Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 75 Records) |
Query Trace: Gold JAW[original query] |
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Improving antifungal stewardship in dermatology in an era of emerging dermatophyte resistance
Caplan AS , Gold JAW , Smith DJ , Lipner SR , Pappas PG , Elewski B . JAAD Int 2024 15 168-169 |
Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease
Hoenigl M , Arastehfar A , Arendrup MC , Brüggemann R , Carvalho A , Chiller T , Chen S , Egger M , Feys S , Gangneux JP , Gold JAW , Groll AH , Heylen J , Jenks JD , Krause R , Lagrou K , Lamoth F , Prattes J , Sedik S , Wauters J , Wiederhold NP , Thompson GR 3rd . Clin Microbiol Rev 2024 e0007423 SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into "sequestered" sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the role of immunotherapy in tackling fungal infections, and the specific PK/pharmacodynamic profiles, tissue distributions as well as drug-drug interactions of novel antifungals. Finally, we review antifungal resistance mechanisms, the role of use of antifungal pesticides in agriculture as drivers of drug resistance, and detail detection methods for antifungal resistance. |
Potential sexual transmission of antifungal-resistant trichophyton indotineae
Spivack S , Gold JAW , Lockhart SR , Anand P , Quilter LAS , Smith DJ , Bowen B , Gould JM , Eltokhy A , Gamal A , Retuerto M , McCormick TS , Ghannoum MA . Emerg Infect Dis 2024 30 (4) 807-809 We describe a case of tinea genitalis in an immunocompetent woman in Pennsylvania, USA. Infection was caused by Trichophyton indotineae potentially acquired through sexual contact. The fungus was resistant to terbinafine (first-line antifungal) but improved with itraconazole. Clinicians should be aware of T. indotineae as a potential cause of antifungal-resistant genital lesions. |
Expert panel review of skin and hair dermatophytoses in an era of antifungal resistance
Hill RC , Caplan AS , Elewski B , Gold JAW , Lockhart SR , Smith DJ , Lipner SR . Am J Clin Dermatol 2024 Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes. |
Esophageal candidiasis-associated hospitalizations: Declining rates and changes in underlying conditions, United States, 2010-2020
Gold JAW , Benedict K . Open Forum Infect Dis 2024 11 (3) ofae117 In a nationally representative hospital discharge database, esophageal candidiasis-associated hospitalization rates per 100 000 population steadily declined from 17.0 (n = 52 698, 2010) to 12.9 (n = 42 355, 2020). During this period, a decreasing percentage of EC-associated hospitalizations involved HIV and an increasing percentage involved gastroesophageal reflux disease, diabetes, and long-term steroid use. |
Low incidence of invasive fungal infections in a large observational cohort of patients initiating IL-17 or IL-23 inhibitor therapy, United States, 2016-2022
Bahr NC , Benedict K , Toda M , Gold JAW , Lipner SR . J Am Acad Dermatol 2024 |
Candida auris screening practices at healthcare facilities in the United States: An Emerging Infections Network survey
Hennessee IP , Forsberg K , Beekmann SE , Polgreen PM , Gold JAW , Lyman M . Infect Control Hosp Epidemiol 2024 1-4 We surveyed members of the Emerging Infections Network about Candida auris screening practices at US healthcare facilities. Only 37% of respondents reported conducting screening; among these, 75% reported detection of at least 1 C. auris case in the last year. Increased screening could improve C. auris detection and prevent spread. |
Healthcare use and health disparities associated with mold exposure diagnosis codes
Benedict K , Chew GL , Hsu J , Toda M , Gold JAW . J Allergy Clin Immunol Pract 2024 Medicaid and commercial health insurance claims databases revealed disparities in patients assigned the ICD-10 code "Contact with and (suspected) exposure to mold (toxic)" by insurance type, age, and sex. Allergic rhinitis was the most common concomitant diagnosis. |
Epidemiology, clinical characteristics, and diagnostic testing practices for pneumocystis pneumonia-associated hospitalizations, United States, 2019-2022
