale species complex) and subjected to antifungal susceptibility testing (AFST) and squalene epoxidase (SQLE) gene mutation analysis. Finally, five isolates, four with underlying SQLE gene mutations and one wild-type strain, were chosen for checkerboard studies using various combinations of antifungal agents. Most isolates (n = 16) showed high MICs of terbinafine (TRB) (0.5 to >16 μg/ml), with SQLE gene mutations being present in all isolates with MICs of ≥0.5 μg/ml. Synergistic interactions were noted with combinations of itraconazole with luliconazole, TRB, and ketoconazole and propylene glycol monocaprylate (PGMC) with luliconazole and with the triple combination of PGMC with luliconazole and ketoconazole. In vitro synergistic interactions provide a sound scientific basis for the possible clinical use of antifungal combinations. Hence, these synergistic combinations may be tested for clinical utility in the wake of rising resistance among dermatophytic infections of the glabrous skin.
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Antifungal Susceptibility and Mutations in the Squalene Epoxidase Gene in Dermatophytes of the Trichophyton mentagrophytes Species Complex. Antimicrob Agents Chemother 2021; 65:e0005621. [PMID: 33972254 PMCID: PMC8284460 DOI: 10.1128/aac.00056-21] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
During the past decade, a prolonged and serious outbreak of dermatophytosis due to a terbinafine-resistant novel species in the Trichophyton mentagrophytes-T. interdigitale complex has been ongoing in India, and it has spread to several European countries. The objective of this study was to investigate the molecular background of the squalene epoxidase (SQLE) gene in order to understand the risk of emergence and spread of multiresistance in dermatophytes. Antifungal susceptibility to fluconazole, griseofulvin, itraconazole, ketoconazole, miconazole, naftifine, sertaconazole, and terbinafine was tested in 135 isolates from India, China, Australia, Germany, and The Netherlands. Based on the latest taxonomic insights, strains were identified as three species: T. mentagrophytessensu stricto (n = 35), T. indotineae (n = 64, representing the Indian clone), and T. interdigitalesensu stricto (n = 36). High MICs of terbinafine (>16 mg/liter) were found in 34 (53%) T. indotineae isolates. These isolates showed an amino acid substitution in the 397th position of the SQLE gene. Elevated MICs of terbinafine (0.5 mg/liter) were noted in 2 (3%) T. indotineae isolates; these isolates lead to Phe415Val and Leu393Ser of the SQLE gene. The stability of the effect of the mutations was proven by serial transfer on drug-free medium. Lys276Asn and Leu419Phe substitutions were found in susceptible T. mentagrophytes strains. The Phe377Leu/Ala448Thr double mutant showed higher MIC values for triazoles. High MICs of terbinafine are as yet limited to T. indotineae and are unlikely to be distributed throughout the T. mentagrophytes species complex by genetic exchange.
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Ahmad Nasrollahi S, Fattahi A, Naeimifar A, Lotfali E, Firooz A, Khamesipoor A, Skandari SE, Miramin Mohammadi A. The in vitro effect of nanoliposomal amphotericin B against two clinically important dermatophytes. Int J Dermatol 2021; 61:383-389. [PMID: 34176127 DOI: 10.1111/ijd.15609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/23/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS The present study aimed to investigate the antifungal activity of amphotericin B-loaded nanoliposomes against Trichophyton interdigitale and Trichophyton rubrum. Moreover, it was attempted to assess the obtained resistance in vitro. METHODS In total, 29 archived clinical strains, namely, T. interdigitale (n = 16) and T. rubrum (n = 13), were included in this study. These strains were determined using a previous ITS1-ITS2 region sequence. Moreover, a liposomal formulation of amphotericin B was formulated by a thin-film hydration method. Particle size, polydispersity index (PdI), and zeta potential (ZP) were measured by a Zetasizer. Furthermore, physicochemical properties, such as appearance, aggregation of particles, particle size, PdI, and ZP, were determined at 0-, 1-, and 3-month intervals. A scanning electron microscope (SEM) was also used to examine nanoparticles structure. The minimum inhibitory concentration (MIC) of amphotericin B-loaded nanoliposomes, itraconazole, efinaconazole, terbinafine, and ciclopirox was determined according to the protocol of the broth microdilution method of CLSI M38-A2. The morphological changes of T. interdigitale and T. rubrum strains exposed to the amphotericin B-loaded nanoliposomes were observed using SEM. RESULTS The amphotericin B-loaded nanoliposomes displayed a lower MIC compared to those of the amphotericin B and liposomes when used separately. Based on the results, amphotericin B-loaded nanoliposomes induced no drug resistance in any of the tested strains. CONCLUSION Accordingly, amphotericin B-loaded nanoliposomes can be a potent antifungal for the topical treatment of onychomycosis. There was no in vitro evidence regarding the resistance of the tested strains to amphotericin B-loaded nanoliposomes. This reflects that amphotericin B-loaded nanoliposomes have a low probability to induce drug resistance in dermatophyte species.
