HEALTH authorities have identified four new cases of Trichophyton mentagrophytes genotype VII (TMVII), an emerging dermatophyte fungus, in New York City, USA, between April–July 2024.
These infections, which manifest as pruritic, annular, scaly lesions on areas such as the face, buttocks, and genitals, were diagnosed in men who have sex with men (MSM). TMVII is believed to spread through sexual contact and often requires prolonged antifungal treatment.
The cases, involving cisgender men aged 30–39 years, represent the first instances of TMVII confirmed in the USA since an initial case in June 2024. One patient, a sex worker, reported contact with another diagnosed individual. Only one patient had travelled internationally to Europe. Two patients were on HIV pre-exposure prophylaxis, while two others had HIV infections, one of whom struggled with consistent antiretroviral adherence.
Symptoms included rashes on various body parts. Treatments primarily involved oral antifungals, such as terbinafine (250 mg daily), and in some cases, additional topical therapies. All patients showed improvement at follow-up. Laboratory testing, including fungal culture and DNA sequencing, confirmed TMVII in all cases, with susceptibility to common antifungals such as terbinafine and itraconazole.
Public health officials emphasise the need for increased awareness among healthcare providers. TMVII infections may be mistaken for eczema or psoriasis, delaying proper treatment. They recommend early empiric antifungal therapy for suspected cases and advise against corticosteroids, which can worsen the condition.
To prevent transmission, patients are urged to avoid skin-to-skin contact and sharing personal items until lesions fully resolve. Enhanced public health surveillance, education, and access to testing are deemed essential to mitigate the spread of this sexually transmissible infection.
Ada Enesco, EMJ
Reference
Zucker j et al. Notes from the field: trichophyton mentagrophytes genotype VII – New York City, April-July 2024. MMWR Morb Mortal Wkly Rep. 2024;73(43):985-8.
