Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance
Abstract
:1. Introduction
2. Epidemiology of Dermatophyte Infections
3. Clinical Perspectives of Tinea
4. Standard Treatment of Tinea Infections and Current Limitations
5. Treatment Failure and Diagnostic Challenges
6. Emergence of Drug Resistant Organisms
7. The Impact of Increasing Trends of Fungal Infections and Growing Antifungal Resistance
8. Management Prospective and Alternative Treatments
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Tinea Infection | Body Area Affected | Most Common Causative Pathogens |
---|---|---|
Tinea Capitis | Head and scalp | T. tonsurans, Microsporum canis [11] |
Tinea Corporis | Trunk and extremities | T. rubrum, T. mentagrophytes, T. tonsurans [25] |
Tinea Cruris | Groin, pubic region, intertriginous anogenital region | T. rubrum, T. mentagrophytes [26,27,28] |
Tinea Faciei | Face | T. rubrum, T. mentagrophytes [30,31] |
Tinea Barbae | Beard and mustache area | T. verrucosum, T. rubrum, T. mentagrophytes [32] |
Tinea Manuum | Hands | T. rubrum [33] |
Tinea Pedis | Feet | T. rubrum, T. mentagrophytes, Epidermophyton floccosum [18,34,35,36] |
Onychomycosis (Tinea Unguium) | Nails | T. rubrum, T. mentagrophytes [37,38] |
Tinea Infection | Systemic Therapy | Local Therapy |
---|---|---|
Tinea Capitis [24] | Terbinafine or Griseofulvin. If kerion is present, add steroids. | Not recommended. Itraconazole or Fluconazole may be used in some cases. |
Tinea Corporis [45,46] | Indicated for severe infection caused by T. rubrum. Terbinafine, Itraconazole, Fluconazole, or Griseofulvin. Terbinafine is indicated for Majocchi Granuloma. | Azoles or Allylamines |
Tinea Cruris [27,47] | Indicated for chronic or recurrent infection. Terbinafine, Itraconazole, or Fluconazole. | Azoles or Allylamines |
Tinea Faciei [30,48] | Indicated for severe or refractory infection or involvement of vellus hair | Azoles or Allylamines |
Tinea Barbae [32] | Terbinafine, Itraconazole, Fluconazole, or Ketoconazole | Azoles or Allylamines as adjunct therapy |
Tinea Manuum [33,49,50] | Indicated for co-infection of the nail, two feet-one hand syndrome, and chronic or recurrent infection. Terbinafine or Itraconazole may be effective. | Azoles or Allylamines |
Tinea Pedis [6,50,51,52,53] | Indicated for treatment-resistant infection. Terbinafine, Itraconazole, Fluconazole, Ketoconazole, or Griseofulvin. | Indicated for uncomplicated or mild interdigital infection. Azoles or Allylamines. Luliconazole or Naftifine may be used for interdigital infection. Initial treatment with topical corticosteroids may be beneficial. |
Onychomycosis (Tinea Unguium) [54,55,56,57,58,59] | Indicated for moderate to severe infection. Terbinafine or Itraconazole. Avoid Griseofulvin (lower efficacy) and Ketoconazole (hepatotoxicity). | Indicated for mild to moderate infection. Efinaconazole, Ciclopirox, or Amorolfine. |
Dermatophyte Pathogen | Resistance Mechanisms | Primary Associated Antifungal(s) |
---|---|---|
T. indotineae | F397L, L393F, F415S, or H440Y squalene epoxidase gene point mutations [84,86], Ala448Thr amino acid substitution in erg1 [87], overexpression of TinCYP51B gene [85] | Terbinafine, Itraconazole, Voriconazole |
T. interdigitale | F397L, L393F, F415S, H440Y F484Y or I121M V237I squalene epoxidase gene point mutations [81] | Terbinafine |
T. mentagrophytes | F397L or L393F squalene epoxidase gene point mutations [81] | Terbinafine |
T. rubrum | F397L, L393F, F415S, H440Y F484Y or I121M V237I squalene epoxidase gene point mutations [81], azole efflux pump (i.e., overexpression of TruMDR2 and TruMDR3 genes) [85] | Terbinafine, Itraconazole, Voriconazole |
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Kruithoff, C.; Gamal, A.; McCormick, T.S.; Ghannoum, M.A. Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance. Life 2024, 14, 1. https://doi.org/10.3390/life14010001
Kruithoff C, Gamal A, McCormick TS, Ghannoum MA. Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance. Life. 2024; 14(1):1. https://doi.org/10.3390/life14010001
Chicago/Turabian StyleKruithoff, Caroline, Ahmed Gamal, Thomas S. McCormick, and Mahmoud A. Ghannoum. 2024. "Dermatophyte Infections Worldwide: Increase in Incidence and Associated Antifungal Resistance" Life 14, no. 1: 1. https://doi.org/10.3390/life14010001