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Trichophyton indotineae

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Trichophyton indotineae
Culture of Trichophyton indotineae on Sabouraud agar in a tube (front above, and back, below).
Scientific classification Edit this classification
Domain: Eukaryota
Kingdom: Fungi
Division: Ascomycota
Class: Eurotiomycetes
Order: Onygenales
Family: Arthrodermataceae
Genus: Trichophyton
Species:
T. indotineae
Binomial name
Trichophyton indotineae
R. Kano, U. Kimura, M. Kakurai, J. Hiruma, H. Kamata, Y. Suga & K. Harada

Trichophyton indotineae is a recently identified fungus species within the Trichophyton genus,[1] known for causing dermatophytosis—a fungal infection of the skin. First emerging in South Asia over the past decade,[2] T. indotineae has been associated with widespread outbreaks of severe, treatment-resistant, and frequently relapsing skin infections among otherwise healthy individuals.[3]

Taxonomy and identification

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Originally classified as Trichophyton mentagrophytes genotype VIII, molecular studies have since distinguished T. indotineae as a separate species within the T. mentagrophytes complex.[1][4]

The macroscopic appearance of Trichophyton indotineae colonies is similar to that of Trichophyton mentagrophytes. The colonies exhibit a white, powdery surface with a reverse side that ranges in color from white to brown. Microscopy is characterized by the presence of small and large round and oval microconidia, septate spindle-shaped macroconidia, and spiral hyphae.[5] Neither the macroscopic nor the microscopic appearance allows differentiation between Trichophyton indotineae and Trichophyton mentagrophytes.

Clinical manifestations

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Infections caused by T. indotineae often present as inflammatory and intensely itchy dermatophytosis, affecting areas such as the groin, buttocks, trunk, and face. Lesions are typically extensive and pruritic, leading to significant discomfort.[6][7]

Antifungal resistance

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A notable characteristic of T. indotineae is its reduced susceptibility to common antifungal treatments, particularly terbinafine, which has traditionally been a first-line oral therapy for dermatophyte infections. However, this resistance is not observed in all strains; some studies have reported up to 85% of isolates[8] exhibiting resistance. This decreased efficacy is often associated with mutations in the squalene epoxidase gene.[9]

Alternative treatments, such as itraconazole administered at high dose for several weeks, have shown efficacy. Voriconazole has also been effective, while fluconazole is generally ineffective. Topical treatments alone are often insufficient but may be beneficial when combined with systemic therapy.[10]

Global spread

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While initially prevalent in South Asia,[11][5] cases of T. indotineae infections have been reported globally, including in North America[12][13] and Europe.[14][15][7][16][17] The global spread is concerning, especially given the challenges associated with treatment-resistant strains.

