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Gupta AK, Wang T, Mann A, Polla Ravi S, Talukder M, Lincoln SA, Foreman HC, Kaplan B, Galili E, Piguet V, Shemer A, Bakotic WL. Antifungal resistance in dermatophytes - review of the epidemiology, diagnostic challenges and treatment strategies for managing Trichophyton indotineae infections. Expert Rev Anti Infect Ther 2024:1-13. [PMID: 39114868 DOI: 10.1080/14787210.2024.2390629] [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: 06/03/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
INTRODUCTION There is an increasing number of reports of Trichophyton indotineae infections. This species is usually poorly responsive to terbinafine. AREAS COVERED A literature search was conducted in May 2024. T.indotineae infections detected outside the Indian subcontinent are generally associated with international travel. Reports of local spread are mounting.As a newly identified dermatophyte species closely related to the T. mentagrophytes complex with limited genetic and phenotypic differences, there is an unmet need to develop molecular diagnosis for T. indotineae. Terbinafine has become less effective as a first-line agent attributed to mutations in the squalene epoxidase gene (Leu393Phe, Phe397Leu). Alternative therapies include itraconazole for a longer time-period or a higher dose (200 mg/day or higher). Generally, fluconazole and griseofulvin are not effective. In some cases, especially when the area of involvement is relatively small, topical non-allylamine antifungals may be an option either as monotherapy or in combination with oral therapy. In instances when the patient relapses after apparent clinical cure then itraconazole may be considered. Good antifungal stewardship should be considered at all times. EXPERT OPINION When both terbinafine and itraconazole are ineffective, options include off-label triazoles (voriconazole and posaconazole). We present four patients responding to these newer triazoles.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mediprobe Research Inc., London, ON, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, ON, Canada
| | | | | | - Mesbah Talukder
- Mediprobe Research Inc., London, ON, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | | | | | - Baruch Kaplan
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Avner Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hoffmann LC, Reinholz M, French LE, Sárdy M, Wollenberg A, Kerschnitzki A, Horváth ON. Epidemiological overview of mucocutaneous fungal infections in Munich. J Dtsch Dermatol Ges 2024. [PMID: 39097945 DOI: 10.1111/ddg.15484] [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: 12/14/2023] [Accepted: 05/07/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Knowledge about the current spectrum of dermatomycoses is important for diagnosis and therapy. PATIENTS AND METHODS A retrospective, monocentric analysis of mucocutaneous fungal infections diagnosed at a large European academic dermatology department in Munich was conducted; 87,229 samples from 48,916 patients from January 1, 2011, to August 30, 2020, were included. RESULTS Fungi were detected in 11,513 samples from 48,916 (23.54%), and 36 different species were identified. Candida (C.) albicans was the most common pathogen (5,055 detections; 43.91% of all positive samples), followed by Trichophyton (T.) rubrum (3,076 detections; 26.72% of all positive samples) and Candida parapsilosis (923 detections; 8.02% of all positive samples). Rare pathogens such as Trichophyton raubitschekii were also detected. Coinfections with multiple species were detected in 44 cases. CONCLUSIONS Even though C. albicans, T. rubrum, and C. parapsilosis were confirmed as the most common pathogens, rare pathogens should also be considered in clinical practice. The predominant spectrum of fungi differed from that reported in other countries. Furthermore, a difference in the pathogen spectrum could be observed depending on the age group and body site.
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Affiliation(s)
- Liv C Hoffmann
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
| | - Markus Reinholz
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Miklós Sárdy
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Department of Dermatology and Allergy, University Hospital Augsburg (UKA), Augsburg, Germany
| | | | - Orsolya N Horváth
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
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Khurana A, Sharath S, Sardana K, Chowdhary A. Clinico-mycological and therapeutic updates on cutaneous dermatophytic infections in the era of Trichophyton indotineae. J Am Acad Dermatol 2024; 91:315-323. [PMID: 38574764 DOI: 10.1016/j.jaad.2024.03.024] [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: 11/12/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
Trichophyton indotineae has emerged as a novel dermatophyte species resulting in treatment recalcitrant skin infections. While the earliest reports came from India, T. indotineae has now spread to many parts of the world and is rapidly becoming a global health concern. Accurate identification of T. indotineae requires elaborate mycological investigations which is beyond the domain of routine microbiology testing. Extensive, non-inflammatory and atypical presentations are commonly seen with this novel species. T. indotineae shows an alarmingly high rate of mutations in the squalene epoxidase gene leading to lowered in vitro susceptibility to terbinafine. This has also translated into a lowered clinical response and requirement of a higher dose and much longer durations of treatment with the drug. Although the species remains largely susceptible to itraconazole, prolonged treatment durations are required to achieve cure with itraconazole. Fluconazole and griseofulvin do not have satisfactory in vitro or clinical activity. Apart from requirement of prolonged treatment durations, relapse postsuccessful treatment is a distressing and yet unexplained consequence of this "species-shift." Use of third generation azoles and combinations of systemic antifungals is unwarranted as both have not demonstrated clear superiority over itraconazole given alone, and the former is an important class of drugs for invasive mycoses.
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Affiliation(s)
- Ananta Khurana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.
| | - Savitha Sharath
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
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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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Sonego B, Corio A, Mazzoletti V, Zerbato V, Benini A, di Meo N, Zalaudek I, Stinco G, Errichetti E, Zelin E. Trichophyton indotineae, an Emerging Drug-Resistant Dermatophyte: A Review of the Treatment Options. J Clin Med 2024; 13:3558. [PMID: 38930086 PMCID: PMC11204959 DOI: 10.3390/jcm13123558] [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: 05/11/2024] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae, a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae, elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae, identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1-12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Andrea Corio
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Vanessa Mazzoletti
- Institute of Dermatology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy;
| | - Alessandro Benini
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, 34125 Trieste, Italy; (B.S.); (A.C.); (A.B.); (N.d.M.); (I.Z.)
| | - Giuseppe Stinco
- Institute of Dermatology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.S.); (E.E.)
| | - Enzo Errichetti
- Institute of Dermatology, Department of Medicine, University of Udine, 33100 Udine, Italy; (G.S.); (E.E.)
