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

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.

Why is this infection called ringworm?

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

"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.

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. (iStock)

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."

Recognizing the symptoms of ringworm

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.

Many different types of fungi can cause ringworm, including Trichophyton, Microsporum and Epidermophyton. (iStock)

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.

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

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.

How does ringworm spread?

"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 spread in damp environments, such as locker room floors or swimming pools. The CDC advises against walking barefoot in locker rooms or public showers. (iStock)

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.

Treatment options

"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."

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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.

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."

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

NYC Reports Treatment-resistant Ringworm Infections, First Ever In The U.S.

A treatment-resistant, highly contagious form of the skin infection tinea, better known as ringworm, has been reported in the U.S. For the first time, the Centers for Disease Control and Prevention said Thursday. The cases were identified in two patients in New York City.

Ringworm is a common, superficial infection of the skin, hair or nails that is very contagious. It is caused by fungi and is typically treated with antifungal medications, but over the past decade, a treatment-resistant strain has emerged in South Asia. The CDC refers to that increase as "an epidemic." Those cases are specifically referred to as Tinea indotineae infections.

These infections, the CDC said, are characterized by "widespread, inflamed, pruritic plaques," or rashes with lesions. The rashes can appear on the body, the thigh, the crease of the thigh, the pubic region and the face. This version of the infection does not respond to terbinafine, the front-line medication used to treat most tinea cases.

Treatment-resistant cases have been diagnosed in Asia, Europe and Canada, but the New York City cases mark the first time they have been diagnosed in the United States.

The New York City cases were reported to federal health officials by a dermatologist on Feb. 28, 2023, who said two patients with severe tinea had symptoms that did not improve with standard treatments, raising alarm.

The patients, both women, shared no links to each other, the CDC said. The first woman, identified as Patient A, was 28 at the time and developed a widespread rash in the summer of 2021. She had no international travel history. In January 2022, after giving birth to a baby, she was diagnosed with tinea and began oral treatment, which did not relieve her symptoms. After a second course of treatment, using the medication itraconazole, her rash was resolved after four weeks, but she is still being monitored for recurrence.

Ringworm infection appears as a reddish rash on a person's forehead

File photo of a tinea (ringworm) infection BSIP/UIG Via Getty Images

The second patient, identified as Patient B in the CDC report, was 47 when she developed a widespread rash in the summer of 2022. She was traveling in Bangladesh at the time, where she was treated with topical creams. Several family members developed similar symptoms, she said. When she returned to the United States, she went to an urgent care center and was prescribed another topical treatment, with no improvement. In December 2022, she took a four-week course of oral medications, which also had no effect. A second four-week course of another medication led to "approximately 80% improvement."

The woman's son and husband live in the same house and have reported similar symptoms. They are being evaluated for possible treatments, the CDC said.

Skin samples taken from the two women first identified the infection as Trichophyton mentagrophytes, another form of ringworm. Further analysis and sequencing correctly identified the infection as Tinea indotineae.

The CDC said the infections show that health care providers should consider Tinea indotineae as a diagnosis when first-line medications and antifungal agents do not relieve symptoms. Any provider who suspects this infection should contact public health officials.

People who suspect they may have this infection should see their doctor or a dermatologist.

Tinea of all forms spreads easily through skin-to-skin contact with an infected person or animal. There can also be secondary spread among different parts of the body.

First Cases Of Treatment-resistant Ringworm Found In Patients In US

Two cases of highly contagious, drug-resistant ringworm infection have been detected in the US.

First cases of treatment-resistant ringworm found in patients from New York. File pic.

The cases were reported to the Centers for Disease Control and Prevention (CDC) in February and shared in a report published on Thursday.

The patients, from New York City, had their first symptoms in 2021 and 2022.

One of the patients carrying the infection was identified as a 47-year-old woman who developed a bad case of ringworm - known as tinea - while travelling in Bangladesh.

A rash had developed across her thighs and buttocks and health officials reported that the severe tinea did not improve after antifungal creams were used.

The woman's infection was caused by a relatively new species of ringworm-causing fungus called Trichophyton indotineae.

Dr Avrom Caplan, an assistant professor of dermatology at NYU Grossman School of Medicine, who treated the patient and was one of the report's authors, told NBC News: "My radar went up immediately."

A case of ringworm or tinea infection. File pic

After the woman returned to the US, she visited the hospital's emergency ward three times for help. Doctors gave several treatments, typically used for ringworm, but there was no improvement by December.

After many attempts, doctors gave the woman a four-week course of griseofulvin therapy, typically used to treat skin infections such as athlete's foot and ringworm. But, doctors are still looking into other treatment options.

The woman's son and husband, who live with her and have had similar rashes, are now undergoing evaluation.

Over the past decade, infections from this drug-resistant fungus have spread rapidly in South Asia, likely driven by overuse of medications to treat them, including topical antifungals and corticosteroids, the CDC report said.

Another case of the skin infection

Another patient, 28, developed the skin infection in 2021 during her third trimester of pregnancy.

She had no underlying medical conditions, no exposure to a person with a similar rash and no international travel history.

The rash was found across the woman's body, including her neck, abdomen, pubic region and buttocks.

She was later diagnosed with tinea and began oral terbinafine therapy in January 2022 after giving birth to her baby.

However, as the rash did not clear up, the patient was then given itraconazole treatment - an antifungal cream.

The rash resolved after four weeks but continues to be monitored for potential recurrence of the infection.

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