<i>Trichophyton indotineae</i> : Epidemiology, antifungal resistance and antifungal stewardship strategies
Bibliographic record
Abstract
There has been a recent shift in the epidemiology of superficial fungal infections (tinea, dermatophytosis, dermatomycoses). Trichophyton indotineae is an emerging dermatophyte species of significant global concern for its contagious nature and antifungal drug resistance. This scoping review includes available clinical and laboratory assessments of T. indotineae to provide a comprehensive up-to-date overview of its epidemiology, clinical manifestations, diagnostic approaches, antifungal susceptibility patterns, resistance mechanisms and management strategies. We discuss T. indotineae resistance against standard and newer antifungals (terbinafine, griseofulvin and triazoles including fluconazole, itraconazole, voriconazole and posaconazole). In particular, the terbinafine susceptibility profile of T. indotineae can be linked to squalene epoxidase (SQLE) single-nucleotide variations. For diagnosis, it is not possible to separate T. indotineae from other members of the T. mentagrophytes complex (T. mentagrophytes and T. interdigitale) without access to molecular diagnostic methods. So, in patients presenting with extensive dermatophytoses, with a history of treatment resistance and/or recent travel, molecular diagnosis to confirm T. indotineae infection should be considered. Healthcare providers often face challenges in choosing between terbinafine and itraconazole treatments. While the use of terbinafine is limited due to resistance, itraconazole is hindered by erratic absorption, possible drug interactions and side effects as well as resistance in some cases. Newer treatments being investigated include super-bioavailable itraconazole, third-generation triazoles (voriconazole, posaconazole) and topical-oral combination regimens. The need for improved diagnostic accessibility, judicious antifungal prescribing, and implementing an effective antifungal stewardship program are highlighted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".