| | - Enrico Zelin
- Institute of Dermatology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
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Haghani I, Babaie M, Hoseinnejad A, Rezaei-Matehkolaei A, Mofarrah R, Yahyazadeh Z, Kermani F, Javidnia J, Shokohi T, Azish M, Kamyab Hesari K, Saeedi M, Ghasemi Z, Khojasteh S, Hajheydari Z, Mosayebi E, Valadan R, Seyedmousavi S, Abastabar M, Hedayati MT. High Prevalence of Terbinafine Resistance Among Trichophyton mentagrophytes/T. interdigitale Species Complex, a Cross-Sectional Study from 2021 to 2022 in Northern Parts of Iran. Mycopathologia 2024; 189:52. [PMID: 38864945 DOI: 10.1007/s11046-024-00855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024]
Abstract
Treatment-resistant dermatophytosis caused by the members of the Trichophyton mentagrophytes/Trichophyton interdigitale species group (TMTISG) is increasing worldwide. We aimed to determine the prevalence of TMTISG in patients with dermatophytosis in two centers from north of Iran and detect the possible mutations in the squalene epoxidase (SQLE) gene in relevant terbinafine (TRB) resistant pathogenic isolates. From November 2021 to December 2022, 1960 patients suspected to dermatophytosis and referred to two mycology referral laboratories in the north of Iran were included in the study. Identification of all dermatophyte isolates was confirmed by RFLP of rDNA internal transcribed spacer (ITS) regions. Antifungal susceptibility testing against five common antifungals using the CLSI-M38-A3 protocol was performed. The TMTISG isolates resistant to TRB, were further analyzed to determine the possible mutations in the SQLE gene. Totally, 647 cases (33%) were positive for dermatophytosis of which 280 cases (43.3%) were identified as members of TMTISG. These were more frequently isolated from tinea corporis 131 (44.56%) and tinea cruris 116 (39.46%). Of 280 TMTISG isolates, 40 (14.3%) were resistant to TRB (MIC ≥ 4 µg/mL), all found to be T. indotineae in ITS sequencing. In SQLE sequencing 34 (85%) of TRB-resistant isolates had coincident mutations of Phe397Leu and Ala448Thr whereas four and two isolates had single mutations of Phe397Leu and Leu393Ser, respectively. Overall, the resistance of Iranian TMTISG isolates to TRB greatly occurred by a mutation of Phe397Leu in the SQLE gene as alone or in combination with Ala448Thr. Nevertheless, for the occurrence of in vitro resistance, only the presence of Phe397Leu mutation seems to be decisive.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Babaie
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hoseinnejad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ramin Mofarrah
- Department of Dermatology, Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Zahra Yahyazadeh
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Department of Parasitology and Mycology, Infectious Diseases and Tropical Medicine Research Center, Health Research Center, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Azish
- Department of Parasitology and Medical Mycology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Kambiz Kamyab Hesari
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Ghasemi
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Khojasteh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Zohreh Hajheydari
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Mosayebi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Valadan
- Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedmojtaba Seyedmousavi
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Gupta AK, Polla Ravi S, Wang T, Bakotic WL, Shemer A. Mapping the Global Spread of T. indotineae: An Update on Antifungal Resistance, Mutations, and Strategies for Effective Management. Mycopathologia 2024; 189:45. [PMID: 38734753 DOI: 10.1007/s11046-024-00856-z] [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: 01/09/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies. METHODS A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction. RESULTS AND DISCUSSION A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing. CONCLUSION Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada.
| | - Shruthi Polla Ravi
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | - Tong Wang
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | | | - Avner Shemer
- Department of Dermatology, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
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Tamimi P, Fattahi M, Firooz A, Ghaderi A, Ayatollahi A, Nasiri Kashani M, Alkhen A. Recalcitrant dermatophyte infections: identification and risk factors. Int J Dermatol 2024. [PMID: 38712801 DOI: 10.1111/ijd.17145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Recalcitrant dermatophytosis is an emerging phenomenon that occurs worldwide, and Trichophyton indotineae is currently the prominent cause. MATERIALS AND METHODS Skin specimens from patients with tinea infection were obtained by scrubbing and then sectioned into three fragments. Two fragments were subjected to direct microscopic examination and culture, while the third portion was utilized in the PCR method. RESULTS Isolates were morphologically identified as Trichophyton mentagrophytes/interdigitale complex (n = 60 [83.33%]), Microsporum canis (n = 8 [11.11%]), Trichophyton rubrum (n = 3 [4.16%]), and Epidermophyton floccosum (n = 1 [1.38%]). Among 60 T. mentagrophytes complex isolates, 53 (88.33%) were classified as T. indotineae and seven as T. interdigitale genotype II. The disease duration was longer in the T. indotineae group (P = 0.035). Both Gradient PCR and skin-sampling methods yield similar results in terms of positive and negative cases (P = 1.0000). The time patients stopped their medication did not impact the positive case numbers (P = 0.803). Gender had no effects on the frequency (P = 0.699). Familial contamination, dermatologic disorder, and other underlying conditions did not differ in the two group infections (P > 0.05). Steroid usage is strongly associated with the emergence of tinea infection (P < 0.04). The duration of antifungal administration had a substantial effect on the emergence of resistant organisms (P = 0.05). CONCLUSIONS Steroid usage, T. indotineae involvement, and prolonged exposure to antifungals were the solid and influential factors in recalcitrant involvement. Regarding quick and suitable diagnosis and treatment, which is essential in preventing recalcitrant cases, we suggest that direct skin sample PCR can meet the demands.
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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
- 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
| | - Aliasghar Ghaderi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran 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
| | - Mansour Nasiri Kashani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Hill RC, Caplan AS, Elewski B, Gold JAW, Lockhart SR, Smith DJ, Lipner SR. Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance. Am J Clin Dermatol 2024; 25:359-389. [PMID: 38494575 PMCID: PMC11201321 DOI: 10.1007/s40257-024-00848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.
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Affiliation(s)
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy A W Gold
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shawn R Lockhart
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Dallas J Smith
- Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
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Hui ST, Gifford H, Rhodes J. Emerging Antifungal Resistance in Fungal Pathogens. CURRENT CLINICAL MICROBIOLOGY REPORTS 2024; 11:43-50. [PMID: 38725545 PMCID: PMC11076205 DOI: 10.1007/s40588-024-00219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 05/12/2024]
Abstract
Purpose of Review Over recent decades, the number of outbreaks caused by fungi has increased for humans, plants (including important crop species) and animals. Yet this problem is compounded by emerging antifungal drug resistance in pathogenic species. Resistance develops over time when fungi are exposed to drugs either in the patient or in the environment. Recent Findings Novel resistant variants of fungal pathogens that were previously susceptible are evolving (such as Aspergillus fumigatus) as well as newly emerging fungal species that are displaying antifungal resistance profiles (e.g. Candida auris and Trichophyton indotineae). Summary This review highlights the important topic of emerging antifungal resistance in fungal pathogens and how it evolved, as well as how this relates to a growing public health burden.
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Affiliation(s)
- Sui Ting Hui
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Hugh Gifford
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Johanna Rhodes
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Department of Medical Microbiology, Radboudumc, the Netherlands
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11
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Oliveira TF, Valeriano CAT, Buonafina-Paz MDS, Souza-Motta CM, Machado AR, Neves RP, Bezerra JDP, Arantes TD, de Hoog S, Magalhães OMC. Molecular Verification of Trichophyton in the Brazilian URM Culture Collection. Mycopathologia 2024; 189:2. [PMID: 38217794 DOI: 10.1007/s11046-023-00811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 01/15/2024]
Abstract
Trichophyton species cause dermatophytosis in humans, with a high, worldwide frequency of reports and important public health relevance. We evaluated 61 Trichophyton strains from different sources deposited in the University Recife Mycology (URM) culture collection of the Universidade Federal de Pernambuco, Brazil. Strains were phenotypically identified and confirmed by sequencing Internal Transcribed Spacers rDNA and partial beta-tubulin 2-exon. Additionally, we evaluated their susceptibility to terbinafine and itraconazole. Physiological analyses included urease activity and growth in casein medium. Phenotypic methods allowed the reliable identification of T. rubrum only, whereas, for other species, molecular methods were mandatory. All Trichophyton species exhibited susceptibility profiles to itraconazole (0.04-5.33 μg/mL) and terbinafine (0.17-3.33 μg/mL). Our analyses revealed a heterogeneous distribution of T. mentagrophytes, which does not support the current distribution within the species complex of T. mentagrophytes and its genotypes.