Benedict K , Baggs J , Gold JAW . Open Forum Infect Dis 2024 11 (2) ofae054 Among 9196 hospitalizations involving Pneumocystis pneumonia, those without HIV had higher in-hospital mortality (24.3% vs 10.5%, P < .001) when compared with those with HIV. These findings underscore the continued importance of Pneumocystis pneumonia clinical awareness and the need for comprehensive prophylaxis guidance, particularly for certain patients without HIV who are immunosuppressed. |
Prevalence and features of fungal keratitis among US patients with commercial health insurance
Benedict K , Gold JAW , Smith DJ . JAMA Ophthalmol 2024 This cases series estimates fungal keratitis prevalence among US patients with commercial insurance. | eng |
Neurovascular complications of iatrogenic fusarium solani meningitis
Strong N , Meeks G , Sheth SA , McCullough L , Villalba JA , Tan C , Barreto A , Wanger A , McDonald M , Kan P , Shaltoni H , Campo Maldonado J , Parada V , Hassan AE , Reagan-Steiner S , Chiller T , Gold JAW , Smith DJ , Ostrosky-Zeichner L . N Engl J Med 2024 390 (6) 522-529 A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days. |
------topical antifungal prescribing for Medicare Part D beneficiaries - United States, 2021
Benedict K , Smith DJ , Chiller T , Lipner SR , Gold JAW . MMWR Morb Mortal Wkly Rep 2024 73 (1) 1-5 Incorrect use of topical antifungals and antifungal-corticosteroid combinations is likely contributing to the global emergence and spread of severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States. Understanding prescribing patterns is an initial step in establishing and promoting recommended use of these medications. Using 2021 Medicare Part D data, CDC examined prescription volumes, rates, and costs for topical antifungals (including topical combination antifungal-corticosteroid medications). Total prescription volumes were compared between higher-volume prescribers (top 10% of topical antifungal prescribers by volume) and lower-volume prescribers. During 2021, approximately 6.5 million topical antifungal prescriptions were filled (134 prescriptions per 1,000 beneficiaries), at a total cost of $231 million. Among 1,017,417 unique prescribers, 130,637 (12.8%) prescribed topical antifungals. Primary care physicians wrote the highest percentage of prescriptions (40.0%), followed by nurse practitioners or physician assistants (21.4%), dermatologists (17.6%), and podiatrists (14.1%). Higher-volume prescribers wrote 44.2% (2.9 million) of all prescriptions. This study found that enough topical antifungal prescriptions were written for approximately one of every eight Medicare Part D beneficiaries in 2021, and 10% of antifungal prescribers prescribed nearly one half of these medications. In the setting of emerging antimicrobial resistance, these findings highlight the importance of expanding efforts to understand current prescribing practices while encouraging judicious prescribing by clinicians and providing patient education about proper use. |
Low utilization of confirmatory testing for tinea capitis by pediatricians at an academic center in New York, United States, 2005-2021
Hwang JK , Gold JAW , Paller AS , Lipner SR . Front Pediatr 2023 11 1297339 We retrospectively reviewed physician diagnostic and treatment practices for pediatric tinea capitis at an academic institution over 16 years, in assessing adherence with published guidelines. We demonstrate the need to increase utilization of confirmatory testing and systemic therapy, and call for directed pediatrician education towards these goals. |
Concerning rates of laboratory-confirmed antifungal-resistant onychomycosis and tinea pedis: An online survey of podiatrists, United States
Benedict K , Gold JAW , Jones CT , Tushla LA , Lipner SR , Joseph WS , Tower DE , Elewski B , Pappas PG . Health Sci Rep 2023 6 (11) e1694 Onychomycosis (tinea unguium) and tinea pedis are common, frequently concomitant infections of the nails and feet, respectively, and are often caused by dermatophyte fungi (Trichophyton, Microsporum, and Epidermophyton spp.). 1 Antifungal‐resistant tinea is an emerging global public health problem. 2 A recent, large analysis of toenail samples from US patients with suspected onychomycosis found that nearly 4% of Trichophyton spp samples had squalene epoxidase gene mutations, which are associated with terbinafine resistance. 3 Clinicians may be increasingly likely to encounter resistant tinea infections. Therefore, we aimed to assess diagnostic approaches, antifungal resistance testing practices, and treatment practices for treatment‐resistant onychomycosis and tinea pedis. |