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Affiliation(s)
- Saman Ahmad Nasrollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Naeimifar
- Pharmaceutical Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti 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
| | - Ali Khamesipoor
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ebrahim Skandari
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Miramin Mohammadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Shen JJ, Arendrup MC, Verma S, Saunte DML. The Emerging Terbinafine-Resistant Trichophyton Epidemic: What Is the Role of Antifungal Susceptibility Testing? Dermatology 2021; 238:60-79. [PMID: 34058736 DOI: 10.1159/000515290] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dermatophytosis is commonly encountered in the dermatological clinics. The main aetiological agents in dermatophytosis of skin and nails in humans are Trichophyton (T.) rubrum, T. mentagrophytes and T. interdigitale (former T. mentagrophytes-complex). Terbinafine therapy is usually effective in eradicating infections due to these species by inhibiting their squalene epoxidase (SQLE) enzyme, but increasing numbers of clinically resistant cases and mutations in the SQLE gene have been documented recently. Resistance to antimycotics is phenotypically determined by antifungal susceptibility testing (AFST). However, AFST is not routinely performed for dermatophytes and no breakpoints classifying isolates as susceptible or resistant are available, making it difficult to interpret the clinical impact of a minimal inhibitory concentration (MIC). SUMMARY PubMed was systematically searched for terbinafine susceptibility testing of dermatophytes on October 20, 2020, by two individual researchers. The inclusion criteria were in vitro terbinafine susceptibility testing of Trichophyton (T.) rubrum, T. mentagrophytes and T. interdigitale with the broth microdilution technique. The exclusion criteria were non-English written papers. Outcomes were reported as MIC range, geometric mean, modal MIC and MIC50 and MIC90 in which 50 or 90% of isolates were inhibited, respectively. The reported MICs ranged from <0.001 to >64 mg/L. The huge variation in MIC is partly explained by the heterogeneity of the Trichophyton isolates, where some originated from routine specimens (wild types) whereas others came from non-responding patients with a known SQLE gene mutation. Another reason for the great variation in MIC is the use of different AFST methods where MIC values are not directly comparable. High MICs were reported particularly in isolates with SQLE gene mutation. The following SQLE alterations were reported: F397L, L393F, L393S, H440Y, F393I, F393V, F415I, F415S, F415V, S443P, A448T, L335F/A448T, S395P/A448T, L393S/A448T, Q408L/A448T, F397L/A448T, I121M/V237I and H440Y/F484Y in terbinafine-resistant isolates.
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Affiliation(s)
- Julia J Shen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Maiken C Arendrup
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Shyam Verma
- 'Nirvan' and 'In skin' Clinics, Vadodara, India
| | - Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Siopi M, Efstathiou I, Theodoropoulos K, Pournaras S, Meletiadis J. Molecular Epidemiology and Antifungal Susceptibility of Trichophyton Isolates in Greece: Emergence of Terbinafine-Resistant Trichophytonmentagrophytes Type VIII Locally and Globally. J Fungi (Basel) 2021; 7:jof7060419. [PMID: 34072049 PMCID: PMC8229535 DOI: 10.3390/jof7060419] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023] Open
Abstract
Trichophyton isolates with reduced susceptibility to antifungals are now increasingly reported worldwide. We therefore studied the molecular epidemiology and the in vitro antifungal susceptibility patterns of Greek Trichophyton isolates over the last 10 years with the newly released EUCAST reference method for dermatophytes. Literature was reviewed to assess the global burden of antifungal resistance in Trichophyton spp. The in vitro susceptibility of 112 Trichophyton spp. molecularly identified clinical isolates (70 T. rubrum, 24 T. mentagrophytes, 12 T. interdigitale and 6 T. tonsurans) was tested against terbinafine, itraconazole, voriconazole and amorolfine (EUCAST E.DEF 11.0). Isolates were genotyped based on the internal transcribed spacer (ITS) sequences and the target gene squalene epoxidase (SQLE) was sequenced for isolates with reduced susceptibility to terbinafine. All T. rubrum, T. interdigitale and T. tonsurans isolates were classified as wild-type (WT) to all antifungals, whereas 9/24 (37.5%) T. mentagrophytes strains displayed elevated terbinafine MICs (0.25–8 mg/L) but not to azoles and amorolfine. All T. interdigitale isolates belonged to ITS Type II, while T. mentagrophytes isolates belonged to ITS Type III* (n = 11), VIII (n = 9) and VII (n = 4). All non-WT T. mentagrophytes isolates belonged to Indian Genotype VIII and harbored Leu393Ser (n = 5) and Phe397Leu (n = 4) SQLE mutations. Terbinafine resistance rates ranged globally from 0–44% for T. rubrum and 0–76% for T. interdigitale/T. mentagrophytes with strong endemicity. High incidence (37.5%) of terbinafine non-WT T. mentagrophytes isolates (all belonging to ITS Type VIII) without cross-resistance to other antifungals was found for the first time in Greece. This finding must alarm for susceptibility testing of dermatophytes at a local scale particularly in non-responding dermatophytoses.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Ioanna Efstathiou
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Konstantinos Theodoropoulos
- Second Department of Dermatology & Venereology, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece;
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (M.S.); (I.E.); (S.P.)