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Affiliation(s)
- Tatiana F Oliveira
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Carlos A T Valeriano
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - M Daniela S Buonafina-Paz
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Cristina M Souza-Motta
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Alexandre R Machado
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Rejane P Neves
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Jadson D P Bezerra
- Laboratório de Micologia (LabMicol), Departamento de Biociências e Tecnologia, Instituto de Patologia Tropical e Saúde Pública (IPTSP), Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
| | - Thales D Arantes
- Laboratório de Micologia (LabMicol), Departamento de Biociências e Tecnologia, Instituto de Patologia Tropical e Saúde Pública (IPTSP), Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Sybren de Hoog
- Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Oliane M C Magalhães
- Departamento de Micologia Prof. Chaves Batista, Universidade Federal de Pernambuco, Recife, PE, Brazil
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12
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Song G, Kong X, Li X, Liu W, Liang G. Prior selection of itraconazole in the treatment of recalcitrant Trichophyton indotineae infection: Real-world results from retrospective analysis. Mycoses 2024; 67:e13663. [PMID: 37882456 DOI: 10.1111/myc.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The number of terbinafine-resistant Trichophyton indotineae is increasing in recent years while the treatment is still a matter to discuss. OBJECTIVES To explore the best therapeutic approach, we present real-world treatment of T. indotineae infection by analysing publicly available data. METHODS We have reviewed all published articles, mainly including case reports and case series, on the drug-resistant T. mentagrophytes complex by using the key search terms to search the databases. RESULTS We enrolled 25 articles from 14 countries, including 203 times of treatment information for 113 patients. The cure rate of itraconazole 200 mg per day at the fourth, eighth and the twelfth week were 27.27%, 48.48% and 54.55%, respectively, which was significantly higher than terbinafine 250 mg per day (8.77%, 24.56% and 28.07%) and even 500 mg/d terbinafine. Griseofulvin 500-1000 mg for 2-6 months may be effective while fluconazole had no record of successful treatment. Voriconazole and ravuconazole had potential therapeutic efficacy. Topical therapy alone showed limited therapeutic efficacy, but the combination with oral antifungals can be alternative. CONCLUSION Oral itraconazole 200 mg per day for 4-8 weeks was the most effective treatment out of these commonly used antifungal drugs, and can be prior selection.
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Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xue Kong
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xiaofang Li
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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13
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Gupta AK, Elewski B, Joseph WS, Lipner SR, Daniel CR, Tosti A, Guenin E, Ghannoum M. Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents. Mycoses 2024; 67:e13683. [PMID: 38214375 DOI: 10.1111/myc.13683] [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: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole-the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes-has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug-drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real-world long-term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Boni Elewski
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Warren S Joseph
- Arizona College of Podiatric Medicine, Midwestern University, Glendale, Arizona, USA
| | | | - C Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Eric Guenin
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, New Jersey, USA
| | - Mahmoud Ghannoum
- Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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14
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Lockhart SR, Chowdhary A, Gold JAW. The rapid emergence of antifungal-resistant human-pathogenic fungi. Nat Rev Microbiol 2023; 21:818-832. [PMID: 37648790 DOI: 10.1038/s41579-023-00960-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Abstract
During recent decades, the emergence of pathogenic fungi has posed an increasing public health threat, particularly given the limited number of antifungal drugs available to treat invasive infections. In this Review, we discuss the global emergence and spread of three emerging antifungal-resistant fungi: Candida auris, driven by global health-care transmission and possibly facilitated by climate change; azole-resistant Aspergillus fumigatus, driven by the selection facilitated by azole fungicide use in agricultural and other settings; and Trichophyton indotineae, driven by the under-regulated use of over-the-counter high-potency corticosteroid-containing antifungal creams. The diversity of the fungi themselves and the drivers of their emergence make it clear that we cannot predict what might emerge next. Therefore, vigilance is critical to monitoring fungal emergence, as well as the rise in overall antifungal resistance.
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Affiliation(s)
- Shawn R Lockhart
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Gupta AK, Polla Ravi S, Wang T, Cooper EA, Lincoln SA, Foreman HC, Bakotic WL. Antifungal Resistance, Susceptibility Testing and Treatment of Recalcitrant Dermatophytosis Caused by Trichophyton indotineae: A North American Perspective on Management. Am J Clin Dermatol 2023; 24:927-938. [PMID: 37553539 DOI: 10.1007/s40257-023-00811-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
There is an ongoing epidemic of chronic, relapsing dermatophytoses caused by Trichophyton indotineae that are unresponsive to one or multiple antifungal agents. Although this new species may have originated from the Indian subcontinent, there has been a notable increase of its reporting in other countries. Based on current literature, antifungal susceptibility testing (AFST) showed a large variation of terbinafine minimum inhibitory concentrations (MICs) (0.04 to ≥ 32 µg/ml). Elevated terbinafine MICs can be attributed to mutations in the squalene epoxidase gene (single mutations: Leu393Phe, Leu393Ser, Phe397Leu, and double mutations: Leu393Phe/Ala448Thr, Phe397Leu/Ala448Thr). Itraconazole MICs had a lower range when compared with that of terbinafine (0.008-16 µg/ml, with most MICs falling between 0.008 µg/ml and < 1 µg/ml). The interpretation of AFST results remains challenging due to protocol variations and a lack of established breakpoints. Adoption of molecular methods for resistance detection, coupled with AFST, may provide a better evaluation of the in vitro resistance status of T. indotineae. There is limited information on treatment options for patients with confirmed T. indotineae infections by molecular diagnosis; preliminary evidence generated from case reports and case series points to itraconazole as an effective treatment modality, while terbinafine and griseofulvin are generally not effective. For physicians working outside of endemic regions, there is currently an unmet need for standardized clinical trials to establish treatment guidelines; in particular, combination therapy of oral and topical agents (e.g., itraconazole and ciclopirox), as well as with other azoles (i.e., fluconazole, voriconazole, ketoconazole), warrants further investigation as multidrug resistance is a possibility for T. indotineae.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada.
| | - Shruthi Polla Ravi
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | - Tong Wang
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | - Elizabeth A Cooper
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
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16
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Dashti Y, Alobaid K, Al-Rashidi S, Dashti M, AbdulMoneim MH, Al-Enezi M, Abou-Chakra N, Jørgensen KM. Autochthonous case of Trichophyton indotineae in Kuwait. J Mycol Med 2023; 33:101432. [PMID: 37666031 DOI: 10.1016/j.mycmed.2023.101432] [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: 07/15/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
Trichophyton indotineae is an emerging dermatophyte that has remarkable impact on public health worldwide. In addition to producing severe extensive skin lesions, this species is frequently resistant to terbinafine, used as a first line agent. As a result, the infection is often refractory, making treatment very challenging. The current report describes the first case of Trichophyton indotineae infection in Kuwait. The infected woman had no recent travel history. She failed to respond to several courses of antifungals, but finally responded to voriconazole. The report suggests that T. indotineae is under recognised, hence, active surveillance of dermatophytes is warranted.
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Affiliation(s)
- Yousef Dashti
- Department of Dermatology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Khaled Alobaid
- Department of Mycology, Mycology Reference Laboratory, Mubarak Al-Kabeer Hospital, Block 4, Street Number: 103, Post code 46304, Jabriya, Kuwait.
