中华皮肤科杂志 ›› 2024, Vol. 57 ›› Issue (5): 418-425.doi: 10.35541/cjd.20230718
中国中西医结合学会皮肤性病学分会真菌学组
中国耐药皮肤癣菌病诊治与防控工作组
收稿日期:2023-12-06
修回日期:2024-03-09
发布日期:2024-04-30
通讯作者:
刘维达
E-mail:liuwd@pumcderm.cams.cn
基金资助:Mycology Group, Combination of Traditional and Western Medicine Dermatology; Chinese Antifungal-Resistant Dermatophytosis Expert Consensus Group
Received:2023-12-06
Revised:2024-03-09
Published:2024-04-30
Contact:
Liu Weida
E-mail:liuwd@pumcderm.cams.cn
Supported by:摘要： 【摘要】 耐药皮肤癣菌感染是近期临床微生物领域与皮肤病领域关注的热点。我国已经出现耐药皮肤癣菌感染病例，预示存在人群传播的风险。中国中西医结合学会皮肤性病学分会真菌学组、中国耐药皮肤癣菌病诊治与防控工作组组织专家基于已有的循证医学证据和研究数据，对耐药皮肤癣菌的病原学、流行病学、菌株鉴定、体外药物敏感性试验以及耐药皮肤癣菌感染的诊断、治疗和防控提出推荐建议，制订了完整的诊治方案，以期为我国耐药皮肤癣菌感染的临床诊治与防控提供科学参考。
中图分类号:
中国中西医结合学会皮肤性病学分会真菌学组 中国耐药皮肤癣菌病诊治与防控工作组. [开放获取] 中国耐药皮肤癣菌感染诊治与防控专家共识（2024版）[J]. 中华皮肤科杂志, 2024,57(5):418-425. doi:10.35541/cjd.20230718
Mycology Group, Combination of Traditional and Western Medicine Dermatology, Chinese Antifungal-Resistant Dermatophytosis Expert Consensus Group. Expert consensus on the diagnosis, treatment, prevention and control of antifungal-resistant dermatophyte infections in China （2024）[J]. Chinese Journal of Dermatology, 2024, 57(5): 418-425.doi:10.35541/cjd.20230718
| ［1］ | Lockhart SR, Chowdhary A, Gold J. The rapid emergence of antifungal⁃resistant human⁃pathogenic fungi［J］. Nat Rev Microbiol, 2023,21（12）:818⁃832. doi: 10.1038/s41579⁃023⁃00960⁃9. |
| ［2］ | Bishnoi A, Vinay K, Dogra S. Emergence of recalcitrant dermatophytosis in India［J］. Lancet Infect Dis, 2018,18（3）:250⁃251. doi: 10.1016/S1473⁃3099（18）30079⁃3. |
| ［3］ | Kong X, Song G, Mei H, et al. The domestic isolation of terbinafine⁃ and itraconazole⁃resistant Trichophyton indotineae in Chinese Mainland［J］. Mycopathologia, 2023,188（4）:383⁃393. doi: 10.1007/s11046⁃023⁃00761⁃x. |
| ［4］ | Chowdhary A, Singh A, Kaur A, et al. The emergence and worldwide spread of the species Trichophyton indotineae causing difficult⁃to⁃treat dermatophytosis: a new challenge in the management of dermatophytosis［J］. PLoS Pathog, 2022,18（9）:e1010795. doi: 10.1371/journal.ppat.1010795. |
| ［5］ | 刘维达, 梁官钊, 李筱芳, 等. 警惕印度毛癣菌感染在中国的流行［J］. 中国真菌学杂志, 2023,18（4）:289⁃290,309. doi: 10.3969/j.issn.1673⁃3827.2023.04.001. |
| ［6］ | Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide［J］. Mycoses, 2008,51 Suppl 4:2⁃15. doi: 10.1111/j.1439⁃0507.2008.01606.x. |
| ［7］ | Song G, Zhang M, Liu W, et al. Changing face of epidemiology of dermatophytoses in Chinese Mainland: a 30 years nationwide retrospective study from 1991 to 2020［J］. Mycoses, 2022,65（4）:440⁃448. doi: 10.1111/myc.13425. |
| ［8］ | Mukherjee PK, Leidich SD, Isham N, et al. Clinical Trichophyton rubrum strain exhibiting primary resistance to terbinafine［J］. Antimicrob Agents Chemother, 2003,47（1）:82⁃86. doi: 10.1128/AAC.47.1.82⁃86.2003. |