References

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  1. ^ a b Kano, Rui; Kimura, Utako; Kakurai, Maki; Hiruma, Junichiro; Kamata, Hiroshi; Suga, Yasushi; Harada, Kazutoshi (December 2020). "Trichophyton indotineae sp. nov.: A New Highly Terbinafine-Resistant Anthropophilic Dermatophyte Species". Mycopathologia. 185 (6): 947–958. doi:10.1007/s11046-020-00455-8. ISSN 0301-486X. PMID 32449054.
  2. ^ Bishnoi, Anuradha; Vinay, Keshavamurthy; Dogra, Sunil (March 2018). "Emergence of recalcitrant dermatophytosis in India". The Lancet Infectious Diseases. 18 (3): 250–251. doi:10.1016/S1473-3099(18)30079-3. PMID 29485088.
  3. ^ Chowdhary, Anuradha; Singh, Ashutosh; Kaur, Amtoj; Khurana, Ananta (2022-09-29). Jabra-Rizk, Mary Ann (ed.). "The emergence and worldwide spread of the species Trichophyton indotineae causing difficult-to-treat dermatophytosis: A new challenge in the management of dermatophytosis". PLOS Pathogens. 18 (9): e1010795. doi:10.1371/journal.ppat.1010795. ISSN 1553-7374. PMC 9521800. PMID 36173977.
  4. ^ Tang, Chao; Kong, Xue; Ahmed, Sarah A.; Thakur, Rameshwari; Chowdhary, Anuradha; Nenoff, Pietro; Uhrlass, Silke; Verma, Shyam B.; Meis, Jacques F.; Kandemir, Hazal; Kang, Yingqian; de Hoog, G. Sybren (June 2021). "Taxonomy of the Trichophyton mentagrophytes/T. interdigitale Species Complex Harboring the Highly Virulent, Multiresistant Genotype T. indotineae". Mycopathologia. 186 (3): 315–326. doi:10.1007/s11046-021-00544-2. ISSN 0301-486X. PMC 8249266. PMID 33847867.
  5. ^ a b Uhrlaß, Silke; Verma, Shyam B.; Gräser, Yvonne; Rezaei-Matehkolaei, Ali; Hatami, Maryam; Schaller, Martin; Nenoff, Pietro (2022-07-21). "Trichophyton indotineae—An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide—A Multidimensional Perspective". Journal of Fungi. 8 (7): 757. doi:10.3390/jof8070757. ISSN 2309-608X. PMC 9323571. PMID 35887512.
  6. ^ Gupta, Aditya K.; Venkataraman, Maanasa; Hall, Deanna C.; Cooper, Elizabeth A.; Summerbell, Richard C. (July 2023). "The emergence of Trichophyton indotineae : Implications for clinical practice". International Journal of Dermatology. 62 (7): 857–861. doi:10.1111/ijd.16362. ISSN 0011-9059. PMID 35867962.
  7. ^ a b Jabet, Arnaud; Brun, Sophie; Normand, Anne-Cecile; Imbert, Sebastien; Akhoundi, Mohammad; Dannaoui, Eric; Audiffred, Laeticia; Chasset, Francois; Izri, Arezki; Laroche, Liliane; Piarroux, Renaud; Bachmeyer, Claude; Hennequin, Christophe; Sabater, Alicia Moreno (January 2022). "Extensive Dermatophytosis Caused by Terbinafine-Resistant Trichophyton indotineae , France". Emerging Infectious Diseases. 28 (1): 229–233. doi:10.3201/eid2801.210883. ISSN 1080-6040. PMC 8714191. PMID 34932456.
  8. ^ Leeyaphan, Charussri; Saengthong-aram, Phuwakorn; Laomoleethorn, Jomgriditip; Phinyo, Phichayut; Lumkul, Lalita; Bunyaratavej, Sumanas (April 2025). "Therapeutic Outcomes in Patients With Trichophyton indotineae : A Systematic Review and Meta-Analysis of Individual Patient Data". Mycoses. 68 (4): e70048. doi:10.1111/myc.70048. ISSN 0933-7407. PMC 11971648. PMID 40186426.
  9. ^ Yamada, Tsuyoshi; Maeda, Mari; Alshahni, Mohamed Mahdi; Tanaka, Reiko; Yaguchi, Takashi; Bontems, Olympia; Salamin, Karine; Fratti, Marina; Monod, Michel (July 2017). "Terbinafine Resistance of Trichophyton Clinical Isolates Caused by Specific Point Mutations in the Squalene Epoxidase Gene". Antimicrobial Agents and Chemotherapy. 61 (7). doi:10.1128/AAC.00115-17. ISSN 0066-4804. PMC 5487658. PMID 28416557.