- Correspondence: ; Tel.: +30-210-583-1909; Fax: +30-210-532-6421
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14
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Singh A, Singh P, Dingemans G, Meis JF, Chowdhary A. Evaluation of DermaGenius ® resistance real-time polymerase chain reaction for rapid detection of terbinafine-resistant Trichophyton species. Mycoses 2021; 64:721-726. [PMID: 33760310 DOI: 10.1111/myc.13271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment-resistant dermatophytosis caused by Trichophyton mentagrophytes/interdigitale complex has emerged as a global public health threat, particularly in endemic countries like India and has spread to many other countries. This veritable spread is alarming due to increase in resistance to terbinafine, which targets the ergosterol biosynthetic pathway by inhibiting the enzyme squalene epoxidase (SQLE). About two third of studies worldwide have reported amino acid substitutions Phe397Leu and Leu393Phe in the SQLE protein to be responsible for high terbinafine MICs. OBJECTIVES We evaluated the efficacy of the newly developed DermaGenius® Resistance real-time PCR assay to rapidly identify Trichophyton isolates harbouring most common SQLE mutant (Phe397Leu and Leu393Phe) conferring high terbinafine resistance from wild-type susceptible isolates. METHODS A total of 97 Trichophyton isolates confirmed by ITS sequencing as T. mentagrophytes/interdigitale (recently named T. indotineae n = 90), T. rubrum/T. soudanense (n = 3), T mentagrophytes (n = 2) and T tonsurans (n = 2) were analysed to evaluate DermaGenius® Resistance real-time PCR assay. All 40 T. indotineae isolates exhibiting amino acid substitutions Phe397Leu or Leu393Phe identified by SQLE gene sequencing were evaluated for detection of non-wild-type strains by real-time PCR. Antifungal susceptibility testing for terbinafine was done by CLSI microbroth dilution method. RESULTS All terbinafine-resistant isolates harbouring amino acid substitutions Phe397Leu or Leu393Phe in SQLE gene were correctly recorded as SQLE mutants by the DermaGenius® Resistance real-time PCR assay. CONCLUSIONS The DermaGenius® Resistance real-time PCR assay effectively identified Trichophyton species and distinguished wild-type from SQLE mutant genotype that harbour Phe397Leu and Leu393Phe amino acid substitutions.
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Affiliation(s)
- Ashutosh Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
| | - Prerna Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
| | | | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, India
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15
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Gnat S, Dyląg M, Łagowski D, Zielinski J. Therapeutic efficacy of topically used luliconazole vs. terbinafine 1% creams. Mycoses 2021; 64:967-975. [PMID: 33884673 DOI: 10.1111/myc.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Dermatomycoses of zoophilic origin, especially those caused by Trichophyton mentagrophytes, often pose considerable therapeutic problems. This is reflected in the growing number of strains of this species with resistance to terbinafine caused by a mutation in the squalene epoxidase (SQLE) gene. Therefore, it is reasonable to look for alternative therapies to the commonly used terbinafine. The aim of the present study was to assess the in vivo effectiveness of topical therapy with luliconazole or terbinafine 1% cream. METHODS Therapeutic efficacy was assessed using direct examination in KOH with DMSO, qPCR analysis with pan-dermatophyte primers and culturing. Moreover, in vitro susceptibility tests for luliconazole and terbinafine were performed. RESULTS The results demonstrated significantly higher antifungal activity of luliconazole than terbinafine against dermatomycoses caused by T. mentagrophytes. The geometric mean of the MIC value for luliconazole against all T. mentagrophytes strains was 0.002 μg/ml, while this value for terbinafine was 0.004 μg/ml. In all studied cases, 28-day local therapy with luliconazole contributed to complete eradication of the aetiological agent of infection. CONCLUSIONS Given the increasingly frequent reports of difficult-to-treat dermatophytoses caused by zoophilic terbinafine-resistant strains, the 1% luliconazole cream can be alternative solution in topical therapy.
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Affiliation(s)
- Sebastian Gnat
- Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, Lublin, 20-033, Poland
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Institute of Genetics and Microbiology, Faculty of Biological Sciences, University of Wroclaw, Wroclaw, Poland
| | - Dominik Łagowski
- Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, Lublin, 20-033, Poland
| | - Jessica Zielinski
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, USA
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16
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Suzuki T, Sato T, Kasuya A, Yaguchi T. A Case of Tinea Faciei, Tinea Corporis, and Tinea Unguium with Dermatophytoma Successfully Treated with Oral Fosravuconazole L-lysine Ethanolate. Med Mycol J 2021; 62:1-4. [PMID: 33642522 DOI: 10.3314/mmj.20-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a 76-year-old Japanese male with tinea faciei, tinea corporis, and tinea unguium with dermatophytoma. We performed fungal culture and confirmed the causative fungus to be Trichophyton rubrum. We treated the patient using oral fosravuconazole l-lysine ethanolate (F-RVCZ). More than one year has passed since the end of treatment, but there has been no recurrence. This case suggests that F-RVCZ is effective for tinea other than tinea unguium.
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Affiliation(s)
- Tomohiro Suzuki
- Department of Dermatology, Teikyo University Chiba Medical Center
| | - Tomotaka Sato
- Department of Dermatology, Teikyo University Chiba Medical Center
| | - Akiko Kasuya
- Office of Clinical Laboratory Technology, Keio University Hospital
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17
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The Growing Problem of Antifungal Resistance in Onychomycosis and Other Superficial Mycoses. Am J Clin Dermatol 2021; 22:149-157. [PMID: 33354740 DOI: 10.1007/s40257-020-00580-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/06/2023]
Abstract
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.