| ［9］ | Hsiao YH, Chen C, Han HS, et al. The first report of terbinafine resistance Microsporum canis from a cat［J］. J Vet Med Sci, 2018,80（6）:898⁃900. doi: 10.1292/jvms.17⁃0680. |
| ［10］ | Salehi Z, Shams⁃Ghahfarokhi M, Razzaghi⁃Abyaneh M. Antifungal drug susceptibility profile of clinically important dermatophytes and determination of point mutations in terbinafine⁃resistant isolates［J］. Eur J Clin Microbiol Infect Dis, 2018,37（10）:1841⁃1846. doi: 10.1007/s10096⁃018⁃3317⁃4. |
| ［11］ | Rezaei⁃Matehkolaei A, Rafiei A, Makimura K, et al. Epidemiological aspects of dermatophytosis in Khuzestan, southwestern Iran, an update［J］. Mycopathologia, 2016,181（7⁃8）:547⁃553. doi: 10.1007/s11046⁃016⁃9990⁃x. |
| ［12］ | 朱红梅, 温海. 特比萘芬耐药皮肤癣菌的研究进展［J］. 中国真菌学杂志, 2020,15（4）:253⁃256. doi: 10.3969/j.issn.1673⁃3827.2020.04.017. |
| ［13］ | Yamada T, Maeda M, Alshahni MM, et al. Terbinafine resistance of Trichophyton clinical isolates caused by specific point mutations in the squalene epoxidase gene［J］. Antimicrob Agents Chemother, 2017,61（7）:e00115⁃00117. doi: 10.1128/AAC.00115⁃17. |
| ［14］ | Kano R, Kimura U, Kakurai M, et al. Trichophyton indotineae sp. nov.: a new highly terbinafine⁃resistant anthropophilic dermatophyte species［J］. Mycopathologia, 2020,185（6）:947⁃958. doi: 10.1007/s11046⁃020⁃00455⁃8. |
| ［15］ | Švarcová M, Větrovský T, Kolařík M, et al. Defining the relationship between phylogeny, clinical manifestation, and phenotype for Trichophyton mentagrophytes/interdigitale complex; a literature review and taxonomic recommendations［J］. Med Mycol, 2023,61（5）:myad042. doi: 10.1093/mmy/myad042. |
| ［16］ | Uhrlaß S, Verma SB, Gräser Y, et al. Trichophyton indotineae⁃an emerging pathogen causing recalcitrant dermatophytoses in India and worldwide⁃a multidimensional perspective［J］. J Fungi （Basel）, 2022,8（7）:757. doi: 10.3390/jof8070757. |
| ［17］ | Centers for Disease Control and Prevention. The rise of resistant ringworm: genomic sequencing confirms the first two reported U.S. cases of Trichophyton indotineae［EB/OL］. ［2023⁃09⁃18］. https://www.cdc.gov/amd/whats⁃new/tindotineae.html. |
| ［18］ | Zhan P, Liu W. The changing face of dermatophytic infections worldwide［J］. Mycopathologia, 2017,182（1⁃2）:77⁃86. doi: 10.1007/s11046⁃016⁃0082⁃8. |
| ［19］ | Verma SB, Panda S, Nenoff P, et al. The unprecedented epidemic⁃like scenario of dermatophytosis in India: Ⅰ. Epidemiology, risk factors and clinical features［J］. Indian J Dermatol Venereol Leprol, 2021,87（2）:154⁃175. doi: 10.25259/IJDVL_301_20. |
| ［20］ | Saunte D, Pereiro⁃Ferreirós M, Rodríguez⁃Cerdeira C, et al. Emerging antifungal treatment failure of dermatophytosis in Europe: take care or it may become endemic［J］. J Eur Acad Dermatol Venereol, 2021,35（7）:1582⁃1586. doi: 10.1111/jdv.17241. |
| ［21］ | Jabet A, Normand AC, Brun S, et al. Trichophyton indotineae, from epidemiology to therapeutic［J］. J Mycol Med, 2023,33（3）:101383. doi: 10.1016/j.mycmed.2023.101383. |
