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First Cases Of Drug-Resistant Ringworm Detected In U.S.

The first cases of a highly contagious, drug-resistant ringworm infection have been detected in the United States, in New York City. In a recent report published by the Centers for Disease Control and Prevention (CDC) , doctors warned that this type of severe ringworm infection (also called tinea) is caused by a relatively new form of fungus called Trichophyton indotineae, which does not respond to common antifungal treatments. Infection from the fungus produces an inflamed, itchy, scaly rash that can appear on the groin (jock itch), feet (athlete's foot), and scalp. Ringworm doesn't have anything to do with worms, but is so named because it can produce a circular rash shaped like a ring. Although just two cases of this infection have so far been identified, in two women, public health officials are concerned that the infection may spread to others as an epidemic of this severe, drug-resistant tinea has emerged in South Asia over the past decade. Scientists studying the condition suspect that the fungus may have become drug-resistant due to the misuse and overuse of topical antifungal treatments and corticosteroids (anti-inflammatory medications). "Dermatologists in India and elsewhere have been alerting us to this infection as it has spread globally," says Avrom S. Caplan, MD , assistant professor of dermatology at NYU Grossman School of Medicine in New York City, and lead author of the new CDC report. "It is highly resistant to one of our first-line oral antifungal medications, and some strains abroad have shown decreased responsiveness to other drugs." What Are the Signs of Ringworm and How Do You Treat It? Four major symptoms of ringworm are itchy skin; ring-shaped rash; inflamed, scaly, and cracked skin; and hair loss, according to the CDC . Irritated spots can crust over and fill with pus. The infection can also affect nails, says the CDC , causing them to become discolored, thick, fragile, or cracked. The CDC says that many cases of ringworm can be successfully treated with over-the-counter, nonprescription antifungal creams, lotions, or powders. For more serious infections, stronger prescription medications may be required. Both women in these recent cases were initially prescribed oral terbinafine , which works by stopping the growth of fungi. When that wasn't successful, doctors prescribed other oral medications that may be used for more serious infections ( itraconazole and griseofulvin ). While effective antifungal medications are available to treat this aggressive infection, Dr. Caplan stresses that overuse of these treatments may be allowing fungi to evolve and become resistant to some common therapies. How Worried Should People Be About Drug-Resistant Ringworm? Because the new drug-resistant fungus is predominant in south Asia, people who have traveled to that area and develop a ringworm-like rash may want to take extra care and have their skin tested. Caplan and his colleagues noted, however, that one of the two cases identified was a woman who had no history of international travel, suggesting the infection could have been transmitted "locally." "The fact that there's this one case in the U.S. In a woman who had no history of travel to India or Asia should raise clinicians' eyebrows a bit — it suggests that this may be something that we could potentially see more of in the U.S.," says Dean Winslow, MD , an infectious-disease specialist and a professor of medicine at Stanford University in California. Caplan also believes more cases will appear, but he doesn't think the situation at this time is cause for alarm. "Our report should help clinicians identify clinical features and understand challenges in treatment and testing of this particular infection," he says. "But I don't think the public should be concerned at this time." How to Stop the Spread of Ringworm Those who have ringworm of any type need to take precautions to avoid spreading this highly contagious fungus, according to Dr. Winslow. "Ringworm spreads easily from person to person," he says. "A commonly heard story is picking up athlete's foot in the shower. The fungus can persist, for at least short periods of time, on inanimate objects." The American Academy of Dermatology offers a list of tips to help those with the rash from spreading it to others, including wearing waterproof sandals or shoes in a public shower, changing clothes every day, and avoiding sharing personal items, such as towels.

Ringworm Resistant To Common Antifungals For First Time In US: What To Know About The Skin Infection

Two cases of a common fungal infection known as tinea, or ringworm, failed to respond to standard treatment due to a recently emerged fungus in the United States, according to a recent Centers for Disease Control and Prevention (CDC) report.

"Tinea is a common, highly contagious, superficial infection of the skin, hair or nails caused by dermatophyte molds," the CDC said in the report.

A new fungal species, known as Trichophyton indotineae, has resulted in a severe epidemic of drug-resistant ringworm in South Asia in the past decade due to the misuse and overuse of topical antifungal treatment and corticosteroids, the report also said.

DRUG-RESISTANT RINGWORM DETECTED IN US FOR FIRST TIME, CDC SAYS

Infections caused by this drug-resistant fungus have also been reported in Europe and Canada, but this is the first time they have been reported in the U.S. — specifically in New York City.

Why is this infection called ringworm?

The name can be confusing because the infection is caused by a fungus, not a worm.

"Ringworm is so named because it usually causes a circular rash that is red and itchy [and] caused by a fungus," Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital on Long Island, New York, told Fox News Digital. 

