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First Terbinafine-Resistant Trichophyton indotineae Isolates with Phe397Leu and/or Thr414His Mutations in Turkey
Murat Durdu1, Hazal Kandemir2, Ayşe Sultan Karakoyun3
1Department of Dermatology, Adana Dr. Turgut Noyan Application and Research Center, Başkent University Faculty of Medicine, Adana, Turkey. sivandr@hotmail.com.
Abstract:
Fungal infections of the skin, nails, and hair caused by dermatophyte species continue to be a worldwide concern. The increase in terbinafine-resistant superficial dermatophytosis has become a major concern over the last decade. In this report, we presented two cases of infection with terbinafine-resistant Trichophyton indotineae, the first diagnosis of this species in Turkey. One patient exhibited erythematous pruritic patches and plaques in the inguinal and gluteal regions, while the other patient showed annular erythematous scaly plaques in the bilateral posterior thigh and gluteal regions. One patient harbored a CD36 mutation. Both strains harbored the same amino acid substitution in the squalene epoxidase gene, whereas one isolate had another unknown mutation. Clinical improvement was observed with resveratrol treatment in the patient with the CD36 mutation but not in the other patient.
Insights
Two cases of terbinafine-resistant Trichophyton indotineae, a fungal infection, were reported in Turkey. Resveratrol showed clinical improvement in one patient with a CD36 mutation, highlighting potential new treatment avenues.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- Superficial dermatophytosis, fungal skin infections, are a global health issue.
- Increasing resistance to terbinafine, a common antifungal, is a growing clinical concern.
- Trichophyton indotineae is an emerging cause of terbinafine-resistant fungal infections.
Purpose of the Study:
- To report the first cases of Trichophyton indotineae infection in Turkey.
- To investigate the clinical presentation and genetic basis of terbinafine resistance in these cases.
- To evaluate the efficacy of resveratrol as a potential treatment.
Main Methods:
- Case report of two patients with terbinafine-resistant fungal infections.
- Identification of the causative fungal species (Trichophyton indotineae).
- Genetic analysis including CD36 mutation screening and squalene epoxidase gene sequencing.
Main Results:
- The first diagnosis of Trichophyton indotineae in Turkey is presented.
- One patient had a CD36 mutation; both strains shared an amino acid substitution in squalene epoxidase.
- Resveratrol treatment led to clinical improvement in the patient with the CD36 mutation.
Conclusions:
- Trichophyton indotineae is an emerging pathogen causing terbinafine-resistant dermatophytosis in Turkey.
- CD36 mutation may play a role in terbinafine resistance and response to resveratrol.
- Further research is needed to understand the mechanisms of resistance and explore novel therapies.
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