Abstract：
BACKGROUND: The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies.
METHODS: A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction.
CONCLUSIONS: A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing.
CONCLUSIONS: Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.
METHODS: A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction.
CONCLUSIONS: A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing.
CONCLUSIONS: Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.
摘要：
背景：吲哚毛癣菌的全球传播对皮肤癣菌病的治疗提出了紧迫的挑战。这篇系统的综述探讨了吲哚丁菌感染的现状，强调抵抗模式，敏感性试验,突变分析,和管理策略。
方法：2023年11月使用Embase进行了文献检索，PubMed,Scopus,和WebofScience数据库。纳入标准涵盖临床试验，观察性研究，案例系列,或通过分子方法诊断为吲哚虫的病例报告。关于抗性机制的报告，抗真菌药敏试验,和管理用于数据提取。
结论：通过系统搜索过程，共识别出1148篇文章，45人符合纳入标准。吲哚虫在全球的传播是显而易见的,2023年，许多新国家报告了病例。几个小组提出的初步流行病学临界值（ECOFF）提供了对临床耐药性可能性的见解。特定突变的存在，尤其是Phe397Leu，与较高的最低抑制浓度(MIC)相关，表明潜在的临床耐药性。也有报道并研究了吲哚的抗药性。也是一个越来越令人担忧的问题。然而，伊曲康唑仍然是一种替代疗法。管理建议包括口服或联合治疗以及基于突变分析和敏感性测试的个性化方法。
结论：吲哚毛癣菌构成了一个复杂的临床情景，需要加强监测，改进的诊断,并谨慎使用抗真菌药物。皮肤癣菌缺乏已建立的临床断点，这凸显了在这一具有挑战性的领域进行进一步研究的必要性。
方法：2023年11月使用Embase进行了文献检索，PubMed,Scopus,和WebofScience数据库。纳入标准涵盖临床试验，观察性研究，案例系列,或通过分子方法诊断为吲哚虫的病例报告。关于抗性机制的报告，抗真菌药敏试验,和管理用于数据提取。
结论：通过系统搜索过程，共识别出1148篇文章，45人符合纳入标准。吲哚虫在全球的传播是显而易见的,2023年，许多新国家报告了病例。几个小组提出的初步流行病学临界值（ECOFF）提供了对临床耐药性可能性的见解。特定突变的存在，尤其是Phe397Leu，与较高的最低抑制浓度(MIC)相关，表明潜在的临床耐药性。也有报道并研究了吲哚的抗药性。也是一个越来越令人担忧的问题。然而，伊曲康唑仍然是一种替代疗法。管理建议包括口服或联合治疗以及基于突变分析和敏感性测试的个性化方法。
结论：吲哚毛癣菌构成了一个复杂的临床情景，需要加强监测，改进的诊断,并谨慎使用抗真菌药物。皮肤癣菌缺乏已建立的临床断点，这凸显了在这一具有挑战性的领域进行进一步研究的必要性。