Two cases of a common fungal infection known as tinea, or ringworm, failed to respond to standard treatment due to a recently emerged fungus in the United States. (iStock)

The red outline of the rash resembles how a typical worm appears when both its ends meet. 

"It is from a group of fungi, known as dermatophytes, [which] can attack any part of the body," Glatt said.

He noted that many different types of fungi can cause ringworm, including Trichophyton, Microsporum and Epidermophyton. 

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Medical professionals refer to the condition as "tinea" followed by the specific body part that's involved.

"Its proper medical name is tinea, and when it is on the body, it is called tinea corporis," Glatt explained. 

"It is the cause of athlete's foot, or tinea pedis, when it attacks the feet and toes, and 'jock itch,' or tinea cruris, when it attacks the groin."

Recognizing the symptoms of ringworm

The symptoms can vary depending on the specific body part that's infected, but ringworm generally causes an itchy, ring-shaped rash with a scaly appearance. 

"Symptoms typically appear between four and 14 days after the skin comes in contact with the fungi that cause ringworm," the CDC noted.

Many different types of fungi can cause ringworm, including Trichophyton, Microsporum and Epidermophyton.  (iStock)

For ringworm of the scalp, also called tinea capitis — which commonly occurs in children — a telltale sign is a "scaly, itchy, red, circular bald spot," per the CDC.

"The bald spot can grow in size, and multiple spots might develop if the infection spreads," the CDC added.

"The fungi that cause this infection can live on skin, surfaces and on household items such as clothing, towels and bedding."

Ringworm of the groin, or "jock itch," often appears as a red, scaly, itchy rash on the inner thighs.

Ringworm on the feet, or athlete's foot, often appears as "red, swollen, peeling, itchy skin" between the toes, especially between the fourth and fifth toe, according to the CDC.

How does ringworm spread?

"The fungi that cause this infection can live on skin, surfaces and on household items such as clothing, towels and bedding," the CDC noted on its website.

It can spread from person to person, such as when touching the rash of someone with ringworm, or from animal to person, such as sleeping with a dog infected with ringworm. 

Ringworm can spread in damp environments, such as locker room floors or swimming pools. The CDC advises against walking barefoot in locker rooms or public showers. (iStock)

Ringworm can also spread in damp environments, such as locker room floors or swimming pools.

The CDC advises against sharing household items such as clothing, towels or combs with those infected with ringworm. It also advises that people not walk barefoot in locker rooms or public showers.

Treatment options

"Usually, these infections are not life-threatening and can be treated with various over-the-counter creams or lotions," Glatt noted.

"Serious infection, however, may require prescription antifungal medications."

POTENTIALLY DEADLY, DRUG-RESISTANT FUNGUS SPREADING RAPIDLY IN US

In the two drug-resistant cases in New York City that were recently reported to the CDC, one involved a 28-year-old pregnant woman who developed ringworm on her neck, belly, pubic region and buttocks. 

The other case was a 47-year-old woman without significant medical problems; she developed an itchy rash typical of ringworm on her thighs and buttocks.

The 47-year-old woman initially developed the rash while in Bangladesh, but the pregnant patient reported no international travel — "suggesting potential local U.S. Transmission of T. Indotineae," per the CDC.

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Oral terbinafine, an antifungal medication, failed to treat either of the patients' severe ringworm cases.

The CDC encourages health care providers "to minimize the misuse and overuse of prescribed and over-the-counter antifungal drugs and corticosteroids."

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The agency also said that patients should be educated about ways to prevent the spread of fungi that cause ringworm.

Nail Fungus Warning Signs: What To Look Out For

© Provided by Getty Images Nail Fungus image

Overview

A fungal infection that occurs in the edge of the nail.

Symptoms

Nail discoloration is observed and sometimes, the nail may have a white spot or may turn yellow, brown, or green.

Causes

It is caused by dermatophyte fungus. Yeast and molds can also cause nail fungus.

Diagnosis

Diagnosis involves physical exam and testing.

→ Common treatment options

→ How is this diagnosed?

Highlights

Treatable by a medical professional

Diagnosed by medical professional

Rarely requires lab test or imaging

Can last several months

Transmitted through indirect contact and direct contact

More common in males

Treatment

Oral antifungal medication is used most often. Antifungal nail lacquer or topical solution may also be effective. Depending on the type and extent of infection, medication course will vary.

Medications

Oral antifungals: Antifungal medicines work by either killing the fungal cells or by preventing the growth and reproduction of fungal cells.

Terbinafine . Itraconazole . Fluconazole

Procedures

Nail excision: Temporary or permanent removal of the nail is carried out.

→ Questions to ask your doctor

→ Interested to know more? Check out the full article here

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