Epidemiological survey of dermatophyte resistance in Europe
Dermatophytosis, tinea, is a common infection and world-wide distributed. It has until recently been considered a mild infection and easy to treat. Unfortunately, an epidemic of atypical widespread recalcitrant and terbinafine resistant dermatophytosis is currently spreading in India. For some years it was considered an Indian problem only, but sporadic reports of resistance have been noted in Germany, Switzerland and Denmark both as imported cases and among European residents. Therefore, a pilot study under the auspice of European Academy of Dermatology and Venerology (EADV) task force of Mycology was initiated in order to explore possible European dermatophyte clinical and mycological proven antifungal drug resistance.
Methods: A standardized questionnaire was sent through EADV Task Force of Mycology network to dermatologist in Europe as a pilot study to explore the extent of the problem.
Results: The study is ongoing, but until now results from 20 countries are obtained of which 15 (79 %) has observed clinical and/or mycological antifungal resistance. Dermatophyte species with suspected resistance Microsporum canis, Trichophyton mentagrophytes (6 specified as genotype VIII (Indian strain)), T. rubrum, T. interdigitale, T. tonsurans, T. verrucosum, T. violaceum, M. audouinii, E. floccosum and N. gypsea. The most prevalent drug with antifungal treatment failure was terbinafine (app. 50% of the cases) followed by itraconazole, fluconazole and griseofulvin.
Conclusion: This pilot study confirms that both clinically and mycological anti-fungal resistance exist in Europe.
Acknowledgments: This study is initiated by the EADV task force Mycology (AY Sergeev, A Prohić, BM Piraccini, B Sigurgeirsson, C Rodríguez-Cerdeira, JC Szepietowski, M Arabatzis, MP Ferreirós, P Lecerf, P Schmid-Grendelmeier, P Nenoff, RJ Nowicki). The authors want to thank following for answering the questionnaire or for helping us to obtain the information from each country: Belgium (J Andre, A Packeu, B Reichert), Denmark (S Korshøj, A Storm, SML Andersen, A Lamberg, D Lybaek), Finland (N Kluger, H Granlund, J Panelius, M Tuomiranta, K Hannula-Jouppi), Hungary (E Remenyik, G Krisztián), Italy (M Starace), Lithuania (V Kucinskiene) , Malta (V Padovese, L Scerri), Norway (JC Sitek, O Sundnes, EM Rehbinder), Russia (L KotrekhovaIf), Serbia (D Skiljevic, J Vukicevic, M Gajic-Veljic), Spain (Members of The Spanish Association of Mycology), Sweden (E Forsberg), Switzerland (P Schmid, P Bosshard). Furthermore, the authors want to acknowledge Department of Mycology, Statens Serum Insitute, Copenhagen, Denmark for their antifungal susceptibility testing.