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, released 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 called Trichophyton indotineae. This species is common in Southeast Asia, and it’s a type of fungus known as a dermatophyte mold, which means it needs protein in the skin to grow.
But one of the NYC cases could not be linked to overseas travel, suggesting the germ is spreading locally in the United States. Despite its resistance to first-line drugs, this fungal strain can still be treated with other drugs.
Dr. Avrom Caplan, a dermatologist at NYU Langone Health, in February alerted public health officials to the two patients, whose condition 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 relieve her symptoms.
“We have been alerted to this infection by our colleagues in India and elsewhere over the past few years,” Caplan said. “This particular patient had many of the characteristics that they reported.”
A month later, genomic sequencing revealed that both women had contracted an infection caused by the fungus Trichophyton indotineae independently of each other. Rashes caused by this species are often inflamed and itchy. They usually spread on the face, body, thighs and pubic area.
The first of two cases began in the summer of 2021, when a 28-year-old pregnant woman developed generalized rashes. After giving birth in January 2022 and being prescribed antifungal medication, her rashes persisted. She had not made any recent international travel.
The second patient, a 47-year-old woman, first developed ringworm during a visit to Bangladesh, where the strain is common. Once back in the United States, doctors prescribed 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” due to the small number of cases. He said that despite the CDC report, the threat level is low for most people and the warning is primarily a warning to doctors who encounter this rare disease. The report included images of what the two infections looked like.
“People shouldn’t worry about that,” he said. “The important takeaways here are for clinicians in particular and for public health authorities. So we know that public health authorities are monitoring this, they are monitoring this.”
Despite the novelty of the fungus in the United States, health officials have already reported cases in Asia, Europe and Canada, according to the CDC. The agency linked the increase in the strain to “inappropriate use” of common topical steroids used to treat the infection.
Both women identified in the CDC report recovered from their rashes after receiving prolonged therapies.
The biggest threat to rashes is chronic relapse, which Caplan says is common among patients in other countries.
Although Caplan stressed that the average person should not be on high alert when it comes to Trichophyton indotineae, he said those who have reason to believe they are infected should immediately “seek advice from a clinician instead of using over-the-counter creams or medications.” obtained through friends and loved ones.
New York City Health Department officials did not immediately respond to a request for comment.