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Ringworm Resistant To Common Antifungals For First Time In US: What To Know About The Skin Infection

CDC on guard over deadly fungus spreading throughout the US

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Two cases of a common fungal infection known as tinea, or ringworm, failed to respond to standard treatment due to a recently emerged fungus in the United States, according to a recent Centers for Disease Control and Prevention (CDC) report.

"Tinea is a common, highly contagious, superficial infection of the skin, hair or nails caused by dermatophyte molds," the CDC said in the report.

A new fungal species, known as Trichophyton indotineae, has resulted in a severe epidemic of drug-resistant ringworm in South Asia in the past decade due to the misuse and overuse of topical antifungal treatment and corticosteroids, the report also said.

DRUG-RESISTANT RINGWORM DETECTED IN US FOR FIRST TIME, CDC SAYS

Infections caused by this drug-resistant fungus have also been reported in Europe and Canada, but this is the first time they have been reported in the U.S. — specifically in New York City.

The name can be confusing because the infection is caused by a fungus, not a worm.

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"Ringworm is so named because it usually causes a circular rash that is red and itchy [and] caused by a fungus," Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau Hospital on Long Island, New York, told Fox News Digital.

The red outline of the rash resembles how a typical worm appears when both its ends meet.

"It is from a group of fungi, known as dermatophytes, [which] can attack any part of the body," Glatt said.

He noted that many different types of fungi can cause ringworm, including Trichophyton, Microsporum and Epidermophyton.

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Medical professionals refer to the condition as "tinea" followed by the specific body part that's involved.

"Its proper medical name is tinea, and when it is on the body, it is called tinea corporis," Glatt explained.

"It is the cause of athlete's foot, or tinea pedis, when it attacks the feet and toes, and 'jock itch,' or tinea cruris, when it attacks the groin."

The symptoms can vary depending on the specific body part that's infected, but ringworm generally causes an itchy, ring-shaped rash with a scaly appearance.

"Symptoms typically appear between four and 14 days after the skin comes in contact with the fungi that cause ringworm," the CDC noted.

For ringworm of the scalp, also called tinea capitis — which commonly occurs in children — a telltale sign is a "scaly, itchy, red, circular bald spot," per the CDC.

"The bald spot can grow in size, and multiple spots might develop if the infection spreads," the CDC added.

Ringworm of the groin, or "jock itch," often appears as a red, scaly, itchy rash on the inner thighs.

Ringworm on the feet, or athlete's foot, often appears as "red, swollen, peeling, itchy skin" between the toes, especially between the fourth and fifth toe, according to the CDC.

"The fungi that cause this infection can live on skin, surfaces and on household items such as clothing, towels and bedding," the CDC noted on its website.

It can spread from person to person, such as when touching the rash of someone with ringworm, or from animal to person, such as sleeping with a dog infected with ringworm.

Ringworm can also spread in damp environments, such as locker room floors or swimming pools.

The CDC advises against sharing household items such as clothing, towels or combs with those infected with ringworm. It also advises that people not walk barefoot in locker rooms or public showers.

"Usually, these infections are not life-threatening and can be treated with various over-the-counter creams or lotions," Glatt noted.

"Serious infection, however, may require prescription antifungal medications."

POTENTIALLY DEADLY, DRUG-RESISTANT FUNGUS SPREADING RAPIDLY IN US

In the two drug-resistant cases in New York City that were recently reported to the CDC, one involved a 28-year-old pregnant woman who developed ringworm on her neck, belly, pubic region and buttocks.

The other case was a 47-year-old woman without significant medical problems; she developed an itchy rash typical of ringworm on her thighs and buttocks.

Highly contagious fungus has a kill rate of over 30% if it becomes invasive

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The 47-year-old woman initially developed the rash while in Bangladesh, but the pregnant patient reported no international travel — "suggesting potential local U.S. Transmission of T. Indotineae," per the CDC.

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Oral terbinafine, an antifungal medication, failed to treat either of the patients' severe ringworm cases.

The CDC encourages health care providers "to minimize the misuse and overuse of prescribed and over-the-counter antifungal drugs and corticosteroids."

The agency also said that patients should be educated about ways to prevent the spread of fungi that cause ringworm.

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Do you have Ringworm? Check the symptoms

One woman, 47, reportedly developed a strange rash that required numerous medical interventions.

Diagnosed with Trichophyton indotineae (T. Indotineae), a type of ringworm, a course of antifungal treatment was ineffective.

The infection then spread to her husband and son, causing scaly rings across the body, according to Wales Online.

