Experts Warn of Tough Fungal Skin Infections in the U.S.

Healthcare providers in the United States should be vigilant about new, highly contagious forms of ringworm and jock itch, which are emerging as potential public health concerns. Two recent studies from NYU Langone Health highlight these threats.

The first study, published in JAMA Dermatology on June 5, 2024, documents the first U.S. case of a sexually transmitted fungal infection caused by Trichophyton mentagrophytes type VII (TMVII). The infection can take months to clear up even with treatment. This case involved a man in his 30s who developed tinea on his penis, buttocks, and limbs after traveling to England, Greece, and California. Genetic tests confirmed the infection was caused by TMVII, a fungal strain increasingly diagnosed in Europe, particularly among men who have sex with men. The man had multiple male partners during his travels, none of whom reported similar symptoms.

Dr. Avrom Caplan, the study's lead author and a dermatologist at NYU Grossman School of Medicine, emphasized the importance of healthcare providers being aware of TMVII. Dr. John Zampella, the study's senior author, noted that physicians should directly inquire about rashes around the groin and buttocks, especially in sexually active patients who have recently traveled and report itchy areas on their bodies. Though TMVII infections are challenging to treat, they generally respond to standard antifungal therapies like terbinafine.

The second study, published online in May in JAMA Dermatology, focuses on Trichophyton indotineae (T. indotineae), a fungus widespread in India now reported globally. This strain, confirmed in the U.S. last year, causes similar rashes but often resists terbinafine treatment. Researchers collected data from 11 patients treated for ringworm in New York City hospitals between May 2022 and May 2023, confirming T. indotineae as the cause. Despite standard terbinafine treatment, their rashes did not improve.

The study revealed several genetic mutations in the fungal samples that prevent terbinafine from effectively targeting fungal cells. These mutations might explain why the therapy often failed. When seven patients were treated with another antifungal, itraconazole, three recovered fully, and two showed improvement. However, Dr. Caplan cautioned that while itraconazole is effective, it can interfere with many medications and cause side effects like nausea and diarrhea, making it challenging for long-term use.

Dr. Caplan highlighted the importance of recognizing the misleading signs of these fungal infections. He also plans to collaborate with fungi experts in the U.S. and internationally to expand research efforts and track emerging cases. While the current rates of TMVII and T. indotineae infections in the U.S. remain low, dermatologists should be on alert for signs.

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