2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/2iy5wruuedsh6.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/00yc7rcvua6a7.js","/_next/static/immutable/chunks/37ktb71aq3480.js","/_next/static/immutable/chunks/2d50b-7eu4558.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/2d6noqpp6ehas.js","/_next/static/immutable/chunks/1sx186c93bpzg.js","/_next/static/immutable/chunks/3dc-1n866s65i.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2w1bvggzb0ga8.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T49a,The search yielded 96 studies (1954-2025) documenting 134 patients. The number of reports has notably increased since the 21st century; however, diagnosis remains challenging due to possible dermatophyte adaptation in the dermal/subcutaneous environment. Trichophyton rubrum is the most frequently isolated pathogen. Acquired immunodeficiencies (e.g. renal transplant recipients) and primary immunodeficiencies (e.g. CARD9, STAT3 mutations) elevate the risk of deep dermatophytosis. Systemic dissemination, often accompanied by lymphadenopathy, was reported in 24 patients, with the most common being infection of the axillary and inguinal lymph nodes. Infections of the bones, lungs, and brain were also reported. Terbinafine (125-1000 mg/day) and itraconazole (100-400 mg/day), with adjunctive topical antifungals and surgical interventions, have been tried for deep dermatophytosis. The use of newer triazoles (voriconazole, posaconazole) should follow the principles of antifungal stewardship and therapeutic drug monitoring recommendations. Multidrug resistance is a potential concern in immunocompromised patients who will often require extended or lifelong treatment.31:T89b,Dermatophytes-a group of obligate keratinophilic fungi that infect the skin, hair and nails-represent the most common cause of fungal infections worldwide. In immunocompromised individuals, a growing body of literature has documented rare instances of dermatophyte infections of the dermis and subcutaneous tissue, which can lead to deep dermatophytosis with systemic dissemination and pseudomycetoma as secondary complications. To assess patient characteristics, risk factors, diagnostic evidence and treatment options for deep dermatophytosis. A systematic review was conducted in June 2025 to identify patients presenting with deep dermatophytosis of the glabrous skin; all cases were validated by confirmatory testing per histopathologic examination and fungal culture. Majocchi's granuloma diagnoses were excluded. The search yielded 96 studies (1954-2025) documenting 134 patients. The number of reports has notably increased since the 21st century; however, diagnosis remains challenging due to possible dermatophyte adaptation in the dermal/subcutaneous environment. Trichophyton rubrum is the most frequently isolated pathogen. Acquired immunodeficiencies (e.g. renal transplant recipients) and primary immunodeficiencies (e.g. CARD9, STAT3 mutations) elevate the risk of deep dermatophytosis. Systemic dissemination, often accompanied by lymphadenopathy, was reported in 24 patients, with the most common being infection of the axillary and inguinal lymph nodes. Infections of the bones, lungs, and brain were also reported. Terbinafine (125-1000 mg/day) and itraconazole (100-400 mg/day), with adjunctive topical antifungals and surgical interventions, have been tried for deep dermatophytosis. The use of newer triazoles (voriconazole, posaconazole) should follow the principles of antifungal stewardship and therapeutic drug monitoring recommendations. Multidrug resistance is a potential concern in immunocompromised patients who will often require extended or lifelong treatment. Healthcare providers should be cognizant that dermatophytosis may become invasive and disseminated in immunocompromised populations. Testing and early treatment should not be overlooked in these patients.32:Ta45,AbstractBackgroundDermatophytes—a group of obligate keratinophilic fungi that infect the skin, hair and nails—represent the most common cause of fungal infections worldwide. In immunocompromised individuals, a growing body of literature has documented rare instances of dermatophyte infections of the dermis and subcutaneous tissue, which can lead to deep dermatophytosis with systemic dissemination and pseudomycetoma as secondary complications.ObjectivesTo assess patient characteristics, risk factors, diagnostic evidence and treatment options for deep dermatophytosis.MethodsA systematic review was conducted in June 2025 to identify patients presenting with deep dermatophytosis of the glabrous skin; all cases were validated by confirmatory testing per histopathologic examination and fungal culture. Majocchi's granuloma diagnoses were excluded.ResultsThe search yielded 96 studies (1954–2025) documenting 134 patients. The number of reports has notably increased since the 21st century; however, diagnosis remains challenging due to possible dermatophyte adaptation in the dermal/subcutaneous environment. Trichophyton rubrum is the most frequently isolated pathogen. Acquired immunodeficiencies (e.g. renal transplant recipients) and primary immunodeficiencies (e.g. CARD9, STAT3 