There has been an increase in the number of cases of antimicrobial-resistant ringworm, the Centres for Disease Control and Prevention (CDC) highlighted.

The health expert explained: "Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them."

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The rash caused by tinea (Image: Wales Online)

Moreover, the genetically mutated strain has "reached epidemic proportions" in India.

Ringworm cases caused by T. Indotineae are "often severe" and "difficult to treat".

While the cases are rife in India, there has been reported causes now in Europe and North America.

David Denning, Professor of Infectious Diseases in Global Health at the University of Manchester, warned the "world is not yet prepared" for such an epidemic.

Ringworm can feel itchy and be resistant to treatment (Image: Getty)

Denning said: "The world is not yet prepared for what will likely become a slowly evolving epidemic of these skin infections."

Dr Warren Heymann shared to the American Academy of Dermatology Association (AAD) more information on the emergence of T. Indotineae as a "global phenomenon".

The "newly identified dermatophyte species" causes "highly inflammatory" lesions, he said.

Described as "scaly" plaques, the lesions have "active red borders" that mainly affect the lower body and groin.

The painful, round lesions might feel itchy or cause a burning sensation.

Dr Heymann said: "Extensive tinea infection and antifungal resistance is no laughing matter."

The resistant fungal infection is "spreading worldwide" and does not respond to standard therapy.

Health providers, at present, might treat infected individuals with a 12-week course of itraconazole.

A Drug-resistant Skin Infection Has Come To NYC. Here's What You Need To Know About It.

New York and federal health officials have issued a warning about two cases of a drug-resistant, highly contagious skin infection in New York City.

The new report, published late last week by the Centers for Disease Control and Prevention, linked two local cases of ringworm rash to an aggressive strain of a fungus named Trichophyton indotineae. This species is common in South Asia, and it's a type of fungus known as a dermatophyte mold, meaning it needs protein in the skin to grow.

But one of the NYC cases could not be tied to overseas travel, suggesting the germ is spreading locally in the U.S. Despite being resistant to first-choice drugs, this fungal strain is still treatable with other medications.

Dr. Avrom Caplan, a dermatologist at NYU Langone Health, alerted public health officials in February of the two patients, whose conditions did not improve after receiving standard oral treatment. Both had severe cases of ringworm rash, which spreads easily through skin-to-skin contact. Caplan treated one of the patients at Langone and co-authored the CDC report.

He said the rashes on this patient were more inflamed than the average case of ringworm. Oral medications also failed to alleviate her symptoms.

"We've been alerted to this infection by our colleagues in India and elsewhere over the past number of years," Caplan said. "This particular patient had many of the features that they have been reporting."

Genomic sequencing a month later revealed both women had contracted an infection caused by the fungus Trichophyton indotineae independently of one another. The ringworm rashes caused by this species are often inflamed and itchy. They typically spread on the face, body, thighs and pubic area.

An example of a ringworm rash caused by a related fungus, Trichophyton rubrum.

The first of the two cases began in the summer of 2021, when a 28-year-old pregnant woman developed widespread rashes. After giving birth in January 2022 and being prescribed antifungal medication, her rashes persisted. She had had no recent international travel.

The second patient, a 47-year-old woman, first developed ringworm while visiting Bangladesh, where the strain is common. Once she returned to the U.S., doctors prescribed her four different treatments to no avail. Her husband and son have since reported similar rashes.

However, Caplan said community spread is "very hard to prove at this point" because of the small number of cases. He said, despite the CDC report, the threat level is low for most people, and that the warning is mostly a heads-up for doctors who encounter this rare condition. The report included pictures of what the two infections looked like.

"People should not be worried about this," he said. "The important takeaway points here are for clinicians in particular and for public health authorities. So, we know public health authorities are looking out for this, they've been looking out for it."

Despite the fungus's novelty in the U.S., health officials have previously reported cases throughout Asia, Europe, and Canada, according to the CDC. The agency linked the rise of the strain to the "inappropriate use" of common topical steroids used to treat the infection.

Both women identified in the CDC report recovered from their rashes after receiving extended therapies.

The biggest threat regarding the rashes is chronic relapse, which, Caplan said, is common among patients in other countries.

Though Caplan stressed that the average person should not be on high alert when it comes to Trichophyton indotineae, he said those with reason to believe they're infected should immediately "seek advice from a clinician instead of using over-the-counter creams or medications obtained through friends and loved ones.

Officials from the New York City Department of Health did not immediately respond to a request for comment.

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