| | - Shahad Al-Rashidi
- Department of Dermatology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maryam Dashti
- Department of Dermatology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Manar Al-Enezi
- Department of Dermatology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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17
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Gupta AK, Talukder M, Carviel JL, Cooper EA, Piguet V. Combatting antifungal resistance: Paradigm shift in the diagnosis and management of onychomycosis and dermatomycosis. J Eur Acad Dermatol Venereol 2023; 37:1706-1717. [PMID: 37210652 DOI: 10.1111/jdv.19217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
Antifungal resistance has become prevalent worldwide. Understanding the factors involved in spread of resistance allows the formulation of strategies to slow resistance development and likewise identify solutions for the treatment of highly recalcitrant fungal infections. To investigate the recent explosion of resistant strains, a literature review was performed focusing on four main areas: mechanisms of resistance to antifungal agents, diagnosis of superficial fungal infections, management, and stewardship. The use of traditional diagnostic tools such as culture, KOH analysis and minimum inhibitory concentration values on treatment were investigated and compared to the newer techniques such as molecular methods including whole genome sequencing, and polymerase chain reaction. The management of terbinafine-resistant strains is discussed. We have emphasized the need for antifungal stewardship including increasing surveillance for resistant infection.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mesbah Talukder
- Mediprobe Research Inc., London, Ontario, Canada
- School of Pharmacy, BRAC University, Dhaka, Bangladesh
| | | | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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18
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Jabet A, Normand AC, Brun S, Dannaoui E, Bachmeyer C, Piarroux R, Hennequin C, Moreno-Sabater A. Trichophyton indotineae, from epidemiology to therapeutic. J Mycol Med 2023; 33:101383. [PMID: 37031652 DOI: 10.1016/j.mycmed.2023.101383] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023]
Abstract
Trichophyton indotineae is a newly described dermatophyte species. This fungal pathogen has recently emerged in India and is responsible for chronic or recurrent widespread superficial infections. Resistance to terbinafine is frequently associated to this pathogen and is related to point mutations in the gene encoding the squalene epoxidase. T. indotineae infections have been reported outside India, highlighting the risk of worldwide diffusion of this microorganism. Species identification and antifungal susceptibility determination are key points for infection control but still remain challenging. Systemic treatment is usually required and itraconazole is frequently prescribed in case of terbinafine resistance. This review summarizes main features of T. indotineae taxonomy, epidemiology, clinical manifestations, identification, antifungal profile, treatment and prevention.
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Affiliation(s)
- Arnaud Jabet
- Service de Parasitologie-Mycologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Service de Parasitologie-Mycologie, Hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Anne-Cécile Normand
- Service de Parasitologie-Mycologie, Hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Sophie Brun
- Service de Parasitologie-Mycologie, Hôpital Avicenne, AP-HP, 93009 Bobigny, France
| | - Eric Dannaoui
- Unité de Parasitologie-Mycologie, Service de Microbiologie, Hôpital Necker, AP-HP, 75015 Paris, France; UR Dynamic 7380, UPEC, EnvA, USC ANSES, Faculté de Santé, 94000 Créteil, France; Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Claude Bachmeyer
- Service de Médecine interne, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Renaud Piarroux
- Service de Parasitologie-Mycologie, Hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Institut Pierre Louis d'Épidémiologie et de Santé Publique, Inserm, Sorbonne Université, 75013 Paris, France
| | - Christophe Hennequin
- Service de Parasitologie-Mycologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Centre de Recherche Saint-Antoine, CRSA, Inserm, Sorbonne Université, 75012 Paris, France
| | - Alicia Moreno-Sabater
- Service de Parasitologie-Mycologie, Hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Centre d'Immunologie et des Maladies Infectieuses, (CIMI-PARIS), Inserm U1135, Sorbonne, 75013 Paris, France
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19
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Haghani I, Akhtari J, Yahyazadeh Z, Espahbodi A, Kermani F, Javidnia J, Hedayati MT, Shokohi T, Badali H, Rezaei-Matehkolaei A, Aghili SR, Al-Rawahi A, Al-Harrasi A, Abastabar M, Al-Hatmi AMS. Potential Inhibitory Effect of Miltefosine against Terbinafine-Resistant Trichophyton indotineae. Pathogens 2023; 12:pathogens12040606. [PMID: 37111492 PMCID: PMC10146699 DOI: 10.3390/pathogens12040606] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Several prolonged and significant outbreaks of dermatophytosis caused by Trichophyton indotineae, a new emerging terbinafine-resistant species, have been ongoing in India in recent years, and have since spread to various countries outside Asia. Miltefosine, an alkylphosphocholine, is the most recently approved drug for the treatment of both visceral and cutaneous leishmaniasis. Miltefosine in vitro activity against terbinafine-resistant and susceptible T. mentagrophytes/T. interdigitale species complex, including T. indotineae, is limited. The current study aimed to assess miltefosine's in vitro activity against dermatophyte isolates, which are the most common causes of dermatophytosis. Miltefosine, terbinafine, butenafine, tolnaftate, and itraconazole susceptibility testing was performed using Clinical and Laboratory Standards Institute broth microdilution methods (CLSI M38-A3) against 40 terbinafine-resistant T. indotineae isolates and 40 terbinafine-susceptible T. mentagrophytes/T. interdigitale species complex isolates. Miltefosine had MIC ranges of 0.063-0.5 µg/mL and 0.125-0.25 µg/mL against both terbinafine-resistant and susceptible isolates. In terbinafine-resistant isolates, the MIC50 and MIC90 were 0.125 µg/mL and 0.25 µg/mL, respectively, and 0.25 µg/mL in susceptible isolates. Miltefosine had statistically significant differences in MIC results when compared to other antifungal agents (p-value 0.05) in terbinafine-resistant strains. Accordingly, the findings suggest that miltefosine has a potential activity for treating infections caused by terbinafine-resistant T. indotineae. However, further studies are needed to determine how well this in vitro activity translates into in vivo efficacy.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Javad Akhtari
- Immunogenetics Research Center, Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Zahra Yahyazadeh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Amirreza Espahbodi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Firoozeh Kermani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249-0600, USA
| | - 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 61357-15794, Iran
| | - Seyed Reza Aghili
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Ahmed Al-Rawahi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 48157-33971, Iran
| | - Abdullah M S Al-Hatmi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa 616, Oman
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
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Kumar M, Thomas P, V A, Nair SS, Bagra JK, Chaturvedi VK, Kumar B, Kumar A, Rudramurthy SM, Abhishek. Molecular epidemiology of Trichophyton infections among canines from Northern India. J Mycol Med 2023; 33:101352. [PMID: 36459816 DOI: 10.1016/j.mycmed.2022.101352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Dermatophytes are keratinophilic fungi that cause skin infections in both humans and animals. Recently, the incidence rates of fungal infections associated with Trichophyton spp. have been considered endemic in many locations. The aim of this study was to isolate and characterize Trichophyton spp. from canines and felines. In the present study, screened 442 canine (n = 386) and feline (n = 56) samples for dermatophytes. Among all the samples, ten isolates were identified as Trichophyton spp. based on micro-morphological features. For comparative analysis, we included three human strains of Trichophyton mentagrophytes complex. In vitro susceptibility of antifungal drugs indicated the highest sensitivity except for fluconazole. The canine and human strains were genetically characterized by sequencing three genes: the internal transcribed spacer region of rDNA, translation elongation factor 1- gene, and beta-tubulin. Based on sequence homology and phylogenetic analysis, the ten canine strains belonged to four different species/ genotypes such as T. mentagrophytes genotype VIII (T. indotineae) (n = 5), T. interdigitale (n = 2), T. simii (n = 2) and T. quinckeanum (n = 1). The three human strains used for comparative analysis were identified as T. mentagrophytes genotype VIII (n = 2) and T. benhamiae (n = 1). The study hence indicates that the T. mentagrophytes genotype VIII, considered as an endemic and emerging human pathogenic clone in India, is also the prevalent in animals.
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Affiliation(s)
- Manish Kumar
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Prasad Thomas
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Athira V
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Sonu S Nair
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Jitendra Kumar Bagra
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - V K Chaturvedi
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Bablu Kumar
- Division of Biological Products, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | - Akhilesh Kumar
- Division of Medicine, Indian Veterinary Research Institute, Izatnagar, Bareilly, India
| | | | - Abhishek
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly, India.