Trichophyton indotineae and other terbinafine-resistant dermatophytes in North America
Lockhart SR , Smith DJ , Gold JAW . J Clin Microbiol 2023 61 (12) e0090323 Dermatophyte infections (a.k.a. ringworm, tinea) affect an estimated 20%-25% of the world's population. In North America, most dermatophytoses are caused by Trichophyton rubrum or Trichophyton mentagrophytes species complexes. Severe and antifungal-resistant dermatophytoses are a growing global public health problem. A new species of the T. mentagrophytes species complex, Trichophyton indotineae, has recently emerged and is notable for the severe infections it causes, its propensity for antifungal resistance, and its global spread. In this issue of the Journal of Clinical Microbiology, C. F. Cañete-Gibas, J. Mele, H. P. Patterson, et al. (J Clin Microbiol 61:e00562-23, 2023, https://doi.org/10.1128/JCM.00562-23) summarize the results of speciation and AFST performed on North American dermatophyte isolates received at a fungal diagnostic reference laboratory. Within their collection, 18.6% of isolates were resistant to terbinafine (a first-line oral antifungal for dermatophytoses), and similar proportions of T. rubrum and T. indotineae demonstrated terbinafine resistance. The authors also found that T. indotineae has been present in North America since at least 2017. These findings highlight the importance of increased surveillance efforts to monitor trends in severe and antifungal-resistant dermatophytoses and the need for antifungal stewardship efforts, the success of which is contingent upon improving laboratory capacity for dermatophyte speciation and AFST. |
Clinical testing guidance for coccidioidomycosis, histoplasmosis, and blastomycosis in patients with community-acquired pneumonia for primary and urgent care providers
Smith DJ , Free RJ , Thompson Iii GR , Baddley JW , Pappas PG , Benedict K , Gold JAW , Tushla LA , Chiller T , Jackson BR , Toda M . Clin Infect Dis 2023 Coccidioidomycosis, histoplasmosis, and blastomycosis are underrecognized and frequently misdiagnosed fungal infections that can clinically resemble bacterial and viral community-acquired pneumonia (CAP). This guidance is intended to help clinicians in outpatient settings test for these fungal diseases in patients with CAP to reduce misdiagnoses, unnecessary antibacterial use, and poor outcomes. |
Antifungal therapeutic drug monitoring practices: Results of an Emerging Infections Network Survey
Benedict K , Gold JAW , Beekmann SE , Polgreen PM , Toda M , Smith DJ . Open Forum Infect Dis 2023 10 (9) ofad468 In a survey of 523 infectious disease specialists, a moderate to high percentage reported using any antifungal therapeutic drug monitoring (TDM) during itraconazole (72%), posaconazole (72%), and voriconazole (90%) treatment, and a low to moderate percentage reported using any antifungal TDM during prophylaxis (32%, 55%, and 65%, respectively). Long turnaround times for send-out TDM testing and logistical difficulties were frequent barriers. |
Blastomycosis-associated hospitalizations, United States, 2010-2020
Benedict K , Hennessee I , Gold JAW , Smith DJ , Williams S , Toda M . J Fungi (Basel) 2023 9 (9) BACKGROUND: Blastomycosis is an environmentally acquired fungal disease that can cause severe illness, with approximately 65% of reported cases requiring hospitalization. Recent trends in blastomycosis-associated hospitalizations in the United States have not been described. METHODS: We analyzed hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample. We calculated hospitalization rates per 100,000 population using U.S. census data and examined factors associated with in-hospital mortality. RESULTS: An estimated 11,776 blastomycosis-associated hospitalizations occurred during 2010-2020 (average yearly rate 0.3 per 100,000 persons), with no apparent temporal trend. Rates were consistently highest among persons ≥65 years old and males. In-hospital death occurred in 7.9% and approximately doubled from 3.9% in 2010 to 8.5% in 2020. Older age, chronic obstructive pulmonary disease, and malignancy were associated with mortality. CONCLUSIONS: Blastomycosis-associated hospitalizations can result in poor outcomes, underscoring the continued need for attention to early detection and treatment of blastomycosis and monitoring of disease trends. |