mutations) elevate the risk of deep dermatophytosis. Systemic dissemination, often accompanied by lymphadenopathy, was reported in 24 patients, with the most common being infection of the axillary and inguinal lymph nodes. Infections of the bones, lungs, and brain were also reported. Terbinafine (125–1000 mg/day) and itraconazole (100–400 mg/day), with adjunctive topical antifungals and surgical interventions, have been tried for deep dermatophytosis. The use of newer triazoles (voriconazole, posaconazole) should follow the principles of antifungal stewardship and therapeutic drug monitoring recommendations. Multidrug resistance is a potential concern in immunocompromised patients who will often require extended or lifelong treatment.ConclusionsHealthcare providers should be cognizant that dermatophytosis may become invasive and disseminated in immunocompromised populations. Testing and early treatment should not be overlooked in these patients.33:T495,Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates.34:T958,Trichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission. To correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing. This retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers. Improvement or resolution at the last follow-up assessment. Among 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates. The results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.35:Tc6d,ImportanceTrichophyton indotineae is an emerging dermatophyte causing outbreaks of extensive tinea infections often unresponsive to terbinafine. This species has been detected worldwide and in multiple US states, yet detailed US data on infections with T indotineae are sparse and could improve treatment practices and medical understanding of transmission.ObjectiveTo correlate clinical features of T indotineae infections with in vitro antifungal susceptibility testing results, squalene epoxidase gene sequence variations, and isolate relatedness using whole-genome sequencing.Design, Setting, and ParticipantsThis retrospective cohort study of patients with T indotineae infections in New York City spanned May 2022 to May 2023. Patients with confirmed T indotineae infections were recruited from 6 New York City medical centers.Main Outcome and MeasureImprovement or resolution at the last follow-up assessment.ResultsAmong 11 patients with T indotineae (6 male and 5 female patients; median [range] age, 39 [10-65] years), 2 were pregnant; 1 had lymphoma; and the remainder were immunocompetent. Nine patients reported previous travel to Bangladesh. All had widespread lesions with variable scale and inflammation, topical antifungal monotherapy failure, and diagnostic delays (range, 3-42 months). Terbinafine treatment failed in 7 patients at standard doses (250 mg daily) for prolonged duration; these patients also had isolates with amino acid substitutions at positions 393 (L393S) or 397 (F397L) in squalene epoxidase that correlated with elevated terbinafine minimum inhibitory concentrations of 0.5 μg/mL or higher. Patients who were treated with fluconazole and griseofulvin improved in 2 of 4 and 2 of 5 instances, respectively, without correlation between outcomes and antifungal minimum inhibitory concentrations. Furthermore, 5 of 7 patients treated with itraconazole cleared or had improvement at the last follow-up, and 2 of 7 were lost to follow-up or stopped treatment. Based on whole-genome sequencing analysis, US isolates formed a cluster distinct from Indian isolates.Conclusion and RelevanceThe results of this case series suggest that disease severity, diagnostic delays, and lack of response to typically used doses and durations of antifungals for tinea were common in this primarily immunocompetent patient cohort with T indotineae, consistent with published data. Itraconazole was generally effective, and the acquisition of infection was likely in Bangladesh.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"fluconazole: generic Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on fluconazole (generic). Clinician-written summaries and actionable practice insights. 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All infections were mild (CTCAE grade 1: 40%; grade 2: 60%); 60% required systemic antifungal therapy (terbinafine or fluconazole) after topical monotherapy failed.","limitations":"- Very small case series (n=5) from a single center; no control group or incidence comparison to other CTCL therapies.\n- Fungal infections may be attributable to the heavily pre-treated, immunocompromised baseline rather than mogamulizumab specifically.\n- Retrospective design with potential for ascertainment bias; infections could be underdiagnosed in the broader mogamulizumab literature.","practice_takeaway":"Clinicians should actively screen CTCL patients on mogamulizumab for fungal skin infections, as these can mimic CTCL lesions or mogamulizumab-associated rash (MAR) and may go undetected. Currently no antifungal prophylaxis guidelines exist for this population; a low threshold for mycological workup (culture, skin scraping, biopsy) is warranted."