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Ma Y, Deng W, Zhang K, Song Y, Zhang L, Shao J, Liu X, Wan Z, Wang X, Li R. Dual RNA-Sequencing and Liquid Chromatography-Mass Spectrometry Unveil Specific Insights on the Pathogenicity of Trichophyton mentagrophytes Complex. J Invest Dermatol 2023; 143:470-479.e6. [PMID: 38295003 DOI: 10.1016/j.jid.2022.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022]
Abstract
Trichophyton mentagrophytes is increasingly considered to be a public health hazard because it causes the most severe manifestations of dermatophytosis. In this study, we performed a series of studies to determine the pathogenicity of the T. mentagrophytes complex. We show that the T. mentagrophytes complex interacts with keratinocytes through pattern-recognition receptors‒MAPK/noncanonical NF-κB pathways and that the hyphal form of T. mentagrophytes is responsible for the increased inflammatory responses in keratinocytes. Moreover, SN-38 is likely a toxin of T. mentagrophytes that induces apoptosis in keratinocytes both in vivo and in vitro. Our results explain the severe pathogenicity and destructiveness of T. mentagrophytes observed in the clinic and pave the way for designing novel toxin-directed therapies to improve patient outcomes.
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Affiliation(s)
- Yubo Ma
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Weiwei Deng
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Kai Zhang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Yinggai Song
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Lu Zhang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Jin Shao
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Xiao Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Zhe Wan
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Xiaowen Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Ruoyu Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China; Research Center for Medical Mycology, Peking University, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
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Chowdhary A, Singh A, Kaur A, Khurana A. The emergence and worldwide spread of the species Trichophyton indotineae causing difficult-to-treat dermatophytosis: A new challenge in the management of dermatophytosis. PLoS Pathog 2022; 18:e1010795. [PMID: 36173977 PMCID: PMC9521800 DOI: 10.1371/journal.ppat.1010795] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- * E-mail:
| | - Ashutosh Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
- National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Amtoj Kaur
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Dr. RML Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Nenoff P, Uhrlaß S, Verma SB, Panda S. Trichophyton mentagrophytes ITS genotype VIII and Trichophyton indotineae: A terminological maze, or is it? Indian J Dermatol Venereol Leprol 2022; 88:586-589. [DOI: 10.25259/ijdvl_112_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/01/2022] [Indexed: 11/04/2022]
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Trichophyton indotineae—An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide—A Multidimensional Perspective. J Fungi (Basel) 2022; 8:jof8070757. [PMID: 35887512 PMCID: PMC9323571 DOI: 10.3390/jof8070757] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/22/2022] Open
Abstract
Trichophyton (T.) indotineae is a newly identified dermatophyte species that has been found in a near-epidemic form on the Indian subcontinent. There is evidence of its spread from the Indian subcontinent to a number of countries worldwide. The fungus is identical to genotype VIII within the T. mentagrophytes/T. interdigitale species complex, which was described in 2019 by sequencing the Internal Transcribed Spacer (ITS) region of ribosomal DNA of the dermatophyte. More than 10 ITS genotypes of T. interdigitale and T. mentagrophytes can now be identified. T. indotineae causes inflammatory and itchy, often widespread, dermatophytosis affecting the groins, gluteal region, trunk, and face. Patients of all ages and genders are affected. The new species has largely displaced other previously prevalent dermatophytes on the Indian subcontinent. T. indotineae has become a problematic dermatophyte due to its predominantly in vitro genetic resistance to terbinafine owing to point mutations of the squalene epoxidase gene. It also displays in vivo resistance to terbinafine. The most efficacious drug currently available for this terbinafine-resistant dermatophytoses, based on sound evidence, is itraconazole.
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Pashootan N, Shams-Ghahfarokhi M, Chaichi Nusrati A, Salehi Z, Asmar M, Razzaghi-Abyaneh M. Phylogeny, Antifungal Susceptibility, and Point Mutations of SQLE Gene in Major Pathogenic Dermatophytes Isolated From Clinical Dermatophytosis. Front Cell Infect Microbiol 2022; 12:851769. [PMID: 35372131 PMCID: PMC8972121 DOI: 10.3389/fcimb.2022.851769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022] Open
Abstract
Drug resistance is one of the major challenges to skin fungal infections, especially in tropical and subtropical infections caused by dermatophytes. This study aimed to determine the antifungal susceptibility of clinically dermatophytes and evaluate point mutations in terbinafine-resistant isolates. A total number of 123 clinical dermatophyte isolates in eight species were evaluated in terms of sensitivity to seven major antifungals. Furthermore, the point mutation in squalene epoxidase (SQLE) gene responsible for terbinafine resistance was studied. The dermatophytes species were identified by morphological characteristics and confirmed by the ITS sequencing. Also, the phylogenetic tree was drawn using the RAxML analyses for 123 dermatophytes isolates. A new XXIX genotype was also found in 4 Trichophyton mentagrophytes isolates. Based on the results obtained, terbinafine was the most effective antifungal drug followed by itraconazole and voriconazole. Trichophyton rubrum and Trichophyton tonsurans were the most susceptible species (MIC50 = 0.01, 0.09 μg/ml), and T. mentagrophytes was the most resistant species (MIC50 = 0.125 μg/ml) to terbinafine. Of the 123 dermatophytes isolates, six isolates showed reduced susceptibility to terbinafine, and only Trichophyton indotineae had a mutation in SQLE gene as a Phe397Leu substitution. Overall, the antifungal susceptibility test is necessary for managing dermatophytosis. These results help physicians to control the course of the disease and provide further insights to select effective drugs for patients with dermatophytosis, especially in tropical and subtropical regions of the world, where dermatophytosis is still a public health problem.
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Affiliation(s)
- Nasrin Pashootan
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | | | - Arash Chaichi Nusrati
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Zahra Salehi
- Department of Mycology, Pasteur Institute of Iran, Tehran, Iran
| | - Mehdi Asmar
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Mehdi Razzaghi-Abyaneh
- Department of Mycology, Pasteur Institute of Iran, Tehran, Iran
- *Correspondence: Mehdi Razzaghi-Abyaneh, ;
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Terbinafine Resistance in Dermatophytes: A French Multicenter Prospective Study. J Fungi (Basel) 2022; 8:jof8030220. [PMID: 35330222 PMCID: PMC8948947 DOI: 10.3390/jof8030220] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
In recent years, we have moved from the sporadic description of terbinafine-resistant (TerR) Trichophyton spp. isolates to the Indian outbreak due to T. indotineae. Population flows have spread TerR worldwide, altering local epidemiology. We conducted a prospective multicentric study to determine the relative frequency of TerR isolates in France (Paris area) and of the newly introduced T. indotineae species. TerR isolates were screened by the terbinafine-containing-agar-medium (TCAM) method and confirmed by EUCAST. Sequencing methods were used to identify isolates to the species/genotype level and to analyze substitutions in the squalene epoxidase gene (SQLE). In total, 3 isolates out of 580 (T. rubrumn = 1; T. interdigitalen = 1; T. indotineaen = 1) grew on TCAM, showed terbinafine resistance by EUCAST and harbored the Phe397Leu (n = 2) or Leu393Ser (n = 1) substitution in the SQLE. ITS-sequencing of isolates of the T. mentagrophytes/interdigitale complex (n = 125) revealed a relative frequency of 4.8% for T. indotineae and the presence of T. mentagrophytes genotype VII. Despite the detection of terbinafine resistance, isolates from this complex remained susceptible to itraconazole, voriconazole and amorolfine. Terbinafine resistance is present in France and the dermatophyte epidemiology is changing. Efficient systems must be implemented to survey the evolution of newly introduced species and to identify TerR isolates.
