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Spread of Antifungal-Resistant Trichophyton indotineae, United Kingdom, 2017–2024

Summary

A fungal infection called Trichophyton indotineae, which originated in Asia, is rapidly spreading throughout the United Kingdom and becoming resistant to common antifungal treatments. The infection typically starts in the groin area and can spread to other parts of the body, and many cases fail to respond to standard antifungal drugs like terbinafine. Researchers tracked 157 cases over seven years and found the fungus now accounts for over a third of all dermatophyte infections sent to the UK reference laboratory. Doctors and laboratory professionals are being urged to recognize this emerging threat and consider better diagnostic and treatment strategies.

Background

Trichophyton indotineae is an emergent dermatophyte causing superficial skin infections that started outbreaking in southern Asia in 2014 and has since spread globally. The fungus is characterized by poor treatment response and widespread antifungal resistance, particularly to terbinafine. Cases have been reported in Europe, Canada, and the United States, with evidence suggesting acquisition and transmission outside endemic areas.

Objective

To describe all cases of T. indotineae infection identified at the UK National Mycology Reference Laboratory during an 8-year period and characterize the spread of this antifungal-resistant dermatophyte in the United Kingdom.

Results

157 cases of T. indotineae were identified, with 84.7% of patients having links to endemic areas. The groin and neighboring sites were involved in 60.7% of cases. T. indotineae prevalence increased from 2% in 2018 to 38% of dermatophyte isolates by July 2024. In vitro terbinafine resistance was documented in 74.2% of tested isolates, with 31.8% of cases showing documented treatment failure.

Conclusion

T. indotineae has been introduced into the United Kingdom from endemic areas and is spreading substantially. Based on current trends, it is predicted to rapidly become the predominant cause of tinea corporis in the United Kingdom. Clinicians and microbiology laboratorians should recognize this fungus as a predominant cause of superficial dermatophytosis.
  • Published in:Emerging Infectious Diseases,
  • Study Type:Descriptive Epidemiological Study,
  • Source: 10.3201/eid3101.240923
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