Update on outbreak of fungal meningitis among U.S. residents who received epidural anesthesia at two clinics in Matamoros, Mexico
Smith DJ , Gold JAW , Chiller T , Bustamante ND , Marinissen MJ , Rodriquez GG , Cortes VBG , Molina CD , Williams S , Vazquez Deida AA , Byrd K , Pappas PG , Patterson TF , Wiederhold NP , Thompson Iii GR , Ostrosky-Zeichner L . Clin Infect Dis 2023 BACKGROUND: Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at two clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during January 1-May 13, 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations. METHODS: Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States. RESULTS: As of July 7, 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed U.S. cases have been diagnosed, with severe vascular complications and eight deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended. CONCLUSIONS: Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on CDC's website. |
The rapid emergence of antifungal-resistant human-pathogenic fungi
Lockhart SR , Chowdhary A , Gold JAW . Nat Rev Microbiol 2023 21 (12) 818-832 During recent decades, the emergence of pathogenic fungi has posed an increasing public health threat, particularly given the limited number of antifungal drugs available to treat invasive infections. In this Review, we discuss the global emergence and spread of three emerging antifungal-resistant fungi: Candida auris, driven by global health-care transmission and possibly facilitated by climate change; azole-resistant Aspergillus fumigatus, driven by the selection facilitated by azole fungicide use in agricultural and other settings; and Trichophyton indotineae, driven by the under-regulated use of over-the-counter high-potency corticosteroid-containing antifungal creams. The diversity of the fungi themselves and the drivers of their emergence make it clear that we cannot predict what might emerge next. Therefore, vigilance is critical to monitoring fungal emergence, as well as the rise in overall antifungal resistance. |
Public health research priorities for fungal diseases: A multidisciplinary approach to save lives
Smith DJ , Gold JAW , Benedict K , Wu K , Lyman M , Jordan A , Medina N , Lockhart SR , Sexton DJ , Chow NA , Jackson BR , Litvintseva AP , Toda M , Chiller T . J Fungi (Basel) 2023 9 (8) Fungal infections can cause severe disease and death and impose a substantial economic burden on healthcare systems. Public health research requires a multidisciplinary approach and is essential to help save lives and prevent disability from fungal diseases. In this manuscript, we outline the main public health research priorities for fungal diseases, including the measurement of the fungal disease burden and distribution and the need for improved diagnostics, therapeutics, and vaccines. Characterizing the public health, economic, health system, and individual burden caused by fungal diseases can provide critical insights to promote better prevention and treatment. The development and validation of fungal diagnostic tests that are rapid, accurate, and cost-effective can improve testing practices. Understanding best practices for antifungal prophylaxis can optimize prevention in at-risk populations, while research on antifungal resistance can improve patient outcomes. Investment in vaccines may eliminate certain fungal diseases or lower incidence and mortality. Public health research priorities and approaches may vary by fungal pathogen. |
Candida auris-associated hospitalizations, United States, 2017-2022
Benedict K , Forsberg K , Gold JAW , Baggs J , Lyman M . Emerg Infect Dis 2023 29 (7) 1485-1487 Using a large US hospital database, we describe 192 Candida auris‒associated hospitalizations during 2017-2022, including 38 (20%) C. auris bloodstream infections. Hospitalizations involved extensive concurrent conditions and healthcare use; estimated crude mortality rate was 34%. These findings underscore the continued need for public health surveillance and C. auris containment efforts. |
