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Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany-"The Tip of the Iceberg?"

  • Nenoff P Labor für Medizinische Mikrobiologie, 04571 Rötha OT Mölbis, Germany.
  • Verma SB "Nirvan" and "In Skin" Clinics, Vadodara, 390020 Gujarat, India.
  • Ebert A Labor für Medizinische Mikrobiologie, 04571 Rötha OT Mölbis, Germany.
  • Süß A Hautärztin, Gemeinschaftspraxis Allgemeinmedizin und Dermatologie, Kurfürstenstraße 23 a, 54616 Wittlich, Germany.
  • Fischer E Hautarztpraxis Gunhild Kratzsch, Kochstraße 66, 04275 Leipzig, Germany.
  • Auerswald E Hautarztpraxis, Lungwitzer Straße 30, 09337 Hohenstein-Ernstthal, Germany.
  • Dessoi S Hautzentrum Nordwest, Tituscorso 2-6, 60439 Frankfurt am Main, Germany.
  • Hofmann W Hautzentrum Nordwest, Tituscorso 2-6, 60439 Frankfurt am Main, Germany.
  • Schmidt S Hautarztpraxis im MVZ Friedrichstadt, Friedrichstraße 41, Haus A-Haupteingang-1. OG, 01067 Dresden, Germany.
  • Neubert K Hautarztpraxis Dipl. med. Kathrin Neubert, Bertolt- Brecht-Straße 2, 09217 Burgstädt, Germany.
  • Renner R Gemeinschaftspraxis Dres. med. S. Sohl & R. Renner, Katharinenstr. 33, 73728 Esslingen, Germany.
  • Sohl S Gemeinschaftspraxis Dres. med. S. Sohl & R. Renner, Katharinenstr. 33, 73728 Esslingen, Germany.
  • Hradetzky U Hautarztpraxis, Landsberger Straße 4, 04157 Leipzig, Germany.
  • Krusche U Hautarztpraxis, Landsberger Straße 4, 04157 Leipzig, Germany.
  • Wenzel HC Hautarztpraxis/Phlebologie, Waldkerbelstraße 12, 04329 Leipzig, Germany.
  • Staginnus A Hautarztpraxis, 04668 Grimma, Germany.
  • Schaller J Dermatopathologie Duisburg, J. Schaller und C. Hendricks, 47166 Duisburg, Germany.
  • Müller V Helios Klinikum Duisburg, Klinik für Dermatologie, Allergologie und Phlebologie, 47166 Duisburg, Germany.
  • Tauer C Hautarztpraxis Christiane Tauer, Marcel- Callo- Platz 4, 98544 Zella-Mehlis, Germany.
  • Gebhardt M Hautarztpraxis, Matthias Gebhardt, Leipziger Str. 90, 08058 Zwickau, Germany.
  • Schubert K Hautarztpraxis Dresden, Loschwitzer Straße 40, D-01309 Dresden, Germany.
  • Almustafa Z Klinik für Dermatologie, Charite, 10117 Berlin, Germany.
  • Stadler R Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Hans-Nolte-Straße 1, D-32429 Minden, Germany.
  • Fuchs A Hautarztpraxis, Darwinstr. 1, 04600 Altenburg, Germany.
  • Sitaru C Universitätsklinikum Freiburg, Klinik für Dermatologie und Venereologie, Mykologisches Labor, Hauptstraße 7, 79104 Freiburg, Germany.
  • Retzlaff C Labor Dres. Löbel und Retzlaff, Felsbachstr. 5, 07745 Jena, Germany.
  • Overbeck C Gemeinschaftspraxis Dermatologie Cora Overbeck und Thomas Neumann, Lange Str. 53, 34346 Hann. Münden, Germany.
  • Neumann T Gemeinschaftspraxis Dermatologie Cora Overbeck und Thomas Neumann, Lange Str. 53, 34346 Hann. Münden, Germany.
  • Kerschnitzki A Klinik für Dermatologie, Klinikum Uni München, Mykologisches Labor, Frauenlobstr. 9-11, 80337 München, Germany.
  • Krause S Stephan Krause, Bundeswehrkrankenhaus Berlin, Klinik III Dermatologie, Scharnhorststraße 13, 10115 Berlin, Germany.
  • Schaller M Department of Dermatology, University Clinic Tübingen, Liebermeisterstraße 25, 72076 Tübingen, Germany.
  • Walker B Department of Dermatology, University Clinic Tübingen, Liebermeisterstraße 25, 72076 Tübingen, Germany.
  • Walther T Thomas Walther, Hautarztpraxis, Bästleinstr. 6, 04347 Leipzig, Germany.
  • Köhler L Hautarztpraxis, Boppstr. 20-24, 55118 Mainz, Germany.
  • Albrecht M Hautarztpraxis, Mockauer Str. 123-125, 04357 Leipzig, Germany.
  • Willing U Hautarztpraxis, Mockauer Str. 123-125, 04357 Leipzig, Germany.
  • Monod M Dermatology Service, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
  • Salamin K Dermatology Service, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
  • Burmester A Department of Dermatology, University Hospital Jena, Erfurter Str. 35, D-07743 Jena, Germany.
  • Koch D Labor für Medizinische Mikrobiologie, 04571 Rötha OT Mölbis, Germany.
  • Krüger C Labor für Medizinische Mikrobiologie, 04571 Rötha OT Mölbis, Germany.
  • Uhrlaß S Labor für Medizinische Mikrobiologie, 04571 Rötha OT Mölbis, Germany.
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  • 2020-10-08
Published in:
  • Journal of fungi (Basel, Switzerland). - 2020
Ciclopirox
Itraconazole
Miconazole
dermatophytoses
point mutation
squalene epoxidase
terbinafine-resistant
transmission
English 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 Phe397Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe397Leu and Ala448Thr amino acid substitutions, and one strain a single Leu393Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala448Thr, and in one Ala448Thr +, new Val444 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.
Language
  • English
Open access status
gold
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https://folia.unifr.ch/global/documents/68521
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