Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany-"The Tip of the Iceberg?".
Details
Serval ID
serval:BIB_28D1B1158F76
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany-"The Tip of the Iceberg?".
Journal
Journal of fungi
ISSN
2309-608X (Electronic)
ISSN-L
2309-608X
Publication state
Published
Issued date
05/10/2020
Peer-reviewed
Oui
Volume
6
Number
4
Pages
E207
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T. mentagrophytes Type VIII from India, with many strains resistant to terbinafine, to other parts of the world. From September 2016 until March 2020, a total of 29 strains of T. mentagrophytes Type VIII (India) were isolated. All patients were residents of Germany: 12 females, 15 males and the gender of the remaining two was not assignable. Patients originated from India (11), Pakistan (two), Bangladesh (one), Iraq (two), Bahrain (one), Libya (one) and other unspecified countries (10). At least two patients were German-born residents. Most samples (21) were collected in 2019 and 2020. All 29 T. mentagrophytes isolates were sequenced (internal transcribed spacer (ITS) and translation elongation factor 1-α gene (TEF1-α)). All were identified as genotype VIII (India) of T. mentagrophytes. In vitro resistance testing revealed 13/29 strains (45%) to be terbinafine-resistant with minimum inhibitory concentration (MIC) breakpoints ≥0.2 µg/mL. The remaining 16 strains (55%) were terbinafine-sensitive. Point mutation analysis revealed that 10/13 resistant strains exhibited Phe <sup>397</sup> Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe <sup>397</sup> Leu and Ala <sup>448</sup> Thr amino acid substitutions, and one strain a single Leu <sup>393</sup> Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala <sup>448</sup> Thr, and in one Ala <sup>448</sup> Thr +, new Val <sup>444</sup> Ile amino acid substitutions were detected. Resistance to both itraconazole and voriconazole was observed in three out of 13 analyzed strains. Treatment included topical ciclopirox olamine plus topical miconazole or sertaconazole. Oral itraconazole 200 mg twice daily for four to eight weeks was found to be adequate. Terbinafine-resistant T. mentagrophytes Type VIII are being increasingly isolated. In Germany, transmission of T. mentagrophytes Type VIII from the Indian subcontinent to Europe should be viewed as a significant public health issue.
Keywords
Ciclopirox, Itraconazole, Miconazole, dermatophytoses, point mutation, squalene epoxidase, terbinafine-resistant, transmission
Pubmed
Web of science
Open Access
Yes
Create date
26/10/2020 7:44
Last modification date
08/08/2024 6:31