■对用于治疗甲癣和其他表面真菌感染的抗真菌药物的耐药性的报道正在增加。抗真菌耐药性的这种上升带来了需要关注的公共卫生挑战。
■这篇综述探讨了皮肤癣菌的流行以及目前皮肤癣菌物种之间的关系,它们对特比萘芬(烯丙胺)和伊曲康唑(唑)的最低抑制浓度(MIC),以及这些物种中普遍存在的各种突变。甲癣和皮肤癣菌病患者中最常见的皮肤癣菌是T.然而,T.indotineae是SQLE基因突变最普遍的分离株,特比萘芬的最高MIC为8µg/ml,而伊曲康唑的MIC为8µg/ml,≥32µg/ml。总的来说,最普遍的SQLE突变是Phe397Leu,Leu393Phe,Ala448Thr,Phe397Leu/Ala448Thr,和Lys276Asn/Leu415Phe(相对较新)。
■管理皮肤癣菌感染需要个性化的方法。应获得详细的历史记录,包括旅行的详细信息,家庭和职业暴露,和皮肤的临床检查,指甲和其他身体系统。相关测试包括真菌学检查(传统和分子)。附加测试,如果可用,包括MIC评估和SQLE突变的检测。如果怀疑特比萘芬耐药,伊曲康唑或伏立康唑(不太常见)应考虑。
UNASSIGNED: The reports of resistance to antifungal agents used for treating onychomycosis and other superficial fungal infections are increasing. This rise in antifungal resistance poses a public health challenge that requires attention.
UNASSIGNED: This review explores the prevalence of dermatophytes and the current relationship between dermatophyte species, their minimum inhibitory concentrations (MICs) for terbinafine (an allylamine) and itraconazole (an azole), and various mutations prevalent in these species. The most frequently isolated dermatophyte associated with resistance in patients with onychomycosis and dermatophytosis was T. mentagrophytes. However, T. indotineae emerged as the most prevalent isolate with mutations in the SQLE gene, exhibiting the highest MIC of 8 µg/ml for terbinafine and MICs of 8 µg/ml and ≥ 32 µg/ml for itraconazole.Overall, the most prevalent SQLE mutations were Phe397Leu, Leu393Phe, Ala448Thr, Phe397Leu/Ala448Thr, and Lys276Asn/Leu415Phe (relatively recent).
UNASSIGNED: Managing dermatophyte infections requires a personalized approach. A detailed history should be obtained including details of travel, home and occupational exposure, and clinical examination of the skin, nails and other body systems. Relevant testing includes mycological examination (traditional and molecular). Additional testing, where available, includes MIC evaluation and detection of SQLE mutations. In case of suspected terbinafine resistance, itraconazole or voriconazole (less commonly) should be considered.