The Centre for Disease Control and Prevention (CDC) reported two cases of drug resistant ringworm in the United States in January. The agency has now published a report urging healthcare providers to watch out for such infections.
About Drug Resistant Ringworm:
Drug-resistant ringworm, also known as antifungal-resistant ringworm, refers to a strain of the fungal infection that has become resistant to traditional antifungal medications commonly used for its treatment. In these cases, standard antifungal drugs fail to effectively eradicate the infection, leading to persistent or recurrent symptoms.
Both cases were reported in women from New York. However, only one of them has a history of international travel, and the two cases are unrelated.
The first case was discovered in a 28-year-old woman in the summer of 2021. Although she had not been in contact with anyone with a similar affliction or traveled internationally, she developed rashes on her neck, stomach, pubic region, and buttocks. Reports describe the patient’s rashes as scaly and annular.
The patient visited a dermatologist in December and was prescribed oral therapy by doctors, which she started taking in January 2022. When a two-week regimen of terbinafine led to no improvement, doctors moved the patient to itraconazole. While the former medication is a typical antifungal, the latter is only used in particularly serious cases and is usually prescribed for yeast infections in the mouth and throat.
After four weeks on itraconazole, the rashes started to clear up. However, the patient is still being monitored by her doctors because of the possibility of the infection recurring.
The second patient identified was a 47-year-old woman who had developed the disease during her travel to Bangladesh. She was diagnosed by Dr. Avrom Caplan of the NYU Grossman School of Medicine, who revealed that the patient had been infected by a relatively new species of ringworm-causing fungus called Trichophyton indoline.
In Bangladesh, the patient was treated with topical antifungal and steroid creams. Upon her return to the U.S., when the rash did not clear up, doctors first prescribed her several creams and treatments typically used for ringworm, and then oral terbinafine.
Over the past decade, cases of ringworm have surged in South Asia. Still, the fact that one of the patients in the report had no travel history to indicate where she may have acquired the disease can be taken as a sign of epidemiological changes within the fungal species.
According to Dr. Priya Soni at Cedars-Sinai Medical Center L.A., “The infection may also be a little more widespread than we have noted before, so, for physicians and other providers, I think it’s important to be aware that we may be seeing more of this particular species as we go into the warmer, moist summer months. I think with globalization and just the travel that we’re going to see over the summer, this may be something that we may see more of as the months go on.”
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