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18
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Gnat S, Łagowski D, Nowakiewicz A, Dyląg M, Osińska M. Complementary effect of mechanism of multidrug resistance in Trichophyton mentagrophytes isolated from human dermatophytoses of animal origin. Mycoses 2021; 64:537-549. [PMID: 33448025 DOI: 10.1111/myc.13242] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dermatophytoses have gained interest worldwide due to the increased resistance to terbinafine and azoles and difficulty in management of these refractory diseases. OBJECTIVES In this study, we identified and analysed Trichophyton mentagrophytes clinical isolates obtained from humans with infections of animal origin. METHODS We used quantitative real-time PCR (qRT-PCR) to examine the transcriptional modulation of three MDR genes (PDR1, MDR2 and MDR4) and analysed squalene epoxidase (SQLE) gene sequences from multidrug-resistant Trichophyton mentagrophytes isolates. RESULTS The expression profile revealed a 2- to 12-fold increase in mRNA accumulation in the presence of any of the antifungals, compared to cells incubated without drugs. A statistically significant relationship between the isolates exposed to itraconazole and increased expression of the tested genes was revealed. Substantially lower transcription levels were noted for cells exposed to luliconazole, that is, a third-generation azole. Additionally, in the case of 50% of terbinafine-resistant strains, Leu397Phe substitution in the SQLE gene was detected. Furthermore, the reduced susceptibility to itraconazole and voriconazole was overcome by milbemycin oxime. CONCLUSIONS In conclusion, our study shed more light on the role of the ABC transporter family in T. mentagrophytes, which, if overexpressed, can confer resistance to single azole drugs and even cross-resistance. Finally, milbemycin oxime could be an interesting compound supporting treatment with azole drugs in the case of refractory dermatomycoses.
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Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Dominik Łagowski
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - Mariusz Dyląg
- Faculty of Biological Sciences, Department of Mycology and Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
| | - Marcelina Osińska
- Faculty of Veterinary Medicine, Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
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Hiruma J, Noguchi H, Hase M, Tokuhisa Y, Shimizu T, Ogawa T, Hiruma M, Harada K, Kano R. Epidemiological study of terbinafine-resistant dermatophytes isolated from Japanese patients. J Dermatol 2021; 48:564-567. [PMID: 33439506 DOI: 10.1111/1346-8138.15745] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022]
Abstract
Terbinafine (TRF) has been used in the treatment of fungal infections for more than 20 years. Recently, TRF-resistant Trichophyton interdigitale and T. rubrum strains have been isolated from human patients worldwide. However, an epidemiological study of TRF-resistant strains in Japanese patients has not been investigated. In the present study, antifungal susceptibility testing was performed on clinical isolates from Japanese patients to assess TRF-resistance patterns of T. interdigitale and T. rubrum strains. We also sequenced the squalene epoxidase (SQLE) encoding gene of TRF-resistant T. rubrum strains. Two hundred and ten T. interdigitale and T. rubrum clinical isolates were obtained from 210 human cases of tinea pedis, tinea corporis, tinea unguium, tinea cruris, tinea manuum, tinea faciei and tinea capitis in Tokyo, Saitama, Chiba, Hyogo and Kumamoto, Japan, in 2020. Five T. rubrum isolates (N74, N79, N99, H30 and K2) grew on Sabouraud's dextrose agar (SDA) containing 1 mg/L of TRF. All five strains exhibited TRF minimum inhibitory concentrations (MICs) ≥32 mg/L but remained susceptible to azoles. We determined SQLE sequences in these TRF-resistant T. rubrum strains and found that all strains harbored missense mutations (L393F) in the SQLE-encoding gene.
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Affiliation(s)
- Junichiro Hiruma
- Department of Dermatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiromitsu Noguchi
- Noguchi Dermatology Clinic, Kamimashiki-gun, Kumamoto, Japan.,Ochanomizu Institute for Medical Mycology and Allergology, Toshima-ku, Tokyo, Japan
| | - Midori Hase
- Ochanomizu Institute for Medical Mycology and Allergology, Toshima-ku, Tokyo, Japan
| | - Yumie Tokuhisa
- Sakurayama Dermatology Clinic, Shimonoseki-shi, Yamaguchi, Japan
| | | | - Takasuke Ogawa
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Masataro Hiruma
- Ochanomizu Institute for Medical Mycology and Allergology, Toshima-ku, Tokyo, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Rui Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, Fujisawa, Kanagawa, Japan
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20
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Łagowski D, Gnat S, Nowakiewicz A, Osińska M, Dyląg M. Intrinsic resistance to terbinafine among human and animal isolates of Trichophyton mentagrophytes related to amino acid substitution in the squalene epoxidase. Infection 2020; 48:889-897. [PMID: 32770418 PMCID: PMC7674369 DOI: 10.1007/s15010-020-01498-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dermatomycoses are the most common fungal infections in the world affecting a significant part of the human and animal population. The majority of zoophilic infections in humans are caused by Trichophyton mentagrophytes. Currently, the first-line drug for both oral and topical therapy is terbinafine. However, an increasing number of cases that are difficult to be cured with this drug have been noted in Europe and Asia. Resistance to terbinafine and other allylamines is very rare and usually correlated with point mutations in the squalene epoxidase gene resulting in single amino acid substitutions in the enzyme, which is crucial in the ergosterol synthesis pathway. PURPOSE Here, we report terbinafine-resistant T. mentagrophytes isolates among which one was an etiological factor of tinea capitis in a man and three were obtained from asymptomatic foxes in Poland. METHODS We used the CLSI protocol to determine antifungal susceptibility profiles of naftifine, amphotericin B, griseofulvin, ketoconazole, miconazole, itraconazole, voriconazole, and ciclopirox. Moreover, the squalene epoxidase gene of the terbinafine-resistant strains was sequenced and analysed. RESULTS In the genomes of all four resistant strains exhibiting elevated MICs to terbinafine (16 to 32 µg/ml), single-point mutations leading to Leu393Phe substitution in the squalene epoxidase enzyme were revealed. Among the other tested substances, a MIC50 value of 1 µg/ml was shown only for griseofulvin. CONCLUSION Finally, our study revealed that the terbinafine resistance phenomenon might not be acquired by exposure to the drug but can be intrinsic. This is evidenced by the description of the terbinafine-resistant strains isolated from the asymptomatic animals.