| ［22］ | Nenoff P, Verma SB, Ebert A, et al. Spread of terbinafine⁃resistant Trichophyton mentagrophytes typeⅧ（India） in Germany⁃"The tip of the Iceberg?"［J］. J Fungi （Basel）, 2020,6（4）:207. doi: 10.3390/jof6040207. |
| ［23］ | Jabet A, Brun S, Normand AC, et al. Extensive dermatophytosis caused by terbinafine⁃resistant Trichophyton indotineae, France［J］. Emerg Infect Dis, 2022,28（1）:229⁃233. doi: 10.3201/eid 2801.210883. |
| ［24］ | Jia S, Long X, Hu W, et al. The epidemic of the multiresistant dermatophyte Trichophyton indotineae has reached China［J］. Front Immunol, 2022,13:1113065. doi: 10.3389/fimmu.2022. 1113065. |
| ［25］ | Xie W, Kong X, Zheng H, et al. Rapid emergence of recalcitrant dermatophytosis by a cluster of multidrug⁃resistant Trichophyton indotineae, China ［J］. Br J Dermatol, 2024,5:ljae009. doi: 10. 1093/bjd/ljae009. |
| ［26］ | Gupta AK, Venkataraman M, Hall DC, et al. The emergence of Trichophyton indotineae: implications for clinical practice［J］. Int J Dermatol, 2023,62（7）:857⁃861. doi: 10.1111/ijd.16362. |
| ［27］ | Khurana A, Masih A, Chowdhary A, et al. Correlation of in vitro susceptibility based on MICs and squalene epoxidase mutations with clinical response to terbinafine in patients with Tinea Corporis/Cruris［J］. Antimicrob Agents Chemother, 2018,62（12）:e01038⁃01018. doi: 10.1128/AAC.01038⁃18. |
| ［28］ | Khurana A, Gupta A, Sardana K, et al. A prospective study on patterns of topical steroids self⁃use in dermatophytoses and determinants predictive of cutaneous side effects［J］. Dermatol Ther, 2020,33（4）:e13633. doi: 10.1111/dth.13633. |
| ［29］ | Ebert A, Monod M, Salamin K, et al. Alarming India⁃wide phenomenon of antifungal resistance in dermatophytes: a multicentre study［J］. Mycoses, 2020,63（7）:717⁃728. doi: 10.1111/myc.13091. |
| ［30］ | Saunte D, Hare RK, Jørgensen KM, et al. Emerging terbinafine resistance in Trichophyton: clinical characteristics, squalene epoxidase gene mutations, and a reliable EUCAST method for detection［J］. Antimicrob Agents Chemother, 2019,63（10）:e01126⁃01119. doi: 10.1128/AAC.01126⁃19. |
| ［31］ | Firooz A, Lotfali E, Fattahi M, et al. A case of terbinafine⁃resistant tinea cruris caused by Trichophyton tonsurans［J］. Case Rep Dermatol Med, 2021,2021:9611072. doi: 10.1155/2021/9611072. |
| ［32］ | Gupta AK, Williams JV, Zaman M, et al. In vitro pharmacodynamic characteristics of griseofulvin against dermatophyte isolates of Trichophyton tonsurans from tinea capitis patients［J］. Med Mycol, 2009,47（8）:796⁃801. doi: 10.3109/13693780802712523. |
| ［33］ | 中华医学会皮肤性病学分会真菌学组. 体股癣诊疗指南（2008版）［J］. 中华皮肤科杂志, 2009,42（2）:75. doi: 10.3760/cma.j.issn.0412⁃4030.2009.02.001. |
| ［34］ | Hui D, Xue⁃cheng S, Ai⁃e X. Evaluation of reflectance confocal microscopy in dermatophytosis［J］. Mycoses, 2013,56（2）:130⁃133. doi: 10.1111/j.1439⁃0507.2012.02222.x. |
