First Reported Cases of Terbinafine-Resistant Trichophyton indotineae Isolates in Israel: Epidemiology, Clinical Characteristics and Response to Treatment.

IF 4.1 2区医学 Q1 DERMATOLOGY

Mycoses Pub Date : 2024-11-01 DOI:10.1111/myc.13812

Eran Galili, Irit Lubitz, Avner Shemer, Nadav Astman, Keren Pevzner, Zeala Gazit, Oz Segal, Anna Lyakhovitsky, Shiraz Halevi, Sharon Baum, Aviv Barzilai, Sharon Amit

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引用次数: 0

Abstract

Background: Trichophyton indotineae, a newly defined species within the T. mentagrophytes/T. interdigitale complex, has emerged as an epidemiological concern worldwide. However, owing to the limitations of commonly applied fungal identification techniques, T. indotineae remains underreported. In addition, T. indotineae's response to treatment has been described in only a few studies.

Objective: To investigate the prevalence, clinical characteristics and treatment outcomes of terbinafine-resistant T. mentagrophytes/T. interdigitale complex infections, as well as to detect T. indotineae cases.

Patients and methods: A retrospective cohort study was conducted on 22 patients with T. mentagrophytes/T. interdigitale complex infections between 2019 and 2023, using either culture or commercial polymerase chain reaction methods. Patient demographics, disease characteristics and treatment responses were recorded. Patients non-responsive to oral terbinafine underwent further analyses, including DNA sequencing of the internal transcribed spacer region for accurate species identification and mutational analysis of the squalene epoxidase (SQLE) gene.

Results: The mean age of the patients was 49.7 years (±18.2), with 54.5% men. Terbinafine-resistant T. mentagrophytes/T. interdigitale complex infections were reported in 46.2% of the cohort (n = 6/13 patients; 9 lost to treatment response follow-up), all of whom exhibited extensive dermatophytosis. Among the terbinafine-resistant T. mentagrophytes/T. interdigitale isolates, all five isolates available for fungal analysis were identified as T. indotineae, harbouring SQLE single-point mutations (Phe397Leu and Leu393Ser). Only three of the terbinafine-resistant cases responded to oral itraconazole 200 mg/day, with two responding only to oral voriconazole and one to oral itraconazole 400 mg/day.

Conclusion: All cases of T. mentagrophytes/T. interdigitale assessed in this study were identified as T. indotineae, which exhibits SQLE gene mutations. This underscores the importance of integrating methods to detect T. indotineae in routine clinical practice.

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以色列首例报告的耐特比萘芬毛癣菌感染病例：流行病学、临床特征和治疗反应。

背景：indotineae 毛癣菌是 T. mentagrophytes/T. interdigitale 复合物中新定义的一种，已成为全球流行病学关注的问题。然而，由于常用真菌鉴定技术的局限性，T. indotineae 仍未得到充分报道。此外，只有少数研究描述了 T. indotineae 对治疗的反应：调查对特比萘芬耐药的T. mentagrophytes/T. interdigitale复合感染的发病率、临床特征和治疗效果，并检测T. indotineae病例：采用培养或商业聚合酶链反应方法，对2019年至2023年期间22名患有T. mentagrophytes/T. interdigitale复合感染的患者进行了回顾性队列研究。研究记录了患者的人口统计学特征、疾病特征和治疗反应。对口服特比萘芬无反应的患者接受了进一步的分析，包括对内部转录间隔区进行DNA测序以准确鉴定物种，以及对角鲨烯环氧化物酶（SQLE）基因进行突变分析：患者的平均年龄为 49.7 岁（±18.2），男性占 54.5%。据报告，46.2%的患者（n = 6/13 例；9 例失去治疗反应随访）患有耐特比萘芬的齿癣菌/齿间癣菌复合感染，所有这些患者都表现出广泛的皮肤癣菌病。在耐特比萘芬的T. mentagrophytes/T. interdigitale分离株中，可用于真菌分析的所有5个分离株都被鉴定为T. indotineae，它们都携带SQLE单点突变（Phe397Leu和Leu393Ser）。在对特比萘芬耐药的病例中，只有三例对口服伊曲康唑 200 毫克/天有反应，两例只对口服伏立康唑有反应，一例对口服伊曲康唑 400 毫克/天有反应：结论：本研究评估的所有T.mentagrophytes/T.interigitale病例均被鉴定为T.indotineae，后者表现出SQLE基因突变。这强调了在常规临床实践中整合检测 T. indotineae 的方法的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.