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Affiliation(s)
- Dominik Łagowski
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Sebastian Gnat
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Aneta Nowakiewicz
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Marcelina Osińska
- Department of Veterinary Microbiology, Faculty of Veterinary Medicine, Institute of Preclinical Veterinary Sciences, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Faculty of Biological Sciences, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland
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21
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Skin Fungal Infections in Children: Diagnostic Challenges. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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Fattahi A, Shirvani F, Ayatollahi A, Rezaei-Matehkolaei A, Badali H, Lotfali E, Ghasemi R, Pourpak Z, Firooz A. Multidrug-resistant Trichophyton mentagrophytes genotype VIII in an Iranian family with generalized dermatophytosis: report of four cases and review of literature. Int J Dermatol 2020; 60:686-692. [PMID: 33047849 DOI: 10.1111/ijd.15226] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/22/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The global spread of terbinafine-resistant Trichophyton mentagrophytes with point mutations in the squalene epoxidase (SQLE) gene is a big concern. AIM The present study presents a series of unusual familial cases of generalized dermatophytosis caused by multidrug-resistant T. mentagrophytes genotype VIII. METHODS Initially, the skin samples of each patient were taken and then subjected to direct microscopy and culture in Mycosel Agar. The molecular identification of Trichophyton species (spp.) was performed for all family members. In addition, the immunologic tests were requested, and an antifungal susceptibility test was carried out using the broth microdilution protocol based on the Clinical and Laboratory Standards Institute M38, third edition. The SQLE gene for a terbinafine-resistant T. mentagrophytes genotype VIII was sequenced and confirmed its nucleotide sequence to KU242352 as a susceptible strain. RESULTS Based on the results of mycological examination and ITS rDNA sequencing, the etiologic agent was identified as T. mentagrophytes as a zoophilic dermatophyte. This species showed multiple drug resistance in vitro against terbinafine (minimum inhibitory concentration (MICs ≥8 µg/ml), itraconazole (MIC ≥4), and fluconazole (MIC ≥16). The SQLE gene of the isolate was subjected to sequencing for mutation, which showed a point mutation as TTC/TTA in the gene leading to Phe397Leu amino acid substitution in the enzyme. Only one of the family members responded to itraconazole and was cured after the long-term use of itraconazole. Other family members were treated with oral voriconazole with no recurrence. CONCLUSION The transmission of this resistant T. mentagrophytes to other countries due to globalization is a serious issue to be considered.
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Affiliation(s)
- Azam Fattahi
- 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
| | - Azin Ayatollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ensieh Lotfali
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Ghasemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Pourpak
- Immunology Asthma & Allergy Research Institute, 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
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Pumival P, Tadtong S, Athikomkulchai S, Chittasupho C. Antifungal Activity and the Chemical and Physical Stability of Microemulsions Containing Citrus hystrix DC Leaf Oil. Nat Prod Commun 2020. [DOI: 10.1177/1934578x20957755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Citrus hystrix DC (kaffir lime) leaf oil exhibited antifungal activities against Aspergillus niger and Candida albicans. This study aimed to evaluate the antifungal activity of kaffir lime leaf oil and microemulsions containing kaffir lime oil against Trichophyton mentagrophytes var. interdigitale. The chemical components of kaffir lime leaf oil were analyzed by gas chromatography coupled with mass spectrometry. Microemulsions containing kaffir lime oil were formulated using Tween 80, propylene glycol, and water using a phase titration method. The microemulsion of kaffir lime leaf oil was evaluated for droplet size, polydispersity index, and zeta potential using a dynamic light scattering technique. The antifungal activities of kaffir lime oil and its microemulsion were investigated through macrodilution and agar well diffusion methods, respectively. The degradation of citronellal in the microemulsion was analyzed by validated UV-Visible spectrophotometry. The minimum inhibitory concentration value of kaffir lime oil was 1.08 ± 0.00 mg/mL. The microemulsion of kaffir lime leaf oil exhibited potent antifungal activity against T. mentagrophytes var. interdigitale. The size, polydispersity index, and zeta potential of freshly prepared microemulsion were 12.82 ± 0.40 nm, 0.183 ± 0.072, and −7.87 ± 0.06 mV, respectively. The microemulsion of kaffir lime leaf oil also demonstrated good physical and chemical stability at specific temperatures. The kaffir lime oil microemulsion was highly stable when stored at 4 °C and 30 °C for 1 month but was unstable at 45 °C. The microemulsion of kaffir lime leaf oil may be an alternative therapeutic against tinea pedis caused by T. mentagrophytes var. interdigitale.