| ［35］ | Tang C, Kong X, Ahmed SA, et al. Taxonomy of the Trichophyton mentagrophytes/T. interdigitale species complex harboring the highly virulent, multiresistant genotype T. indotineae［J］. Mycopathologia, 2021,186（3）:315⁃326. doi: 10.1007/s11046⁃021⁃00544⁃2. |
| ［36］ | Tang C, Ahmed SA, Deng S, et al. Detection of emerging genotypes in Trichophyton mentagrophytes species complex: a proposal for handling biodiversity in dermatophytes［J］. Front Microbiol, 2022,13:960190. doi: 10.3389/fmicb.2022.960190. |
| ［37］ | Normand AC, Moreno⁃Sabater A, Jabet A, et al. MALDI⁃TOF mass spectrometry online identification of Trichophyton indotineae using the MSI⁃2 application［J］. J Fungi （Basel）, 2022,8（10）:1103. doi: 10.3390/jof8101103. |
| ［38］ | Dabas Y, Xess I, Singh G, et al. Molecular identification and antifungal susceptibility patterns of clinical dermatophytes following CLSI and EUCAST guidelines［J］. J Fungi （Basel）, 2017,3（2）:17. doi: 10.3390/jof3020017. |
| ［39］ | Curatolo R, Juricevic N, Leong C, et al. Antifungal susceptibility testing of dermatophytes: development and evaluation of an optimised broth microdilution method［J］. Mycoses, 2021,64（3）:282⁃291. doi: 10.1111/myc.13202. |
| ［40］ | Shaw D, Singh S, Dogra S, et al. MIC and upper limit of wild⁃type distribution for 13 antifungal agents against a Trichophyton mentagrophytes⁃Trichophyton interdigitale complex of Indian origin［J］. Antimicrob Agents Chemother, 2020,64（4）:e01964⁃01919. doi: 10.1128/AAC.01964⁃19. |
| ［41］ | Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: is the problem deeper than we perceive?［J］. Indian Dermatol Online J, 2016,7（2）:73⁃76. doi: 10.4103/2229⁃5178.178100. |
| ［42］ | Yamada T, Yaguchi T, Maeda M, et al. Gene amplification of CYP51B: a new mechanism of resistance to azole compounds in Trichophyton indotineae［J］. Antimicrob Agents Chemother, 2022,66（6）:e0005922. doi: 10.1128/aac.00059⁃22. |
| ［43］ | Kano R, Hsiao YH, Han HS, et al. Resistance mechanism in a terbinafine⁃resistant strain of Microsporum canis［J］. Mycopathologia, 2018,183（3）:623⁃627. doi: 10.1007/s11046⁃018⁃0242⁃0. |
| ［44］ | Monod M, Feuermann M, Salamin K, et al. Trichophyton rubrum azole resistance mediated by a new ABC transporter, TruMDR3［J］. Antimicrob Agents Chemother, 2019,63（11）:e00863⁃00819. doi: 10.1128/AAC.00863⁃19. |
| ［45］ | 中国体癣和股癣诊疗指南工作组. 中国体癣和股癣诊疗指南（基层实践版2022）［J］. 中国真菌学杂志, 2022,17（3）:177⁃182. doi: 10.3969/j.issn.1673⁃3827.2022.03.001. |
| ［46］ | Song G, Kong X, Li X, et al. Prior selection of itraconazole in the treatment of recalcitrant Trichophyton indotineae infection: Real⁃world results from retrospective analysis［J］. Mycoses, 2024,67（1）:e13663. doi: 10.1111/myc.13663. |
