First U.S. case of treatment-resistant ringworm found in New York City patient

CNN
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The US Centers for Disease Control and Prevention has reported the first known case of antifungal-resistant ringworm in the United States and is urging health care providers to be aware of such infections.

Details of the case were reported to CDC in February 2023 and shared in the report. report Published Thursday. The patients, two adult unrelated women living in New York City, first experienced symptoms in 2021 and 2022. One patient had no history of international travel, suggesting some form of community transmission within the United States.

Despite its name, ringworm is not caused by parasites. Rather, it is caused by several types of fungi. In this case, the infection was caused by a recently discovered fungus, Trichophyton indica.

Cases were initially concentrated in South Asian patients, but infections have now been confirmed in European countries as well. These are the first known cases in the United States.

According to the cases in the new report, the first patient went to see a dermatologist in New York City in late February. People with ringworm often have superficial skin rashes that form rings around normally-appearing skin. For the first patient, an anonymous 28-year-old woman appears to have developed a rash in the summer of 2021. She had seen a dermatologist in December of the same year, but she said she had not traveled abroad and she was unaware of any exposure to infections. People with similar rashes.

The first patient had what appeared to be “large circular, scaly pruritic patches” on the neck, stomach, genitals and buttocks, the report said. Her doctors put her on oral therapy, starting her in January 2022.

After two weeks of taking the common antifungal drug terbinafine did not improve her rash, doctors gave her a liquid drug called itraconazole. Itraconazole is a drug commonly used to treat yeast infections that occur in the mouth and throat. Itraconazole seemed to work, and the infection cleared after the patient took the drug for four weeks. Her doctors are still monitoring her because her ringworm infection may return.

The second patient, a 47-year-old woman, developed a rash while visiting Bangladesh in the summer of 2022. Bangladeshi doctors treated him with topical antifungals and steroid creams, but the rash did not appear to subside. Several other families in Bangladesh also developed similar rashes.

In the fall, when a second patient returned to the United States, she made three trips to the emergency room for help. Her doctors put her on several creams and treatments commonly used for ringworm, but by December, dermatologists noted no improvement. Her rash was on her thighs and buttocks.

She was also given oral terbinafine, but her symptoms did not improve. After four weeks of griseofulvin therapy, which is also commonly used to treat athlete’s foot and scalp fungal infections, she improved, but her doctors are considering other treatments. Her son and her husband, who live with her, have also been tested for similar infections.

The report encourages health care workers to be aware of these infections and contact state or local public health departments so that cases can be tested further. The researchers point out that the testing techniques used in most clinical laboratories commonly misidentify this ringworm case as another type of ringworm.

Treatment with itraconazole appeared to work if initial therapy was ineffective, but it may be difficult for some patients to absorb and may be helpful if patients are taking other medications. do not always interact well. Work can take up to 12 weeks.

“Antimicrobial management efforts are essential to minimizing the misuse and overuse of prescription and over-the-counter antifungals and corticosteroids,” the report states.

The CDC also encouraged doctors to educate patients on how to prevent the spread of ringworm.

Doctors advise patients not to share clothing or hats with anyone with a rash and to avoid close contact with someone with ringworm.