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Affiliation(s)
- Piyapong Pumival
- Faculty of Pharmacy, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | - Sarin Tadtong
- Faculty of Pharmacy, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | | | - Chuda Chittasupho
- Faculty of Pharmacy, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai, Thailand
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24
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Gnat S, Łagowski D, Nowakiewicz A, Osińska M, Kopiński Ł. Population differentiation, antifungal susceptibility, and host range of Trichophyton mentagrophytes isolates causing recalcitrant infections in humans and animals. Eur J Clin Microbiol Infect Dis 2020; 39:2099-2113. [PMID: 32607909 PMCID: PMC7561545 DOI: 10.1007/s10096-020-03952-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/10/2020] [Indexed: 02/05/2023]
Abstract
The major problems in determining the causative factors of the high prevalence of dermatophytoses include the lack of a well-standardized antifungal susceptibility testing method, the low consistency of in vitro and clinical minimal inhibitory concentration values, the high genomic diversity of the population, and the unclear mechanism of pathogenicity. These factors are of particular importance when the disease is recalcitrant and relapses. Herein, we identified and characterized Trichophyton mentagrophytes isolates obtained from therapy-resistant cases in humans and animals. We used genomic diversity analysis of 17 human and 27 animal clinical isolates with the MP-PCR technique, determined their phenotypic enzymatic activity and host range, and performed antifungal susceptibility testing to currently available antifungal drugs from various chemical groups. Genomic diversity values of 35.3% and 33.3% were obtained for clinical isolates from humans and animals, respectively, yet without any relationship to the host species or antifungal drug to which resistance in therapy was revealed. The highest activity of keratinase enzymes was recorded for fox, guinea pig, and human hairs. These hosts can be considered as the main species in the host range of these isolates. A phenyl morpholine derivative, i.e. amorolfine, exhibited superior activity against strains obtained from both humans and animals with the lowest MIC50. Interestingly, high compliance of terbinafine in vitro resistance with clinical problems in the treatment with this substance was shown as well. The high resistance of dermatophytes to drugs is the main cause of the recalcitrance of the infection, whereas the other features of the fungus are less important.
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Affiliation(s)
- Sebastian Gnat
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Dominik Łagowski
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland.
| | - Aneta Nowakiewicz
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Marcelina Osińska
- Faculty of Veterinary Medicine, Institute of Biological Bases of Animal Diseases, Department of Veterinary Microbiology, University of Life Sciences, Akademicka 12, 20-033, Lublin, Poland
| | - Łukasz Kopiński
- Faculty of Agrobioengineering, Department of Management and Marketing, University of Life Sciences, Dobrzanskiego 37, 20-626, Lublin, Poland
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25
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Kano R, Kimura U, Kakurai M, Hiruma J, Kamata H, Suga Y, Harada K. Trichophyton indotineae sp. nov.: A New Highly Terbinafine-Resistant Anthropophilic Dermatophyte Species. Mycopathologia 2020; 185:947-958. [PMID: 32449054 DOI: 10.1007/s11046-020-00455-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
In this report, we describe the first isolation of two highly terbinafine (TRF)-resistant Trichophyton interdigitale-like strains from a Nepali patient and an Indian patient with tinea corporis in Japan. These strains (designated NUBS19006 and NUBS19007) exhibited a TRF minimal inhibitory concentration (MIC) of > 32 mg/L and contained a missense mutation (Phe397Leu) in squalene epoxidase (SQLE) gene. The internal transcribed spacer (ITS) region sequences amplified from the isolates (NUBS19006 and NUBS19007) were 99.5% identical to Japanese isolates of T. interdigitale and T. interdigitale strain CBS 428.63. The homology of region sequences were also 97.6% identical to T. mentagrophytes strain CBS 318.56. Moreover, the ITS sequences amplified from the isolates were 100% identical to highly TRF-resistant strains of T. interdigitale, which were isolated in Delhi, India, and harbored mutations in SQLE. The urease test on Christensen's urease agar was positive for T. mentagrophytes and T. interdigitale after 7 days of incubation. On the other hand, the type strain of T. rubrum CBS 100081 T and highly TRF-resistant strains (NUBS19006 and NUBS19007) were negative on Christensen urease agar after 7 and 14 days of incubation. Moreover, NUBS19006 and NUBS19007 were also negative reaction on the hair perforation test. To avoid confusion in the taxonomy of the T. mentagrophytes/T. interdigitale complex, we suggest that the highly TRF-resistant Indian strains be considered a new species independent of T. interdigitale, according to clinical and mycological features.
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Affiliation(s)
- Rui Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan.
| | - Utako Kimura
- Department of Dermatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Maki Kakurai
- Kakurai Dermatology Clinic, 905-1, Ojima, Shimotsuma, Ibaraki, 304-0051, Japan
| | - Junichiro Hiruma
- Department of Dermatology, Tokyo Medical University, 6-1-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hiroshi Kamata
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences, 1866 Kameino, Fujisawa, Kanagawa, 252-0880, Japan
| | - Yasushi Suga
- Department of Dermatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, 6-1-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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26
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Shamsizadeh F, Pchelin IM, Makimura K, Alshahni MM, Satoh K, Katiraee F, Ahmadi B, Rezaei-Matehhkolaei A. DNA topoisomerase 2 gene polymorphism in dermatophytes. Mycoses 2020; 63:694-703. [PMID: 32277529 DOI: 10.1111/myc.13086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dermatophytes are a group of keratinophilic fungi of medical importance. Despite a relatively long history of molecular taxonomic studies, there is still a need for information on genetic polymorphism in wider variety of genomic loci. OBJECTIVES Our goal was to study partial DNA topoisomerase 2 gene (TOP2) polymorphism in dermatophytes. METHODS We performed DNA sequencing of TOP2 in 26 dermatophyte species along with ribosomal internal transcribed spacer (ITS) sequencing. RESULTS The number of polymorphic sites in TOP2 data set was similar to that one in ITS data set. Nannizzia species formed paraphyletic group in TOP2 tree. Trichophyton simii was paraphyletic in concatenated TOP2-ITS tree, one of its two clades contained solely Iranian isolates. CONCLUSIONS Our results revealed several unresolved problems in the taxonomy of dermatophytes, including probable polyphyly of the genus Nannizzia and the species T simii.
