Drug-resistant ringworm reported in US for first time; community spread likely

The newly emerging fungal pathogen is often misidentified in common lab tests.

ARS TECHNICA – A dermatologist in New York City has reported the country’s first known cases of highly contagious ringworm infections that are resistant to common anti-fungal treatments—and caused by a newly emerging fungus that is rapidly outstripping other infectious fungi around the world.

In February, the dermatologist reported two cases to health officials in the state, which are described in a brief case study published Thursday in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The two cases occurred a year apart and had no connection to each other. The first, from the summer of 2021, was in a 28-year-old pregnant woman who had no recent international travel history, no underlying medical conditions, and no known contact with anyone who had a similar rash. The case suggests that the fungus is quietly spreading in the community.

“The rise of T. indotineae is linked to the abuse of topical treatments that contain egregiously large combinations of steroids and antifungal/antibacterial agents, spurring the development of resistance. This is particularly a problem in India.”

Ringworm—aka tineas, dermatophytosis, jock itch, and athlete’s foot—is a superficial fungal infection of the skin that causes red, itchy, sometimes scaly circular rashes.

There are more than 40 different species of fungi that can cause the infection, which spreads from infected people and animals and also lurks in environments and on common household items, like towels. Ringworm is extremely common and can strike anyone. Usually, it’s treatable with over-the-counter creams.

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But, in the 28-year-old’s case, her 2021 infection was only finally cured in early 2022, after the birth of her baby, after first-line treatment failed and she underwent a four-week course of an oral anti-fungal medicine, itraconazole.

Global scourge

The fungus behind the infections is Trichophyton indotineae (previously described as Trichophyton mentagrophytes type VIII), which is a newly emerging fungus globally.

Though genetic studies date isolates back to at least 2008 in Australia, a multidrug-resistant lineage seemed to erupt in India between 2017 and 2018. Since then, it has reached epidemic proportions in the subcontinent …


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