At least two patients in New York City have been infected with antimicrobial-resistant ringworm, the first such cases in the United States with severe skin conditions.
Ringworm, also known as tinea, is a common, superficial infection of the skin, hair, or nails. It’s caused by a certain type of fungi that feed on keratin. It’s highly contagious and spreads easily through skin-to-skin contact with an infected person or animal.
According to the agency, a dermatologist on Feb. 28 notified public health officials about two patients who had “severe tinea that did not improve” when treated with an oral anti-fungal called terbinafine, a mainstay treatment.
Trichophyton indotineae
Infections involving this species have been reported throughout Asia, as well as in Europe and Canada. But this marks the first time T. indotineae infections have been reported in the United States.The epidemic “has likely been driven by misuse and overuse of topical antifungals and corticosteroids,” according to the CDC.
Two Cases in New York City
The two patients, two females, have no links to each other, the CDC noted.Patient A was 28 when she got a widespread rash in the summer of 2021. She had no recent history of traveling abroad.
After she gave birth to a baby in January 2022, she was diagnosed with ringworm and was given a course of oral terbinafine. But after two weeks, the condition didn’t resolve, so the doctor halted the terbinafine.
She was given a second course of treatment, this time using the medication itraconazole. After four weeks, her rash completely resolved. She is now being monitored in case the rash recurs.
Patient B was 47 when she got a widespread rash in the summer of 2022, when she was traveling in Bangladesh.
She was treated there with topical creams, during which time several of her family members living there developed similar symptoms, she said.
When she returned to the United States, she visited an emergency department three times during autumn of 2022. On the first visit, she was prescribed hydrocortisone 2.5% ointment and diphenhydramine, which are allergy medications. On the second visit, she was given clotrimazole, which treats certain fungal skin conditions, and on the third visit, she was given terbinafine cream.
All treatments didn’t improve her rash, and by December 2022, dermatologists noted “widespread, discrete, scaly, annular, pruritic plaques” on her thighs and buttocks.
After a four-week course of oral terbinafine, her symptoms didn’t improve. Following that, she saw roughly 80 percent improvement with a four-week course of griseofulvin therapy.
The woman’s son and husband who live in the same house have reported similar lesions on their skin and are “currently undergoing evaluation,” the CDC stated.
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