Fatal invasive mold infections after transplantation of organs recovered from drowned donors, United States, 2011-2021
Wu K , Annambhotla P , Free RJ , Ritter JM , Leitgeb B , Jackson BR , Toda M , Basavaraju SV , Gold JAW . Emerg Infect Dis 2023 29 (7) 1455-1458 Drowned organ donors can be exposed to environmental molds through the aspiration of water; transplantation of exposed organs can cause invasive mold infections in recipients. We describe 4 rapidly fatal cases of potentially donor-derived invasive mold infections in the United States, highlighting the importance of maintaining clinical suspicion for these infections in transplant recipients. |
Low rates of antifungal therapeutic drug monitoring among inpatients who received itraconazole, posaconazole, or voriconazole, United States, 2019-2021
Benedict K , Gold JAW , Toda M , Thompson GR 3rd , Wiederhold NP , Smith DJ . Open Forum Infect Dis 2023 10 (8) ofad389 Antifungal therapeutic drug monitoring (TDM) is recommended for hospitalized patients receiving itraconazole, posaconazole, or voriconazole for treatment or prophylaxis. In this analysis of hospital-based data, TDM was uncommonly performed (15.8%) in a large cohort of eligible patients, suggesting missed opportunities to avoid subtherapeutic drug levels and minimize toxicity. |
Racial disparities, risk factors, and clinical management practices for tinea capitis: An observational cohort study among U.S. children with Medicaid
Hennessee IP , Benedict K , Dulski TM , Lipner SR , Gold JAW . J Am Acad Dermatol 2023 89 (6) 1261-1264 Tinea capitis (TC), a common childhood scalp and hair dermatophytosis, is associated with lower socioeconomic status,1 54 but national data on TC incidence and risk factors among children from lower income | 55 households are lacking to guide public health efforts and clinical care. We estimated incidence, assessed | 56 risk factors, and described clinical practices for TC among a large U.S. cohort of Medicaid-insured | 57 children. | In the MerativeTM MarketScan® Multi-State Medicaid Database* 58 , we identified TC cases among children | <18 years, underlying conditions, and TC-related diagnostic testing† 59 (Supplemental Table, available via | 60 Mendeley at https://data.mendeley.com/datasets/7wz5p6bxk3/1). We calculated one-year TC incidence | 61 overall and by race/ethnicity, age, and underlying health conditions. We used Poisson regression to | 62 assess associations between risk factors and TC incidence and compared TC diagnostic and treatment | 63 patterns by race/ethnicity using chi-square tests (α=0.05). |
Isolation of terbinafine-resistant trichophyton rubrum from onychomycosis patients who failed treatment at an academic center in New York, United States
Hwang JK , Bakotic WL , Gold JAW , Magro CM , Lipner SR . J Fungi (Basel) 2023 9 (7) Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022-31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy. |
Increased hospitalizations involving fungal infections during COVID-19 pandemic, United States, January 2020-December 2021
Gold JAW , Adjei S , Gundlapalli AV , Huang YA , Chiller T , Benedict K , Toda M . Emerg Infect Dis 2023 29 (7) 1433-1437 Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019-2021. During 2020-2021, patients hospitalized with COVID-19-associated fungal infections had higher (48.5%) in-hospital mortality rates than those with non-COVID-19-associated fungal infections (12.3%). Improved fungal disease surveillance is needed, particularly during respiratory virus pandemics. |
Will invasive fungal infections be the Last of Us The importance of surveillance, public-health interventions, and antifungal stewardship