}},{"doi":"10.1093/cid/ciag312","pmid":"42116798","title":"Changes in Epidemiology of Candidemia in the United States with a Focus on\n Candida auris","journal_title":"Clinical Infectious Diseases","journal_issn":"1058-4838","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1093/cid/ciag312","source_score":12,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-15T13:23:11.733Z","updated_at":"2026-05-15T13:23:11.733Z","tags":[{"paper_doi":"10.1093/cid/ciag312","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"category","value":"Immunology","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"category","value":"Infectious Diseases","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"condition","value":"Antifungal Resistance","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"condition","value":"Candida auris Infection","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"condition","value":"Candidemia","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"generic","value":"fluconazole","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"modality","value":"Antifungal","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"sample_size","value":"n=27926","value_numeric":27926},{"paper_doi":"10.1093/cid/ciag312","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"warning","value":"Epic Cosmos is a large EHR network but is not a true population-based registry — findings may not represent institutions outside the Epic ecosystem.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"warning","value":"The paper's DOI suffix appears atypical ('ciag312' vs. standard 'ciad' prefix for CID); may be a pre-publication identifier.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag312","tag_type":"warning","value":"The total case count (29,454 cases) differs from the unique patient count (27,926); tags reflect unique patients as the primary sample size.","value_numeric":null}],"summaries":{"what_studied":"Retrospective U.S. study using the Epic Cosmos database examining candidemia trends (2015–2024), including species distribution, antifungal resistance, 30-day mortality, and risk factors for *Candida auris* candidemia among 27,926 unique patients.","key_result":"Overall 30-day mortality was 31.5%, rising from 24.7% to 31.8% over the study period (p=0.02). *C. auris* cases increased (p=0.008); fluconazole resistance in *C. parapsilosis* rose from 2.5% to 10.8% (p=0.02) and in *C. tropicalis* from 6.2% to 18.1% (p=0.03). *C. auris* candidemia was independently associated with Black race, renal failure, and higher Social Vulnerability Index (p<0.001 for all).","limitations":"- Retrospective database study (Epic Cosmos); coding accuracy and completeness may vary across contributing institutions.\n- No data on antifungal treatment regimens or adequacy of source control, which limits causal inference on mortality drivers.\n- Social Vulnerability Index and race-based associations are observational; confounding by unmeasured socioeconomic factors is possible.","practice_takeaway":"Clinicians should be alert to rising candidemia mortality and the growing threat of fluconazole-resistant *C. parapsilosis* and *C. tropicalis* — empiric echinocandin use and early species identification are increasingly important.\n*C. auris* risk is higher in Black patients, those with renal failure, and socially vulnerable populations; targeted surveillance in these groups is warranted."}},{"doi":"10.1111/jdv.70115","pmid":"41104791","title":"Deep and disseminated dermatophytosis in immunocompromised populations—A systematic review","journal_title":"Journal of the European Academy of Dermatology and Venereology","journal_issn":"0926-9959","published_at":"2025-10-17T00:00:00.000Z","url":"https://doi.org/10.1111/jdv.70115","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-10-22","doi":"10.1111/jdv.70115","days":"7","issn":"0926-9959","rank":"10","field":"Clinical Medicine","score":"2","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1111/jdv.70115","title":"Deep and disseminated dermatophytosis in immunocompromised populations-A systematic review.","journal":"Journal of the European Academy of Dermatology and Venereology : JEADV","methods":"","results":"$30","abstract":"$31","keywords":["deep dermatophytosis","dermatophyte","disseminated fungal infection","invasive fungal infection","ringworm","tinea"],"pubmed_id":"41104791","conclusions":"","publication_date":"2025-10-17T00:00:00"},"crossref":{"DOI":"10.1111/jdv.70115","URL":"https://doi.org/10.1111/jdv.70115","ISSN":["0926-9959","1468-3083"],"link":[{"URL":"https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.70115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Deep and disseminated dermatophytosis in immunocompromised populations—A systematic review"],"author":[{"given":"Aditya K.","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Mediprobe Research Inc. London Ontario Canada"}]},{"given":"Tong","family":"Wang","sequence":"additional","affiliation":[{"name":"Mediprobe Research Inc. London Ontario Canada"}]},{"given":null,"family":"Susmita","sequence":"additional","affiliation":[{"name":"Mediprobe Research Inc. London Ontario Canada"}]},{"given":"Ditte Marie L.","family":"Saunte","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark"},{"name":"Department