Two cases of highly contagious, drug-resistant ringworm infections have been detected in New York City — the first such cases ever reported in the United States, the Centers for Disease Control and Prevention reported Thursday.
The infection was first identified in a 47-year-old women who had developed a bad case of ringworm, also known as tinea, while traveling in Bangladesh.
A rash had erupted across most of the women’s body and typical antifungal creams did nothing to alleviate it.
“My radar went up immediately,” said Dr. Avrom Caplan, an assistant professor of dermatology at NYU’s Grossman School of Medicine, who treated the patient and was one of the report’s authors.
The woman’s infection turned out to be caused by a relatively new species of ringworm-causing fungus, called Trichophyton indotineae. Over the past decade, infections from this drug-resistant fungus have spread rapidly in South Asia, likely driven by overuse of medications to treat them, including topical antifungals and corticosteroids, the CDC report said.
The woman’s case spurred Caplan to ask his colleagues if they had seen similar infections. He soon discovered a second case in a 28-year-old New York woman.
That woman had developed ringworm across much of her body during the summer of 2021. In this case, however, the patient had not traveled outside of the United States.
Neither woman had underlying health conditions that might increase their risk for drug-resistant infections.
Caplan alerted public health officials about the two cases in February. Outside of Asia, cases have been identified in Europe and Canada.
Like drug-resistant bacteria, drug-resistant fungi are a serious public health concern. Cases of another type of drug-resistant fungal infection, Candida auris, have been spreading in health care facilities in the U.S. That infection is extremely difficult to treat and can be deadly.
“We’re always so focused on antimicrobial resistance as it relates to bacteria that we forget that those rules also apply to fungi,” said Dr. Adam Friedman, professor and chair of dermatology at the George Washington University School of Medicine & Health Sciences.
Friedman, who was not involved with the new report, said he has witnessed an uptick in patients with fungal infections whose conditions either take longer to respond to usual treatments or require additional medications.
“If you are treating something with a drug that you expect would work, but it doesn’t get better, you need to go back to the drawing board,” Friedman said.
What is ringworm, and how is it treated?
Ringworm is not caused by a worm, as the name would suggest. It is a fungal infection. It spreads easily through skin-to-skin contact and usually looks like a circular pattern of raised, itchy scales. It can pop up on the face, chest, scalp or groin area.
Typically, cases are treated with antifungal creams. But some particularly difficult cases require antifungal medications, such as terbinafine or itraconazole, taken in pill form.
The two New York patients detailed in the CDC report were successfully treated with the oral drugs. But the medications, especially itraconazole, require a physician’s care. The drug can cause heart failure and should not be taken with certain medications, according to the National Library of Medicine.
Caplan said that he suspects there may be other U.S. cases of Trichophyton indotineae. The husband and son of the 47-year-old patient, for example, have also developed ringworm. They are currently undergoing testing to see if the fungi are the same.
At this point however, he said, Trichophyton indotineae “is not a widespread problem” in the U.S.
He suggested that people with suspected ringworm infections contact a dermatologist for evaluation. He also recommended washing linens, clothes and towels regularly to minimize spread of the fungi.
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