| ［47］ | Singh S, Chandra U, Anchan VN, et al. Limited effectiveness of four oral antifungal drugs （fluconazole, griseofulvin, itraconazole and terbinafine） in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial［J］. Br J Dermatol, 2020,183（5）:840⁃846. doi: 10.1111/bjd.19146. |
| ［48］ | Singh A, Masih A, Khurana A, et al. High terbinafine resistance in Trichophyton interdigitale isolates in Delhi, India harbouring mutations in the squalene epoxidase gene［J］. Mycoses, 2018,61（7）:477⁃484. doi: 10.1111/myc.12772. |
| ［49］ | Noguchi H, Matsumoto T, Hiruma M, et al. Tinea unguium caused by terbinafine⁃resistant Trichophyton rubrum successfully treated with fosravuconazole［J］. J Dermatol, 2019,46（12）:e446⁃e447. doi: 10.1111/1346⁃8138.15033. |
| ［50］ | Babu PR, Pravin A, Deshmukh G, et al. Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis［J］. Indian J Dermatol, 2017,62（4）:395⁃399. doi: 10.4103/ijd.IJD_191_17. |
| ［51］ | Fattahi A, Shirvani F, Ayatollahi A, et al. Multidrug⁃resistant Trichophyton mentagrophytes genotype Ⅷ in an Iranian family with generalized dermatophytosis: report of four cases and review of literature［J］. Int J Dermatol, 2021,60（6）:686⁃692. doi: 10.1111/ijd.15226. |
| ［52］ | Rengasamy M, Shenoy MM, Dogra S, et al. Indian Association of Dermatologists, Venereologists and Leprologists （IADVL） Task Force against Recalcitrant Tinea （ITART） Consensus on the Management of Glabrous Tinea （INTACT）［J］. Indian Dermatol Online J, 2020,11（4）:502⁃519. doi: 10.4103/idoj.IDOJ_233_20. |
| ［53］ | Gaurav V, Bhattacharya SN, Sharma N, et al. Terbinafine resistance in dermatophytes: time to revisit alternate antifungal therapy［J］. J Mycol Med, 2021,31（1）:101087. doi: 10.1016/j.mycmed.2020.101087. |
| ［54］ | Hiruma J, Kitagawa H, Noguchi H, et al. Terbinafine⁃resistant strain of Trichophyton interdigitale strain isolated from a tinea pedis patient［J］. J Dermatol, 2019,46（4）:351⁃353. doi: 10.1111/1346⁃8138.14809. |
| ［55］ | Gueneau R, Joannard B, Haddad N, et al. Extensive dermatophytosis caused by terbinafine⁃resistant Trichophyton indotineae, successfully treated with topical voriconazole［J］. Int J Antimicrob Agents, 2022,60（5⁃6）:106677. doi: 10.1016/j.ijantimicag.2022.106677. |
| ［56］ | Rajagopalan M, Inamadar A, Mittal A, et al. Expert consensus on the management of dermatophytosis in India （ECTODERM India）［J］. BMC Dermatol, 2018,18（1）:6. doi: 10.1186/s12895⁃018⁃0073⁃1. |
| ［57］ | Crotti S, Cruciani D, Spina S, et al. A terbinafine sensitive Trichophyton indotineae strain in Italy: the first clinical case of tinea corporis and onychomycosis［J］. J Fungi （Basel）, 2023,9（9）:865. doi: 10.3390/jof9090865. |
| ［58］ | Moreno⁃Sabater A, Normand AC, Bidaud AL, et al. Terbinafine resistance in dermatophytes: a French multicenter prospective study［J］. J Fungi （Basel）, 2022,8（3）:220. doi: 10.3390/jof8030220. |
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