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Posso-De Los Rios CJ, Tadros E, Summerbell RC, Scott JA. Terbinafine Resistant Trichophyton Indotineae Isolated in Patients with Superficial Dermatophyte Infection in Canadian Patients. J Cutan Med Surg 2022; 26:371-376. [PMID: 35144480 DOI: 10.1177/12034754221077891] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Trichophyton mentagrophytes type VIII (segregated as Trichophyton indotineae) is a new strain of antifungal resistant Trichophyton spp. that has been found in different countries around the world. This new strain has been found to be resistant to terbinafine. OBJECTIVES We present the clinical characteristics, diagnosis and treatment approach of Canadian patients with mycology and molecular confirmation of superficial mycosis caused by T. indotineae. METHODS Mycology testing from cultures and PCR were used to confirm T. indotineae. We collected clinical information from patients with a confirmed diagnosis. RESULTS We report eight Canadian patients mainly presenting with extensive superficial mycosis due to T. indotineae. Three patients presented lesions on the face in addition to lesions on their body. Four patients were initially started on itraconazole or fluconazole, one patient was started on topical therapy, and three patients were referred to infectious disease. CONCLUSIONS This new strain represents a dermatology and public health concern. Treatment guidelines are lacking. We include a practical approach and treatment recommendations for clinicians who will be encountering these emerging cases in Canada while waiting for evidence-based treatment guidelines.
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Affiliation(s)
| | - Enas Tadros
- Dermatology Clinic, DermCare. 1065 Canadian Pl Unit 206, Mississauga, ON, Canada
| | - Richard C Summerbell
- 7938274071 Dalla Lana School of Public Health, University of Toronto, ON, Canada.,Dynacare Laboratories. 115 Midair Court, Brampton, ON, Canada.,Sporometrics. 219 Dufferin Street, Suite 20C, Toronto, ON, Canada
| | - James A Scott
- 7938274071 Dalla Lana School of Public Health, University of Toronto, ON, Canada.,Dynacare Laboratories. 115 Midair Court, Brampton, ON, Canada.,Sporometrics. 219 Dufferin Street, Suite 20C, Toronto, ON, Canada
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28
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Increasing Terbinafine Resistance in Danish Trichophyton Isolates 2019–2020. J Fungi (Basel) 2022; 8:jof8020150. [PMID: 35205904 PMCID: PMC8879722 DOI: 10.3390/jof8020150] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Terbinafine resistance in Trichophyton species has emerged and appears to be increasing. A new EUCAST susceptibility testing method and tentative ECOFFs were recently proposed for Trichophyton. Terbinafine resistance and target gene mutations were detected in 16 Danish isolates in 2013–2018. In this study, samples/isolates submitted for dermatophyte susceptibility testing 2019–2020 were examined. Species identification (ITS sequencing for T. mentagrophytes/T. interdigitale species complex (SC) isolates), EUCAST MICs and squalene epoxidase (SQLE) profiles were obtained. Sixty-three isolates from 59 patients were included. T. rubrum accounted for 81% and T. mentagrophytes/T. interdigitale SC for 19%. Approximately 60% of T. rubrum and T. mentagrophytes/interdigitale SC isolates were terbinafine non-wildtype and/or had known/novel SQLE mutations with possible implications for terbinafine MICs. All infections with terbinafine-resistant T. mentagrophytes/interdigitale SC isolates were caused by Trichophyton indotineae. Compared to 2013–2018, the number of patients with terbinafine-resistant Trichophyton isolates increased. For T. rubrum, this is partly explained by an increase in number of requests for susceptibility testing. Terbinafine-resistant T. indotineae was first detected in 2018, but accounted for 19% of resistance (4 of 21 patients) in 2020. In conclusion, terbinafine resistance is an emerging problem in Denmark. Population based studies are warranted and susceptibility testing is highly relevant in non-responding cases.
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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: 34] [Impact Index Per Article: 17.0] [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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A Case of Terbinafine-Resistant Tinea Cruris Caused by Trichophyton tonsurans. Case Rep Dermatol Med 2021; 2021:9611072. [PMID: 34925922 PMCID: PMC8677411 DOI: 10.1155/2021/9611072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
A 26-year-old male patient referred to our center with a history of extremely itchy crusted skin lesions in his groins for one year. Moreover, his friend, a 25-year-old male, also developed similar lesions in the groin after using the shared pool, whose condition also did not improve with similar treatment. A regular mycology test (direct and culture test) was performed, as well as molecular examination. The antifungal susceptibility assay to terbinafine, itraconazole, posaconazole, fluconazole, and voriconazole was conducted according to the Clinical and Laboratory Standards Institute M38 third ed. The sequencing study identified T. tonsurans as the causative organism in both patients. The abovementioned organism isolated from both patients displayed resistance against terbinafine and fluconazole (MIC ≥ 4 µg/ml and MIC ≥ 8 µg/ml, respectively). Moreover, the susceptibility of both subjects to posaconazole (0.313 µg/ml), voriconazole (0.25–0.0625 µg/ml), and (1 µg/ml) itraconazole increased. The present report aimed to emphasize the increase in antifungal resistance and a demand for antifungal stewardship, to control this public health threat.
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Brasch J, Gräser Y, Beck-Jendroscheck V, Voss K, Torz K, Walther G, Schwarz T. „Indische“
Trichophyton mentagrophytes
‐Stämme mit reduzierter Itraconazol‐Empfindlichkeit in Deutschland. J Dtsch Dermatol Ges 2021; 19:1723-1728. [PMID: 34894184 DOI: 10.1111/ddg.14626_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jochen Brasch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Yvonne Gräser
- Nationales Konsiliarlabor für Dermatophyten, Institut für Mikrobiologie und Infektionsimmunologie, Charité - Universitätsmedizin Berlin
| | - Vera Beck-Jendroscheck
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Karen Voss
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Kaspar Torz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Grit Walther
- Nationales Referenzzentrum für invasive Pilzinfektionen (NRZMyk), Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie - Hans-Knöll-Institut, Jena
| | - Thomas Schwarz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Brasch J, Gräser Y, Beck-Jendroscheck V, Voss K, Torz K, Walther G, Schwarz T. "Indian" strains of Trichophyton mentagrophytes with reduced itraconazole susceptibility in Germany. J Dtsch Dermatol Ges 2021; 19:1723-1727. [PMID: 34850554 DOI: 10.1111/ddg.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 01/23/2023]
Abstract
We use published reports and three of our own tinea cases as an opportunity to report on "Indian" strains of Trichophyton (T.) mentagrophytes with ITS genotype VIII and reduced susceptibility to itraconazole due to the mutation c.1342G>A in the SQLE gene in Germany. In vitro measurements of resistance revealed normal susceptibility to terbinafine, but markedly reduced susceptibility to itraconazole - although no valid breakpoints are currently defined and minimum inhibitory concentrations (MICs) depend on the methods used. Problems related to the determination and interpretation of MICs are outlined. Our cases show that azole-resistant "Indian" strains of T. mentagrophytes with ITS genotype VIII occurred in Germany as early as 2011, which is earlier than was previously assumed. This variant of the pathogen cannot be phenotypically distinguished from customary strains of T. mentagrophytes; its identification is based on genetics. The taxonomic classification is still under debate. This variant is anthropophilic and causes only mildly inflammatory tinea lesions with many fungal elements. Its further dissemination must therefore be expected. Prerequisites for rapid and valid antimycotic testing against dermatophytes need to be developed.
