(Source-Gavi-the-Vaccine-Alliance)
The Indiana Department of Health has alerted coroners, law enforcement, and healthcare providers to be vigilant about new, highly contagious forms of ringworm and jock itch. These fungal infections are becoming a significant public health concern, as detailed in two recent reports from NYU Langone Health. The reports highlight the emergence of sexually transmitted fungal infections in the United States, which can persist for months despite treatment.
In the first study, NYU Langone experts documented the first U.S. case of a sexually transmitted fungal infection caused by Trichophyton mentagrophytes type VII (TMVII). This species is part of a group that causes skin rashes known as tinea, which can affect the face, limbs, groin, and feet. However, the tinea in these new reports often deviates from the typical ringworm appearance, resembling eczema and thus going untreated for extended periods.
Published online in JAMA Dermatology, the study describes a man in his 30s who developed tinea on his penis, buttocks, and limbs after traveling to England, Greece, and California. Genetic testing revealed TMVII as the culprit, a form increasingly diagnosed in Europe, particularly among men who have sex with men. Despite the man’s multiple sexual encounters, none of his partners reported similar symptoms. Dr. Avrom S. Caplan, the study’s lead author, emphasized the need for healthcare providers to recognize TMVII as a new and severe skin infection now present in the U.S.
Fungal Infections Treatment Challenges and Resistance
Dr. Caplan and his colleague, Dr. John G. Zampella, highlighted the difficulties in treating TMVII fungal infections, which can take months to resolve even with standard antifungal therapies like terbinafine. Dr. Zampella, an associate professor at NYU Grossman School of Medicine, urged physicians to inquire directly about rashes in the groin and buttocks, especially in sexually active patients who have recently traveled abroad and report itching.
The second report, also published in JAMA Dermatology, sheds light on Trichophyton indotineae, another challenging fungal strain. This infection, widespread in India and now globally reported, was first confirmed in the U.S. last year. T. indotineae causes similar itchy and contagious rashes but often resists terbinafine treatment. Researchers collected data from 11 patients treated for ringworm in New York City hospitals, finding that the infection persisted despite standard terbinafine therapy.
Genetic analysis of T. indotineae samples revealed mutations that hinder terbinafine’s effectiveness by preventing it from attaching to fungal cells and damaging their protective membranes. When treated with another antifungal, itraconazole, some patients showed improvement, though the drug’s side effects and interactions with other medications pose significant challenges.
Future Research and Ongoing Monitoring
Dr. Caplan underscored the importance of recognizing the deceptive symptoms of these infections and tailoring treatment to each patient’s needs. The findings offer crucial insights into how fungal infections from South Asia can evade traditional therapies. Dr. Caplan plans to collaborate with experts nationwide and internationally to expand research and monitor emerging cases.
Despite the low current rates of TMVII and T. indotineae in the United States, dermatologists are urged to remain vigilant. The studies were funded by NYU Langone and involved numerous researchers from various institutions, including the New York State Department of Health, Weill Cornell Medicine, and the U.S. Centers for Disease Control and Prevention.
The collaborative effort highlights the ongoing need for awareness and research to combat these evolving public health threats effectively.
