2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30: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.31: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.32: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\":\"Allylamine Antifungal: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Allylamine Antifungal (modality). Clinician-written summaries and actionable practice insights. 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Antifungal","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"modality","value":"Azole Antifungal","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"sample_size","value":"n=11","value_numeric":11},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"study_design","value":"Retrospective Cohort","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"warning","value":"Design is labeled retrospective cohort but functions as a small descriptive case series (n=11).","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"warning","value":"Only abstract/results details were available; dosing and duration for most agents and follow‑up length were not specified.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.1126","tag_type":"warning","value":"Outcome definitions were based on last follow‑up, and two patients on itraconazole were lost to follow‑up or stopped treatment.","value_numeric":null}],"summaries":{"what_studied":"A retrospective cohort case series from six New York City centers (May 2022–May 2023) examined 11 patients with confirmed Trichophyton indotineae, correlating clinical features with antifungal minimum inhibitory concentrations, squalene epoxidase mutations, and whole‑genome sequencing; outcome was improvement or resolution at last follow‑up.","key_result":"Terbinafine (250 mg daily) failed in 7 patients, and their isolates carried SQLE L393S or F397L with elevated terbinafine MICs ≥0.5 μg/mL. 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. Take a travel history—most patients reported travel to Bangladesh—and consider susceptibility testing when terbinafine fails."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Allylamine Antifungal"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Allylamine Antifungal"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Allylamine Antifungal"}}}]]

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