ABSTRACT
Terbinafine (TRF) has been used in the treatment of fungal infections for more than 20 years. Recently, TRF-resistant Trichophyton interdigitale and T. rubrum strains have been isolated from human patients worldwide. However, an epidemiological study of TRF-resistant strains in Japanese patients has not been investigated. In the present study, antifungal susceptibility testing was performed on clinical isolates from Japanese patients to assess TRF-resistance patterns of T. interdigitale and T. rubrum strains. We also sequenced the squalene epoxidase (SQLE) encoding gene of TRF-resistant T. rubrum strains. Two hundred and ten T. interdigitale and T. rubrum clinical isolates were obtained from 210 human cases of tinea pedis, tinea corporis, tinea unguium, tinea cruris, tinea manuum, tinea faciei and tinea capitis in Tokyo, Saitama, Chiba, Hyogo and Kumamoto, Japan, in 2020. Five T. rubrum isolates (N74, N79, N99, H30 and K2) grew on Sabouraud's dextrose agar (SDA) containing 1 mg/L of TRF. All five strains exhibited TRF minimum inhibitory concentrations (MICs) ≥32 mg/L but remained susceptible to azoles. We determined SQLE sequences in these TRF-resistant T. rubrum strains and found that all strains harbored missense mutations (L393F) in the SQLE-encoding gene.
Subject(s)
Arthrodermataceae , Antifungal Agents/pharmacology , Arthrodermataceae/genetics , Drug Resistance, Fungal/genetics , Hand Dermatoses , Humans , Japan/epidemiology , Terbinafine , Tinea , Trichophyton/geneticsABSTRACT
A 57-year-old previously healthy woman who works in the fish-processing industry presented with a 1-year history of a slightly pruritic, hyperkeratotic, brownish, erythematous lesion of the left cheek measuring 5 × 5 mm in diameter. Histopathology revealed granuloma formation in the superficial dermal layer by multinucleated giant cells that contained pale-brown septate hyphae. Periodic acid-Schiff stain showed many hyphae and catenate spores within the multinucleated giant cells. Tissue specimens and skin scrapings were obtained and incubated on mycosel agar, yielding black, velvety colonies that were morphologically identified as belonging to Exophiala species. Sequence analysis of the internal transcribed spacer region of the ribosomal RNA gene showed 99-100% homology to Exophiala oligosperma sequences. This report describes a rare case of phaeohyphomycosis of the face caused by E. oligosperma.