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Affiliation(s)
- Forough Shamsizadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ivan M Pchelin
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
| | - Koichi Makimura
- Laboratory of Medical Mycology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Mohamed Mahdi Alshahni
- Laboratory of Medical Mycology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Kazuo Satoh
- Laboratory of Medical Mycology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
| | - Farzad Katiraee
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Rezaei-Matehhkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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27
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Taghipour S, Shamsizadeh F, Pchelin IM, Rezaei-Matehhkolaei A, Zarei Mahmoudabadi A, Valadan R, Ansari S, Katiraee F, Pakshir K, Zomorodian K, Abastabar M. Emergence of Terbinafine Resistant Trichophyton mentagrophytes in Iran, Harboring Mutations in the Squalene Epoxidase ( SQLE) Gene. Infect Drug Resist 2020; 13:845-850. [PMID: 32214830 PMCID: PMC7078656 DOI: 10.2147/idr.s246025] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction Trichophyton mentagrophytes and T. interdigitale are important causative agents of superficial mycoses, demonstrating emergent antifungal drug resistance. We studied the antifungal susceptibility profiles in Iranian isolates of these two species. Methods A total of 96 T. interdigitale and 45 T. mentagrophytes isolates were subjected to molecular typing by ribosomal ITS region. Antifungal susceptibility profiles for terbinafine, griseofulvin, clotrimazole, efinaconazole, luliconazole, amorolfine and ciclopirox were obtained by CLSI broth microdilution method. The squalene epoxidase (SQLE) gene was subjected to sequencing for mutations, if any, in isolates exhibiting elevated MICs for terbinafine. Results Luliconazole and efinaconazole showed the lowest MIC values against T. mentagrophytes and T. interdigitale isolates. There were five isolates with terbinafine MICs ≥32 µg/mL in our sample. They belonged to T. mentagrophytes type VIII and harbored two alternative SQLE gene sequence variants, leading to Phe397Leu and Ala448Thr or Leu393Ser and Ala448Thr substitutions in the enzyme. All terbinafine resistant strains could be inhibited by luliconazole and efinaconazole. Conclusion This study documented a step in the global spread of resistance mechanisms in T. mentagrophytes. However, treatment alternatives for resistant isolates were available.
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Affiliation(s)
- Simin Taghipour
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Forough Shamsizadeh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ivan M Pchelin
- Kashkin Research Institute of Medical Mycology, North-Western State Medical University Named After I.I. Mechnikov, Saint Petersburg, Russia
| | - Ali Rezaei-Matehhkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Zarei Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Valadan
- Molecular and Cell Biology Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saham Ansari
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Katiraee
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Keyvan Pakshir
- Basic Sciences in Infectious Diseases Research Center, Parasitology & Mycology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Basic Sciences in Infectious Diseases Research Center, Parasitology & Mycology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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28
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Kimura U, Hiruma M, Kano R, Matsumoto T, Noguchi H, Takamori K, Suga Y. Caution and warning: Arrival of terbinafine‐resistant
Trichophyton interdigitale
of the Indian genotype, isolated from extensive dermatophytosis, in Japan. J Dermatol 2020; 47:e192-e193. [DOI: 10.1111/1346-8138.15300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Utako Kimura
- Department of Dermatology Juntendo University Urayasu Hospital Urayasu Japan
- Ochanomizu Institute for Medical Mycology and Allergology Toshima Japan
| | - Masataro Hiruma
- Ochanomizu Institute for Medical Mycology and Allergology Toshima Japan
| | - Rui Kano
- Department of Veterinary Pathobiology Nihon University College of Bioresource Sciences Fujisawa Japan
| | - Tadahiko Matsumoto
- Ochanomizu Institute for Medical Mycology and Allergology Toshima Japan
- Noguchi Dermatology Clinic Kumamoto Japan
| | - Hiromitsu Noguchi
- Ochanomizu Institute for Medical Mycology and Allergology Toshima Japan
- Noguchi Dermatology Clinic Kumamoto Japan
| | - Kenji Takamori
- Department of Dermatology Juntendo University Urayasu Hospital Urayasu Japan
| | - Yasushi Suga
- Department of Dermatology Juntendo University Urayasu Hospital Urayasu Japan
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29
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Kakurai M, Harada K, Maeda T, Hiruma J, Kano R, Demitsu T. Case of tinea corporis due to terbinafine-resistant Trichophyton interdigitale. J Dermatol 2020; 47:e104-e105. [PMID: 31994232 DOI: 10.1111/1346-8138.15243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maki Kakurai
- Kakurai Dermatology Clinic, Ibaraki, Japan.,Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazutoshi Harada
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Tatsuo Maeda
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Junichiro Hiruma
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Rui Kano
- Department of Veterinary Pathobiology, Nihon University College of Bioresource Sciences, Kanagawa, Japan
| | - Toshio Demitsu
- Department of Dermatology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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30
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Kano R, Hiruma J, Yokota M, Noguchi H, Hase M, Kamata H, Harada K, Hiruma M. In Vitro Ravuconazole Susceptibility of Anthropophilic Dermatophyte Strains Isolated from Japanese Patients. Jpn J Infect Dis 2019; 73:250-252. [PMID: 31875604 DOI: 10.7883/yoken.jjid.2019.265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ravuconazole (RVCZ) is a new human anti-fungal azole drug available in Japan since 2018 and is a broad-spectrum agent that exhibits excellent activity against dermatophytes. In the present study, the in vitro RVCZ susceptibility of clinical isolates of anthropophilic dermatophytes, including Trichophyton interdigitale strains with either low susceptibility to itraconazole (ITCZ) or resistance to terbinafine (TEBR), was investigated using the Clinical & Laboratory Standards Institute M38-A2 test. The MICs of RCVZ for 20 clinical isolates of T. interdigitale were < 0.03125-0.125 mg/L; for 4 clinical isolates of T. rubrum, < 0.03125-0.0625 mg/L; and for 20 clinical isolates of T. tonsurans, < 0.03125 mg/L. Similarly, the MICs of RCVZ for the T. interdigitale strains with either low susceptibility to ITCZ or resistance to TEBR were also < 0.03125 mg/L. To our knowledge, this is first study to investigate the in vitro RVCZ susceptibility of T. interdigitale strains with either low susceptibility to ITCZ or resistance to TEBR. Our results indicated that RVCZ was the most effective drug against these strains.
