First case of tinea corporis due to Trichophyton mentagrophytes genotype VIII in South-East Europe (Greece)
Changes in dermatophyte epidemiology in Europe should be continuously monitored and reported, in view of the increased human mobility from and to endemic areas and the increased cohabitation of humans with animal carriers. Recently, zoophilic Trichophyton mentagrophytes genotype VIII, presenting increased resistance to antifungals, have been reported from Asian countries such as India. The present case report is the first case of tinea corporis caused by this genotype in Greece.
The 32 year-old male patient presented in 2019, with multiple skin lesion of 6 months duration. The lesions annular or arch-like with central clearing were located on the nuchal area, axillae and left calf. The patient had received oral terbinafine 250 mg o.d. for 2 months with only partial response. He reported no contact with animals, close contact with potentially infected people, visit of athletic spaces and he had travelled in Egypt and UAE in 2018 as a mariner in a commercial ship, living in his own exclusive premises. Direct microscopy was positive for hyphae and the culture grew a mold with granular surface producing spherical to elongated microconidia. Internal transcribed Spacer (ITS) sequencing of the strain showed it to belong to T. mentagrophytes genotype VIII. Antifungal susceptibilities were determined by the microdilution standard CLSI M38-A2 and the strain had high MIC to clotrimazole, fluconazole and terbinafine, low ones to itraconazole and ketoconazole and ≤1 µg/mL to amorolfine, ciclopirox and griseofulvin. The patient was treated with local ketoconazole bid for 3 months and itraconazole 200 mg od for 1.5 months and subsequently 400 mg od for one month, with complete resolution.
This is the first report of the zoophilic resistant T. mentagrophytes genotype VIII from Greece although it has been reported from India and countries such as Iran, Oman, Australia and European countries such as the Netherlands. Although our patient had travelled in Middle East, the source of infection remains unclear. It is also possible that the fungus has entered Greece and the transmission happened inside the country in an anthropophilic manner. Further surveillance of dermatophytes from tinea corporis is necessary and will clarify the actual epidemiology of the genotype.