Rodriguez Stewart RM , Gold JAW , Chiller T , Sexton DJ , Lockhart SR . Expert Rev Anti Infect Ther 2023 21 (8) 1-4 The video game-turned-HBO show ‘The Last of Us’ is a fanciful representation of a zombie apocalypse caused by a fungal infection. Although Ophiocordyceps, the ‘zombie fungi’ featured in the show, do not infect vertebrates, the show serves as a reminder that many fungi can cause life-threatening invasive fungal infections (IFIs). Candida and Aspergillus species are the most common and well-known causes of IFIs, but at least 300 species of opportunistic human pathogenic yeasts and molds exist. | | Each year, IFIs are responsible for over 1.5 million deaths globally and, in the United States alone, impose health-care costs ranging from five to seven billion dollars [Citation1,Citation2]. During the COVID-19 pandemic, rates of death from fungal infections have increased [Citation3], and the burden of IFIs is poised to grow given the expanding population of patients living with immunosuppressive conditions (e.g. solid organ and stem cell transplantation), increasing antifungal resistance, and potential climate-change related expansion of the geographic ranges in which pathogenic fungi live. Despite the morbidity and mortality associated with fungal infections and their growing public health importance, we still have much to learn about their diagnosis and management. In this review, we discuss gaps and global disparities in fungal laboratory capacity including antifungal susceptibility testing, the paucity of fungal surveillance, and the importance of antifungal stewardship, all against the backdrop of increasing antifungal resistance and a limited armamentarium of antifungal therapies. |
Low positivity rate and high percentage of nondermatophyte molds in an analysis of 35,257 fungal nail culture results from a United States national commercial laboratory, 2019-2022
Benedict K , Lipner SR , Lockhart SR , Gold JAW . JAAD Int 2023 12 43-45 Onychomycosis is an under-recognized public health topic. Recent US data on laboratory testing and causative organisms are lacking, with the last large analysis performed in 2000.1 Understanding culture testing patterns and species isolated can help characterize disease burden and inform diagnosis and treatment practices. | | We analyzed results of nail fungal cultures ordered during March 1, 2019-March 1, 2022 performed at Labcorp, a major national commercial laboratory, by patient demographics characteristics, region, species, ordering provider type, result timing, and month. |
Notes from the field: First reported U.S. Cases of tinea caused by Trichophyton indotineae - New York City, December 2021-March 2023
Caplan AS , Chaturvedi S , Zhu Y , Todd GC , Yin L , Lopez A , Travis L , Smith DJ , Chiller T , Lockhart SR , Alroy KA , Greendyke WG , Gold JAW . MMWR Morb Mortal Wkly Rep 2023 72 (19) 536-537 Tinea is a common, highly contagious, superficial infection of the skin, hair, or nails caused by dermatophyte molds.* During the past decade, an epidemic of severe, antifungal-resistant tinea has emerged in South Asia because of the rapid spread of Trichophyton indotineae,† a novel dermatophyte species; the epidemic has likely been driven by misuse and overuse of topical antifungals and corticosteroids§ (1,2). T. indotineae infections are highly transmissible and characterized by widespread, inflamed, pruritic plaques on the body (tinea corporis), the crural fold, pubic region, and adjacent thigh (tinea cruris), or the face (tinea faciei) (1). T. indotineae isolates are frequently resistant to terbinafine, a mainstay of tinea treatment (1,3). T. indotineae infections have been reported throughout Asia and in Europe and Canada but have not previously been described in the United States (3). | | On February 28, 2023, a New York City dermatologist notified public health officials of two patients who had severe tinea that did not improve with oral terbinafine treatment, raising concern for potential T. indotineae infection; these patients shared no epidemiologic links. Skin culture isolates from each patient were previously identified by a clinical laboratory as Trichophyton mentagrophytes and were subsequently forwarded to the Wadsworth Center, New York State Department of Health, for further review and analysis. Sanger sequencing of the internal transcribed spacer region of the ribosomal gene, followed by phylogenetic analysis performed during March 2023, identified the isolates as T. indotineae (Supplementary Figure; https://stacks.cdc.gov/view/cdc/127678). Activity related to this investigation was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.¶ |
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