of Allergy and Dermatology Copenhagen University Hospital – Herlev and Gentofte Gentofte Denmark"}]},{"given":"Roderick","family":"Hay","sequence":"additional","affiliation":[{"name":"St. John's Institute of Dermatology King's College London London UK"}]},{"given":"Vincent","family":"Piguet","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Division of Dermatology Women's College Hospital Toronto Ontario Canada"}]}],"issued":{"date-parts":[[2025,10,17]]},"member":"311","prefix":"10.1111","source":"Crossref","volume":null,"archive":["Portico"],"created":{"date-time":"2025-10-17T12:01:38Z","timestamp":1760702498000,"date-parts":[[2025,10,17]]},"indexed":{"date-time":"2025-10-17T12:41:13Z","timestamp":1760704873842,"date-parts":[[2025,10,17]]},"license":[{"URL":"http://creativecommons.org/licenses/by-nc-nd/4.0/","start":{"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000,"date-parts":[[2025,10,17]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":"$32","language":"en","relation":{},"resource":{"primary":{"URL":"https://onlinelibrary.wiley.com/doi/10.1111/jdv.70115"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2025-08-06"},{"name":"accepted","group":{"name":"publication_history","label":"Publication 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effect estimates are descriptive and non-comparative.","value_numeric":null},{"paper_doi":"10.1111/jdv.70115","tag_type":"warning","value":"The review excludes Majocchi's granuloma; ensure diagnostic criteria align when applying these data.","value_numeric":null},{"paper_doi":"10.1111/jdv.70115","tag_type":"warning","value":"Treatment response rates reflect reported outcomes and may be influenced by reporting bias and variable follow-up.","value_numeric":null}],"summaries":{"what_studied":"A systematic review (search June 2025) of histopathology- and culture-confirmed deep dermatophytosis of glabrous skin, excluding Majocchi's granuloma; 96 studies from 1954–2025 describing 134 patients.","key_result":"Median age was 51 years (IQR 22); 70.1% (94/134) were male, and Trichophyton rubrum was most frequent. Dissemination occurred in 24/134 patients (lymph node involvement confirmed in 15), with bone (5 cases) and brain abscesses (4 cases) reported; among therapies, improvement was reported with terbinafine in 64.8% (35/54), itraconazole in 46.5% (33/71), posaconazole in 58.8% (10/17), and voriconazole in 38.5% (5/13).","limitations":"Most included reports were case reports or small series, creating publication bias; antifungal susceptibility testing and therapeutic drug monitoring data were sparse, and some treatment data were incompletely reported.","practice_takeaway":"In immunocompromised patients with atypical nodules, ulcers, abscesses, or lymphadenopathy, obtain histopathology and culture to diagnose deep dermatophytosis and treat concomitant superficial tinea to reduce autoinoculation risk. Oral terbinafine or itraconazole are commonly used; if newer triazoles are needed, follow antifungal stewardship with therapeutic drug monitoring and watch for drug–drug interactions."}},{"doi":"10.1001/jamadermatol.2024.1126","pmid":"38748419","title":"Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2024-05-15T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2024.1126","source_score":127,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2024-06-06","doi":"10.1001/jamadermatol.2024.1126","days":"30","issn":"2168-6068","rank":"5","field":"Clinical Medicine","score":"127","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2024.1126","title":"Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae.","journal":"JAMA dermatology","methods":"","results":"$33","abstract":"$34","keywords":[],"pubmed_id":"38748419","conclusions":"","publication_date":"2024-05-15T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2024.1126","URL":"https://doi.org/10.1001/jamadermatol.2024.1126","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2818522/jamadermatology_caplan_2024_oi_240012_1721149713.16585.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"701","type":"journal-article","issue":"7","score":1,"title":["Clinical Course, Antifungal Susceptibility, and Genomic Sequencing of Trichophyton indotineae"],"author":[{"given":"Avrom S.","family":"Caplan","sequence":"first","affiliation":[{"name":"The Ronald O. 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Improvement occurred in 2/4 on fluconazole and 2/5 on griseofulvin (no outcome–MIC correlation); 5/7 on itraconazole cleared or improved (2/7 lost to follow‑up or stopped), and U.S. isolates formed a distinct cluster from Indian isolates; 9/11 reported travel to Bangladesh.","limitations":"Small sample (n=11) and single‑city, multi‑center case series limit generalizability. Uncontrolled, retrospective design with heterogeneous treatments and incomplete follow‑up (2 of 7 on itraconazole lost or stopped) constrains outcome interpretation.","practice_takeaway":"Expect terbinafine failure associated with SQLE mutations and elevated MICs in T indotineae; in this series, itraconazole led to clearance or improvement in 5 of 7 treated patients. 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