Assessing U.S. public health awareness and laboratory readiness for Trichophyton Indotineae

Abstract

Trichophyton indotineae is a highly transmissible, multidrug-resistant dermatophyte that presents a growing international public health concern. Accurate diagnosis often requires molecular testing, yet many laboratories lack the tools or awareness to identify it. To evaluate diagnostic readiness in the United States, we surveyed public health mycologists and microbiologists across all 50 states, Puerto Rico, American Samoa, and the Centers for Disease Control and Prevention (CDC). The survey assessed familiarity with T. indotineae and access to speciation and resistance testing. We received 45 responses (86.5% response rate), revealing that 71% of respondents were either unfamiliar with T. indotineae or unsure if they had encountered it. Only four public health laboratories reported the capability to identify T. indotineae or perform antifungal susceptibility testing. Most indicated they would refer unidentified dermatophyte samples to the CDC, despite the agency confirming it does not currently offer CLIA-certified testing for this pathogen. These findings highlight major gaps in awareness and testing capacity across the U.S. public health system. Improving diagnostic access and provider education will be critical for effective surveillance and management of this emerging fungal threat.