First US cases of tinea caused by T. indotineae reported in New York
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Key takeaways:
- These are the first U.S. cases of drug-resistant tinea, or ringworm, caused by Trichophyton indotineae.
- T . indotineae is a newly emerged fungus that causes severe and highly contagious skin infections.
Health officials identified the first cases of severe tinea, or ringworm, caused by Trichophyton indotineae in the U.S., according to case reports published in MMWR.
“During the past decade, an epidemic of severe, antifungal-resistant tinea has emerged in South Asia because of the rapid spread of Trichophyton indotineae, a novel dermatophyte species,” Avrom S. Caplan, MD, dermatologist at NYC Health + Hospitals, and colleagues wrote. “The epidemic has likely been driven by misuse and overuse of topical antifungals and corticosteroids.”
Concerns of T. indotineae, which has been reported throughout Asia, Europe and Canada, but have not previously been reported in the U.S., arose among New York City health officials on Feb. 28, 2023, when a local dermatologist notified them of two patients with severe tinea that did not improve with oral terbinafine treatment, according to the report.
The first patient, a 28-year-old woman, developed a widespread infection during the summer of 2021. She had no known exposure to someone with a similar rash and no recent international travel history.
In December 2021, she received a diagnosis of tinea and began oral terbinafine therapy in January 2022, which did not improve her condition after 2 weeks. According to the report, terbinafine was discontinued and treatment with itraconazole began, which reportedly resolved the rash completely.
The second patient, a 47-year-old woman, developed a widespread rash in the summer of 2022 while in Bangladesh, where she was treated with topical antifungal and steroid combination creams.
She returned to the U.S., where she visited the ED three times throughout the fall of 2022 and was treated with hydrocortisone 2.5% ointment and diphenhydramine at her first ED visit, clotrimazole cream at her second, and terbinafine cream at her third, with no improvement reported after any of the treatments.
In December, she began treatment with a 4-week course of oral terbinafine, but her symptoms did not improve. She was then given a 4-week course of griseofulvin, resulting in approximately 80% improvement.
According to the MMWR report, itraconazole therapy is being considered given the recent confirmation of suspected T. indotineae infection.
The authors wrote that these cases highlight several important facts: the potential local U.S. transmission of T. indotineae based on the first patient having no travel history; culture-based identification techniques used by most clinical laboratories can misidentify T. indotineae because skin culture isolates from each patient were previously identified as T. mentagrophytes; and that treatment with oral itraconazole can be successful and has been documented.
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