Aditya K Gupta, Shruthi Polla Ravi, Tong Wang, Wayne L Bakotic, Avner Shemer
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Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction.</p><p><strong>Results and discussion: </strong>A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing.</p><p><strong>Conclusion: </strong>Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. 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引用次数: 0
摘要
导言:indotineae 毛癣菌在全球的蔓延给皮肤癣菌病的治疗带来了紧迫的挑战。这篇系统性综述探讨了当前毛癣菌感染的情况,强调了抗药性模式、药敏试验、突变分析和管理策略:2023 年 11 月,我们使用 Embase、PubMed、Scopus 和 Web of Science 数据库进行了文献检索。纳入标准包括临床试验、观察性研究、病例系列或通过分子方法诊断 T. indotineae 的病例报告。有关耐药机制、抗真菌药敏试验和管理的报告用于数据提取:通过系统检索,共发现 1148 篇文章,其中 45 篇符合纳入标准。indotineae 真菌在全球的传播是显而易见的,2023 年许多新的国家都报告了病例。一些研究小组提出的暂定流行病学临界值(ECOFFs)有助于了解临床耐药性的可能性。特定突变(尤其是 Phe397Leu)的存在与较高的最低抑菌浓度(MICs)相关,表明可能存在临床耐药性。吲哚啉菌的耐药性也有报道和研究,并日益受到关注。尽管如此,伊曲康唑仍然是一种替代疗法。治疗建议包括口服或联合疗法,以及基于突变分析和药敏试验的个体化方法:结论: indotineae毛癣菌的临床表现非常复杂,需要加强监测、改进诊断和谨慎使用抗真菌药物。皮癣菌缺乏既定的临床断点,这凸显了在这一具有挑战性的领域开展进一步研究的必要性。
Mapping the Global Spread of T. indotineae: An Update on Antifungal Resistance, Mutations, and Strategies for Effective Management.
Introduction: The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies.
Methods: A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction.
Results and discussion: A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing.
Conclusion: Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.
期刊介绍:
Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.