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First case of fatal, sexually transmitted ringworm reported in the USA

Health experts are raising the alarm about new and highly contagious species of fungus after a sexually transmitted strain of ringworm was discovered in a New York man in his 30s – the first case documented in the United States.

According to a recent report, dermatologists have announced the emergence of two new species of fungi that are causing worrying cases of ringworm. Despite its name, ringworm has nothing to do with parasitic worms; rather, it is circular rashes caused by fungal infections of the skin, also known as tinea.

Despite its name, ringworm is not caused by worms, but by fungal infections. These infections are characterized by itchy, circular rashes and can appear anywhere on the body. Depending on the location, they are also known as athlete’s foot or tinea cruris.

Traditionally, ringworm is treated with readily available anti-fungal creams, but recent cases in Asia, Europe, and now the United States have revealed a new trend: more unusual and resilient ringworm species.

Unusual fungal infection

Dr. Avrom Caplan, an autoimmune skin disease specialist at NYU Langone Health, recently came across a unique case. A man in his 30s was developing scaly, circular rashes on his genital area.

Tests initially pointed to a common fungus as the culprit, but genetic sequencing revealed the real culprit: Trichophyton mentagrophytes ITS genotype VII (TMVII). This newly emerging fungus was discovered in Europe and may spread primarily through sexual contact, unlike most ringworm strains.

A French study published last year that analyzed 13 cases of TMVII found evidence of sexual transmission in almost all of them. All of the patients were men who reported regular sexual intercourse with other men.

Further research suggests that Southeast Asia may be the place of origin, with initial spread possibly facilitated by contact with infected sex workers.

Dr. John G. Zampella, the study’s lead author, recommends that doctors ask directly about rashes in the groin and buttocks areas. This is especially true for sexually active people, people who have recently traveled, and people who experience itching elsewhere on the body, as patients may be hesitant to discuss problems in the genital area.

In the current study, Caplan’s case appears to be the first reported case of TMVII in the United States. The patient’s travel history to Europe and California, coupled with the fact that he had multiple male partners during these trips, is consistent with the European findings.

“The realization for clinicians is that TMVII has arrived in the United States, and we should be aware of that,” Caplan said. Gizmodo.

This isn’t the only worrisome fungus Caplan has encountered. Last May, he co-authored a study describing the first known cases of Trichophyton indotineae (T. indotineae) in the United States.

T. indotineae: A double threat of severity and resistance

T. indotineae, which probably originated in India, is of serious concern for several reasons. First, it causes a more severe form of ringworm with itchy and sometimes atypical rashes all over the body, possibly resembling eczema. Second, it is resistant to typical over-the-counter antifungal creams.

Even the first oral medication, terbinafine, often fails. Other oral antifungals such as fluconazole and griseofulvin also often prove ineffective. While itraconazole seems to work at the moment, the eight-week treatment period is long and the drug can have negative interactions with other common medications.

In addition, there is evidence that T. indotineae could also be transmitted sexually.

“This is very concerning given the significant impact on quality of life, the potential for spread to other people, the frequent failure of first-line oral antifungals, and the long duration of treatment required with an oral antifungal,” Caplan explained, emphasizing the significant differences from the more common ringworm, which is easily treated with topical creams.

Research, awareness and improved diagnostics

Although these emerging fungi do not pose an immediate health crisis in the United States, further research is needed.

Unlike other infections, laboratory results currently cannot clearly determine the effectiveness of a particular drug against these new fungi. This lack of information can significantly increase the duration of a patient’s treatment. In addition, Caplan and his colleagues want to raise awareness among dermatologists about these new strains.

Both TMVII and T. indotineae can be confused with common sources of ringworm when using standard testing methods, resulting in delayed appropriate treatment and prolonged suffering.

Caplan is working with public health authorities and the American Academy of Dermatology to raise awareness of these fungi and develop easily accessible resources for effective diagnosis and treatment.

“There are a lot of really great people working on these problems,” Caplan assured. “While these infections are a concern, we are making a concerted effort to get them under control.”

The study was published in JAMA Dermatology.

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