Detection of Squalene Epoxidase Mutations in United States Patients with Onychomycosis: Implications for Management

Gupta, Aditya K.; Cooper, Elizabeth A.; Wang, Tong; Ravi, Shruthi Polla; Lincoln, Sara A.; Piguet, Vincent; McCarthy, Laurence R.; Bakotic, Wayne L.

doi:10.1016/j.jid.2023.04.032

Cited by 20 publications

(27 citation statements)

References 51 publications

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“…mentagrophytes and 3.6% of T . rubrum samples were found to harbour one or more single amino acid mutations in the squalene epoxidase gene using multiplex PCR 8 . More advanced techniques (e.g., real‐time PCR and PCR‐based DNA microarray) offer additional advantages such as reduced risk of contamination, fewer false negative results and the ability to simultaneously detect multiple targets, although increased costs and equipment needs may limit their use 94 …”

Section: Counteracting Resistance Through Antifungal Stewardshipmentioning

confidence: 99%

“…Resistance to oral antifungals such as terbinafine is being increasingly detected, and resistant yeast and mould species associated with systemic infection are now categorized by the World Health Organization as fungal pathogens that represent a great threat to public health 6 . An ever‐growing body of literature has marked the emergence and global spread of antifungal resistance among species of Trichophyton ; accordingly, patients in the United States are presenting with onychomycosis and other superficial fungal infections that do not respond to terbinafine or other systemic antifungals such as fluconazole or itraconazole 7–9 …”

Section: Introductionmentioning

confidence: 99%

“…6 An evergrowing body of literature has marked the emergence and global spread of antifungal resistance among species of Trichophyton; accordingly, patients in the United States are presenting with onychomycosis and other superficial fungal infections that do not respond to terbinafine or other systemic antifungals such as fluconazole or itraconazole. [7][8][9] Antifungal resistance has profound implications for the treatment of onychomycosis and other fungal infections. While resistance can lead to poor treatment efficacy, low adherence and long treatment duration, these factors in turn can provide an opportunity for resistance to develop.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole—the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes—has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug–drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real‐world long‐term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.

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Section: Counteracting Resistance Through Antifungal Stewardshipmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Gupta,

Elewski,

Joseph

et al. 2024

Mycoses

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“…A 2019 survey of 39 mycologists in 23 European countries was undertaken to explore the extent of antifungal resistance in dermatophytes -85% (17/20 countries) had observed or mycologically confirmed antifungal resistance (a total of 126 cases) affecting the scalp, body, groin and plantar surfaces [15]. This year, Gupta et al [16] analysed 5432 toenail clippings from patients across the US with suspected onychomycosis and demonstrated a terbinafine conferring mutation rate of 3.7%.…”

Section: Main Bodymentioning

confidence: 99%

Dermatophyte resistance – on the rise

Bristow,

Joshi

2023

Journal of Foot and Ankle Research

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Dermatophytes are group of filamentous fungi which have adapted to living on the skin of humans and other animals. In the last decade, reports have emerged from Asia of new dermatophyte strains showing resistance to the commonly used antifungal agent terbinafine and others. The spread of these resistant strains has been noted in many other countries globally. Little is known about the mechanisms or management of this emerging problem. Urgent research and changes to current practice are required if the spread of the infection is to be contained and managed effectively.

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“…2 A recent, large analysis of toenail samples from US patients with suspected onychomycosis found that nearly 4% of Trichophyton spp samples had squalene epoxidase gene mutations, which are associated with terbinafine resistance. 3 Clinicians may be increasingly likely to encounter resistant tinea infections. Therefore, we aimed to assess diagnostic approaches, antifungal resistance testing practices, and treatment practices for treatment-resistant onychomycosis and tinea pedis.…”

mentioning

confidence: 99%

Concerning rates of laboratory‐confirmed antifungal‐resistant onychomycosis and tinea pedis: An online survey of podiatrists, United States

Benedict,

Gold,

Jones

et al. 2023

Health Science Reports

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Detection of Squalene Epoxidase Mutations in United States Patients with Onychomycosis: Implications for Management

Cited by 20 publications

References 51 publications

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents

Dermatophyte resistance – on the rise

Concerning rates of laboratory‐confirmed antifungal‐resistant onychomycosis and tinea pedis: An online survey of podiatrists, United States

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