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Affiliation(s)
- Rui Kano
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences
| | | | - Maki Yokota
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences
| | - Hiromitsu Noguchi
- Noguchi Dermatology Clinic.,Ochanomizu Institute for Medical Mycology and Allergology
| | - Midori Hase
- Ochanomizu Institute for Medical Mycology and Allergology
| | - Hiroshi Kamata
- Department of Veterinary Dermatology, Nihon University College of Bioresource Sciences
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31
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Antifungal resistance in dermatophytes: Emerging problem and challenge for the medical community. J Mycol Med 2019; 29:283-284. [DOI: 10.1016/j.mycmed.2019.100913] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Indexed: 11/18/2022]
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32
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Saunte DML, Hare RK, Jørgensen KM, Jørgensen R, Deleuran M, Zachariae CO, Thomsen SF, Bjørnskov-Halkier L, Kofoed K, Arendrup MC. Emerging Terbinafine Resistance in Trichophyton: Clinical Characteristics, Squalene Epoxidase Gene Mutations, and a Reliable EUCAST Method for Detection. Antimicrob Agents Chemother 2019; 63:e01126-19. [PMID: 31383665 PMCID: PMC6761549 DOI: 10.1128/aac.01126-19] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/28/2019] [Indexed: 11/20/2022] Open
Abstract
In recent years, cases involving terbinafine-resistant Trichophyton isolates have been reported increasingly, particularly in India. We present 14 cases of terbinafine treatment failure in Trichophyton-infected Danish patients due to acquired resistance. Patients infected with Trichophyton rubrum (n = 12) or Trichophyton interdigitale (n = 2) with elevated terbinafine MICs during 2013-2018 were included. Antifungal susceptibility testing (AFST) was performed following a modified EUCAST E.Def 9.3.1 method (5 days of incubation) with or without cycloheximide and chloramphenicol (CC) supplementation of the growth medium. The squalene epoxidase (SE) target gene was sequenced, and 3-dimensional enzyme homology modeling was performed. Most patients (12/14 [86%]) were male. The mean age was 53.5 years (range, 11 to 77 years). The mean duration of infections was 4.8 years at the time of resistance detection. Prior systemic terbinafine treatment was documented for all patients, and topical therapy for 62% (information was missing in one case). Overall, nine isolates (64%) displayed high terbinafine resistance (MICs, 4 to >8 mg/liter), while two (14%) displayed moderate (MICs, 1 to 2 mg/liter) and three (21%) displayed low (MICs, 0.125 to 0.25 mg/liter) terbinafine resistance compared with control isolates. MICs generated with or without CC supplementation were similar, but CC prevented contamination. Known and novel SE amino acid substitutions (F397L, L393F, L393S, F415S, H440Y F484Y, and I121M V237I) were detected in resistant but not control isolates. Three-dimensional homology modeling suggested a role of the novel I121M and V237I alterations. Terbinafine resistance has been detected in Denmark using a modified EUCAST method, which facilitated susceptibility testing of dermatophytes. Action is needed for this emerging public health problem.
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Affiliation(s)
- Ditte M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus K Hare
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Karin M Jørgensen
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - René Jørgensen
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Mette Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus O Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Simon F Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristian Kofoed
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Maiken C Arendrup
- Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
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33
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Noguchi H, Matsumoto T, Hiruma M, Kimura U, Kano R, Yaguchi T, Fukushima S, Ihn H. Tinea unguium caused by terbinafine‐resistant
Trichophyton rubrum
successfully treated with fosravuconazole. J Dermatol 2019; 46:e446-e447. [DOI: 10.1111/1346-8138.15033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiromitsu Noguchi
- Noguchi Dermatology Clinic KumamotoJapan
- Ochanomizu Institute for Medical Mycology and Allergology TokyoJapan
| | - Tadahiko Matsumoto
- Noguchi Dermatology Clinic KumamotoJapan
- Ochanomizu Institute for Medical Mycology and Allergology TokyoJapan
| | - Masataro Hiruma
- Ochanomizu Institute for Medical Mycology and Allergology TokyoJapan
| | - Utako Kimura
- Department of Dermatology Juntendo University Urayasu Hospital ChibaJapan
| | - Rui Kano
- Department of Veterinary Pathobiology Nihon University College of Bioresource Sciences KanagawaJapan
| | - Takashi Yaguchi
- Division of Bio‐resources Medical Mycology Research Center Chiba University ChibaJapan
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery Faculty of Life Sciences Kumamoto University Kumamoto Japan
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