  10. ^ Gupta, Aditya K.; Wang, Tong; Mann, Avantika; Polla Ravi, Shruthi; Talukder, Mesbah; Lincoln, Sara A.; Foreman, Hui-Chen; Kaplan, Baruch; Galili, Eran; Piguet, Vincent; Shemer, Avner; Bakotic, Wayne L. (September 2024). "Antifungal resistance in dermatophytes – review of the epidemiology, diagnostic challenges and treatment strategies for managing Trichophyton indotineae infections". Expert Review of Anti-infective Therapy. 22 (9): 739–751. doi:10.1080/14787210.2024.2390629. ISSN 1478-7210. PMID 39114868.
  11. ^ Singh, Ashutosh; Masih, Aradhana; Khurana, Ananta; Singh, Pradeep Kumar; Gupta, Meenakshi; Hagen, Ferry; Meis, Jacques F.; Chowdhary, Anuradha (July 2018). "High terbinafine resistance in Trichophyton interdigitale isolates in Delhi, India harbouring mutations in the squalene epoxidase gene". Mycoses. 61 (7): 477–484. doi:10.1111/myc.12772. ISSN 0933-7407.
  12. ^ Posso-De Los Rios, Claudia J.; Tadros, Enas; Summerbell, Richard C.; Scott, James A. (July 2022). "Terbinafine Resistant Trichophyton Indotineae Isolated in Patients With Superficial Dermatophyte Infection in Canadian Patients". Journal of Cutaneous Medicine and Surgery. 26 (4): 371–376. doi:10.1177/12034754221077891. ISSN 1203-4754. PMID 35144480.
  13. ^ Cañete-Gibas, Connie F.; Mele, James; Patterson, Hoja P.; Sanders, Carmita J.; Ferrer, Dora; Garcia, Victor; Fan, Hongxin; David, Marjorie; Wiederhold, Nathan P. (2023-07-11). Hanson, Kimberly E. (ed.). "Terbinafine-Resistant Dermatophytes and the Presence of Trichophyton indotineae in North America". Journal of Clinical Microbiology. 61 (8): e0056223. doi:10.1128/jcm.00562-23. ISSN 0095-1137. PMC 10446870. PMID 37432126.
  14. ^ Astvad, Karen Marie Thyssen; Hare, Rasmus Krøger; Jørgensen, Karin Meinike; Saunte, Ditte Marie Lindhardt; Thomsen, Philip Kjettinge; Arendrup, Maiken Cavling (2022-07-29). "Correction: Astvad et al. Increasing Terbinafine Resistance in Danish Trichophyton Isolates 2019–2020. J. Fungi 2022, 8, 150". Journal of Fungi. 8 (8): 801. doi:10.3390/jof8080801. ISSN 2309-608X. PMC 9409937. PMID 36012877.
  15. ^ Sacheli, Rosalie; Harag, Saadia; Dehavay, Florence; Evrard, Séverine; Rousseaux, Danielle; Adjetey, Akole; Seidel, Laurence; Laffineur, Kim; Lagrou, Katrien; Hayette, Marie-Pierre (2020-09-29). "Belgian National Survey on Tinea Capitis: Epidemiological Considerations and Highlight of Terbinafine-Resistant T. mentagrophytes with a Mutation on SQLE Gene". Journal of Fungi. 6 (4): 195. doi:10.3390/jof6040195. ISSN 2309-608X. PMC 7712443. PMID 33003309.
  16. ^ Moreno-Sabater, Alicia; Normand, Anne-Cécile; Bidaud, Anne-Laure; Cremer, Geneviève; Foulet, Françoise; Brun, Sophie; Bonnal, Christine; Aït-Ammar, Nawel; Jabet, Arnaud; Ayachi, Aymen; Piarroux, Renaud; Botterel, Françoise; Houzé, Sandrine; Desoubeaux, Guillaume; Hennequin, Christophe (2022-02-23). "Terbinafine Resistance in Dermatophytes: A French Multicenter Prospective Study". Journal of Fungi. 8 (3): 220. doi:10.3390/jof8030220. ISSN 2309-608X. PMC 8948947. PMID 35330222.
  17. ^ Nenoff, Pietro; Verma, Shyam B.; Ebert, Andreas; Süß, Anke; Fischer, Eleni; Auerswald, Elke; Dessoi, Stephanie; Hofmann, Wencke; Schmidt, Simone; Neubert, Kathrin; Renner, Regina; Sohl, Sirius; Hradetzky, Uta; Krusche, Ursula; Wenzel, Hans-Christian (2020-10-05). "Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany–"The Tip of the Iceberg?"". Journal of Fungi. 6 (4): 207. doi:10.3390/jof6040207. ISSN 2309-608X. PMC 7712673. PMID 33027904.
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