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Affiliation(s)
- Jochen Brasch
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel
| | - Yvonne Gräser
- National Consultative Laboratory for Dermatophytes, Institute for Microbiology and Infection Immunology, Charité - Universitätsmedizin Berlin
| | - Vera Beck-Jendroscheck
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel
| | - Karen Voss
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel
| | - Kaspar Torz
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel
| | - Grit Walther
- National Reference Center for Invasive Fungal Infections (NRZMyk), Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena
| | - Thomas Schwarz
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel
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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: 46] [Impact Index Per Article: 15.3] [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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Olorofim Effectively Eradicates Dermatophytes In Vitro and In Vivo. Antimicrob Agents Chemother 2021; 65:e0138621. [PMID: 34570652 DOI: 10.1128/aac.01386-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Superficial fungal infections are prevalent worldwide, with dermatophytes as the most common cause. Various antifungal agents including azoles and allylamines are commonly used to treat dermatophytosis. However, their overuse has yielded drug-resistant strains, calling for the development of novel antimycotic compounds. Olorofim is a newly developed antifungal compound that targets pyrimidine biosynthesis in molds. The purpose of this study was to determine the in vitro and in vivo antifungal effects of olorofim against common dermatophytes. The in vitro activity of olorofim against dermatophytes was assessed by microtiter broth dilution method. Bioinformatic analysis of olorofim binding to dihydroorotate dehydrogenase (DHODH) of dermatophytes was also performed, using Aspergillus fumigatus DHODH as a template. The in vivo efficacy of the drug was investigated, using a guinea pig model, experimentally infected with Microsporum gypseum. Microtiter assays confirmed the high in vitro sensitivity of dermatophytes to olorofim (MIC = 0.015-0.06 mg/liter). Amino acid sequence analysis indicated that DHODH is highly conserved among dermatophytes. The critical residues, in dermatophytes, involved in olorofim binding were similar to their counterparts in A. fumigatus DHODH, which explains their susceptibility to olorofim. Typical skin lesions of dermatophyte infection were observed in the guinea pig model at 7 days postinoculation. Following 1 week of daily topical administration of olorofim, similar to the clotrimazole group, the skin lesions were resolved and normal hair growth patterns appeared. In light of the in vitro and in vivo activity of olorofim against dermatophytes, this novel agent may be considered as a treatment of choice against dermatophytosis.
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35
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Osman M, Kasir D, Rafei R, Kassem II, Ismail MB, El Omari K, Dabboussi F, Cazer C, Papon N, Bouchara JP, Hamze M. Trends in the epidemiology of dermatophytosis in the Middle East and North Africa region. Int J Dermatol 2021; 61:935-968. [PMID: 34766622 DOI: 10.1111/ijd.15967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
Dermatophytosis corresponds to a broad series of infections, mostly superficial, caused by a group of keratinophilic and keratinolytic filamentous fungi called dermatophytes. These mycoses are currently considered to be a major public health concern worldwide, particularly in developing countries such as those in the Middle East and North Africa (MENA) region. Here we compiled and discussed existing epidemiologic data on these infections in the MENA region. Most of the available studies were based on conventional diagnostic strategies and were published before the last taxonomic revision of dermatophytes. This has led to misidentifications, which might have resulted in the underestimation of the real burden of these infections in the MENA countries. Our analysis of the available literature highlights an urgent need for further studies based on reliable diagnostic tools and standard susceptibility testing methods for dermatophytosis, which represents a major challenge for these countries. This is crucial for guiding appropriate interventions and activating antifungal stewardship programs in the future.
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Affiliation(s)
- Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Dalal Kasir
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Issmat I Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, USA
| | - Mohamad Bachar Ismail
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Faculty of Science, Lebanese University, Tripoli, Lebanon
| | - Khaled El Omari
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Quality Control Center Laboratories, Chamber of Commerce, Industry, and Agriculture of Tripoli and North Lebanon, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Casey Cazer
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Nicolas Papon
- Univ Angers, Univ Brest, GEIHP, SFR ICAT, Angers, France
| | | | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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36
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Madarasingha NP, Eriyagama S. An emerging threat of recalcitrant dermatophytosis in Sri Lanka - are we ready to tackle? Int J Dermatol 2021; 61:e2-e3. [PMID: 34587286 DOI: 10.1111/ijd.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/29/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
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37
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Firooz A, Daneshpazhooh M, Lotfali E, Sharzad Kavkani M, Ghasemi Z, Khamesipoor A, Nassiri Kashani M, Miramin Mohammadi A, Skandari SE, Ahmad Nasrollahi S, Fattahi A. Drug Sensitivity Profile of Fungi Isolated from Onychomycosis Patients and Evaluation of Squalene Epoxidase Mutation in One Terbinafine-Resistant Trichophyton mentagrophytes Species. Microb Drug Resist 2021; 27:1658-1663. [PMID: 34297623 DOI: 10.1089/mdr.2020.0572] [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: 12/13/2022] Open
Abstract
Background: The resistance to treatment of onychomycosis is increasingly reported. The present study aimed to assess the antifungal activity of itraconazole, terbinafine, luliconazole, and efinaconazole against dermatophytes, molds, and also yeast isolated from patients with onychomycosis. Furthermore, the mechanism of resistance to terbinafine in resistant Trichophyton mentagrophytes species was evaluated using the squalene epoxidase (SQLE) gene sequence. Methods: A total of 71 fungal isolates were collected from 97 patients with suspected onychomycosis. The identification of fungal species was performed using conventional and molecular approaches. In vitro drug susceptibility for itraconazole, terbinafine, luliconazole, and efinaconazole was carried out using the broth microdilution method according to the CLSI-M60 and CLSI-M38 3rd ed., respectively. The SQLE gene of one terbinafine-resistant T. mentagrophytes was amplified using the specific primers. Results: Efinaconazole and luliconazole demonstrated higher effectiveness against all isolates in the study. One mismatch was detected at position 1177, which showed A → C change associated with Phe397Leu amino acid substitution of the SQLE protein in terbinafine-resistant T. mentagrophytes. Conclusion: The occurrence of resistant strains of organisms causing onychomycosis should be considered and evaluated. Furthermore, the identification of amino acid changes responsible for resistance to antifungals is a useful consideration in drug-target interaction.
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Affiliation(s)
- Alireza Firooz
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Dermatology Hospital, 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
| | | | - Zeinab Ghasemi
- Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khamesipoor
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Nassiri Kashani
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Miramin Mohammadi
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ebrahim Skandari
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Ahmad Nasrollahi
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Fattahi
- Center for Research and Training in Skin Disease and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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38
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Gawaz A, Nenoff P, Uhrlaß S, Schaller M. [Treatment of a terbinafine-resistant trichophyton mentagrophytes type VIII]. Hautarzt 2021; 72:900-904. [PMID: 34241651 DOI: 10.1007/s00105-021-04857-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
This article reports on a patient suffering from terbinafine-resistant tinea corporis acquired in Asia. Trichophyton mentagrophytes type VIII was first isolated in India. In the past few years, it has gained clinical relevance by causing terbinafine-resistant tinea corporis and cruris. Therefore, in cases of recalcitrant tinea in persons returning from Asia, systemic itraconazole should be started. Specially formulated itraconazole enables high bioavailability despite lower dosage.
