■吲哚毛癣菌是一种新兴的皮肤癣菌,可引起广泛的癣感染,通常对特比萘芬无反应。该物种已在世界范围内和美国多个州被发现,然而,美国关于吲哚T菌感染的详细数据很少,可以改善治疗实践和医学对传播的认识.
■为了将吲哚T菌感染的临床特征与体外抗真菌药敏试验结果联系起来,角鲨烯环氧酶基因序列变异,并使用全基因组测序分离亲缘关系。
■这项针对纽约市丁香杆菌感染患者的回顾性队列研究涵盖了2022年5月至2023年5月。从纽约市的6个医疗中心招募了确诊的T-indotineae感染的患者。
■最后一次随访评估时的改善或解决。
■在11例吲哚T患者中(男性6例,女性5例;中位[范围]年龄,39[10-65]年),2人怀孕;1人患有淋巴瘤;其余均具有免疫能力。九名患者报告以前曾前往孟加拉国。所有患者均有广泛的病变,有不同的规模和炎症,局部抗真菌单药治疗失败,和诊断延迟(范围,3-42个月)。7例患者在标准剂量(每天250mg)下长期服用特比萘芬治疗失败;这些患者的分离株在角鲨烯环氧酶的393(L393S)或397(F397L)位具有氨基酸取代,与特比萘芬最低抑制浓度升高至0.5μg/mL或更高相关。接受氟康唑和灰黄霉素治疗的患者在4例中的2例和5例中的2例得到改善,分别,结果与抗真菌最低抑制浓度之间没有相关性。此外,7例接受伊曲康唑治疗的患者中有5例在末次随访时清除或改善,7人中有2人失去随访或停止治疗.基于全基因组测序分析,美国分离株形成了一个与印度分离株不同的集群。
■本病例系列的结果表明,疾病的严重程度,诊断延迟,和缺乏对典型使用的剂量和持续时间的抗真菌药对癣的反应是常见的在这个主要有免疫能力的患者队列与吲哚。与公布的数据一致。伊曲康唑一般有效,感染很可能发生在孟加拉国。
UNASSIGNED: Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to
terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission.
UNASSIGNED: To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing.
UNASSIGNED: This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers.
UNASSIGNED: Improvement or resolution at the last follow-up assessment.
UNASSIGNED: Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months).
Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated
terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates.
UNASSIGNED: The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.