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Affiliation(s)
- A Gawaz
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - P Nenoff
- Labor für Medizinische Mikrobiologie, Mölbis, Deutschland
| | - S Uhrlaß
- Labor für Medizinische Mikrobiologie, Mölbis, Deutschland
| | - M Schaller
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Sardana K, Mathachan SR, Sachdeva S, Khurana A. Is there a rationale for the use of voriconazole in dermatophytosis in the absence of mycological and mutational data? An urgent need for antifungal stewardship. Clin Exp Dermatol 2021; 46:1621-1623. [PMID: 34189762 DOI: 10.1111/ced.14824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- K Sardana
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - S R Mathachan
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - S Sachdeva
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - A Khurana
- Department of Dermatology, Venereology and Leprosy, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Abstract
BACKGROUND AND OBJECTIVE With the widespread use of antifungals to treat superficial mycoses, reports of antifungal resistance are increasing. Antifungal resistance is becoming a public health challenge and needs to be addressed in parallel with antibacterial and antiviral resistance. METHODS We review the growing resistance of fungal pathogens such as Trichophyton species and the emergence of novel pathogens, including multidrug-resistant strains in superficial mycoses. We also discuss the importance of laboratory diagnosis and antifungal susceptibility testing (AFST) in the management of recalcitrant infections. RESULTS AND CONCLUSION Antifungal resistance can occur naturally or develop over time when fungi are exposed to antifungals. The frequency of terbinafine-resistant Trichophyton isolates is increasing. Opportunistic pathogens such as Aspergillus and Candida species have developed resistance to classic azoles such as itraconazole and fluconazole, and the newer azoles such as posaconazole and voriconazole. Although uncommon, topical antifungals such as efinaconazole and tavaborole have shown to induce resistance in Trichophyton rubrum. The emergence of multidrug-resistant Trichophyton mentagrophytes/interdigitale, Candida auris, and Aspergillus species causing severe infections is highly concerning. Routine AFST should be considered to determine the most effective treatment, especially if there is failure to therapy. Combination treatment of oral and topical antifungals may be a consideration for managing recalcitrant infections.
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Affiliation(s)
- Aditya K Gupta
- Department of Medicine, Division of Dermatology, University of Toronto School of Medicine, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
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41
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Galvan D, Effting L, Torres Neto L, Conte-Junior CA. An overview of research of essential oils by self-organizing maps: A novel approach for meta-analysis study. Compr Rev Food Sci Food Saf 2021; 20:3136-3163. [PMID: 34125485 DOI: 10.1111/1541-4337.12773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 03/13/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022]
Abstract
Essential oils (EOs) are commercially important products, sources of compounds with antioxidant and antimicrobial activities considered indispensable for several fields, such as the food industry, cosmetics, perfumes, pharmaceuticals, sanitary and agricultural industries. In this context, this systematic review and meta-analysis, a novel approach will be presented using chemometric tools to verify and recognize patterns of antioxidant, antibacterial, and antifungal activities of EOs according to their geographic, botanical, chemical, and microbiological distribution. Scientific papers were selected following the Preferred Reporting Items for Systematic Review and Meta-Analyses statement flow diagram, and the data were evaluated by the self-organizing map and hierarchical cluster analysis. Overall, this novel approach allowed us to draw an overview of antioxidants and antimicrobials activities of EOs reported in 2019, through 585 articles evaluated, obtaining a dataset with more than 10,000 data, distributed in more than 80 countries, 290 plant genera, 150 chemical compounds, 30 genera of bacteria, and 10 genera of fungi. The networks for geographic, botanical, chemical, and microbiological distribution indicated that Brazil, Asia, the botanical genus Thymus, species Thymus vulgaris L. "thyme," the Lamiaceae family, limonene, and the oxygenated monoterpene class were the most representative in the dataset, while the species Escherichia coli and Candida albicans were the most used to assess the antimicrobial activity of EOs. This work can be seen as a guide for the processing of metadata using a novel approach with non-conventional statistical methods. However, this preliminary approach with EOs can be extended to other sources or areas of food science.
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Affiliation(s)
- Diego Galvan
- Center for Food Analysis (NAL), Technological Development Support Laboratory (LADETEC), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Laboratory of Advanced Analysis in Biochemistry and Molecular Biology (LAABBM), Department of Biochemistry, Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Nanotechnology Network, Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Luciane Effting
- Chemistry Department, State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - Luiz Torres Neto
- Center for Food Analysis (NAL), Technological Development Support Laboratory (LADETEC), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Laboratory of Advanced Analysis in Biochemistry and Molecular Biology (LAABBM), Department of Biochemistry, Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Nanotechnology Network, Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil.,Graduate Program in Food Science (PPGCAL), Institute of Chemistry (IQ), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil
| | - Carlos Adam Conte-Junior
- Center for Food Analysis (NAL), Technological Development Support Laboratory (LADETEC), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Laboratory of Advanced Analysis in Biochemistry and Molecular Biology (LAABBM), Department of Biochemistry, Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil.,Nanotechnology Network, Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil.,Graduate Program in Food Science (PPGCAL), Institute of Chemistry (IQ), Federal University of Rio de Janeiro (UFRJ), Cidade Universitária, Rio de Janeiro, Brazil
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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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43
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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: 50] [Impact Index Per Article: 16.7] [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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Shamsizadeh F, Ansari S, Zarei Mahmoudabadi A, Hubka V, Čmoková A, Guillot J, Rafiei A, Zomorodian K, Nouripour-Sisakht S, Diba K, Mohammadi T, Zarrinfar H, Rezaei-Matehkolaei A. In vitro antifungal susceptibility patterns of Trichophyton benhamiae complex isolates from diverse origin. Mycoses 2021; 64:1378-1386. [PMID: 33864711 DOI: 10.1111/myc.13287] [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: 02/01/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Species from the Trichophyton benhamiae complex are mostly zoophilic dermatophytes which cause inflammatory dermatophytosis in animals and humans worldwide. OBJECTIVES This study was purposed to (a) to identify 169 reference and clinical dermatophyte strains from the T benhamiae complex species by molecular method and adhering to the newest taxonomy in the complex (b) to evaluate the in vitro antifungal susceptibility profile of these strains against eight common and new antifungal agents that may be used for the treatment of dermatophytosis. METHODS All isolates, mainly originated from Europe but also from Iran, Japan and USA, were subjected to ITS-rDNA sequencing. The in vitro antifungal susceptibility profiles of eight common and new antifungal drugs against the isolates were determined by CLSI M38-A2 protocol and according to microdilution method. RESULTS Based on the ITS-rDNA sequencing, T benhamiae was the dominant species (n = 102), followed by T europaeum (n = 29), T erinacei (n = 23), T japonicum (n = 10), Trichophyton sp (n = 4) and T eriotrephon (n = 1). MIC ranges across all isolates were as follows: luliconazole: 0.0002-0.002 µg/ml, terbinafine: 0.008-0.125 µg/ml, efinaconazole: 0.008-0.125 µg/ml, ciclopirox olamine: 0.03-0.5 µg/ml, itraconazole: 0.06-2 µg/ml, griseofulvin: 0.25-4 µg/ml, amorolfine hydrochloride: 0.125-4 µg/ml and tavaborole: 1-16 µg/ml. CONCLUSION Luliconazole, efinaconazole and terbinafine were the most potent antifungals against T benhamiae complex isolates, regardless of the geographic locations where strains were isolated. These data might help dermatologists to develop effective therapies for successful treatment of infections due to T benhamiae complex species.
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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.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saham Ansari
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Zarei Mahmoudabadi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vít Hubka
- Department of Botany, Faculty of Science, Charles University, Prague, Czech Republic.,Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology, Czech Academy of Sciences, Vídeňská, Czech Republic
| | - Adéla Čmoková
- Department of Botany, Faculty of Science, Charles University, Prague, Czech Republic.,Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology, Czech Academy of Sciences, Vídeňská, Czech Republic
| | - Jacques Guillot
- Dynamic Research Group UPEC, EnvA, USC Anses, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kamiar Zomorodian
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Kambiz Diba
- Department of Medical Mycology and Parasitology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Tooba Mohammadi
- Department of Medical Mycology and Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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