Trichophyton mentagrophytes ITS Genotype VIII/Trichophyton indotineae Infection and Antifungal Resistance in Bangladesh

<i>Trichophyton</i> (<i>T</i>.) <i>mentagrophytes</i> ITS genotype VIII, also known as <i>Trichophyton indotineae</i>, is a new species of the <i>T. mentagrophytes</i>/<i>T. interdigitale</i> complex and its first records, albeit under a different species name, are from the Indian subcontinent, Middle Eastern Asia, and West Asia<i>. T. mentagrophytes</i> genotype VIII (<i>T</i>. <i>indotineae</i>) has spread globally and has now been documented in over 30 countries. The aim of this study was to investigate the occurrence and proportion of terbinafine- and itraconazole-resistant isolates of <i>T. mentagrophytes ITS</i> genotype VIII (<i>T. indotineae</i>) in Bangladesh. This was part of an official collaborative project between IADVL (Indian Association of Dermatologists, Venereologists, and Leprologists) and Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Over a period of 6 months, ninety-nine patients of chronic recalcitrant tinea corporis were recruited from BSMMU hospital. Species identification was performed by fungal culture and morphological observation of the upper and lower surfaces of fungal colonies, as well as by using fluorescent microscopy. In addition, a PCR (polymerase chain reaction)-ELISA was performed to group the patients into those with the <i>T. mentagrophytes</i>/<i>T. interdigitale</i> complex. The internal transcribed spacer (ITS) gene was sequenced. Samples were tested for resistance to terbinafine and itraconazole by mutational analyses of the squalene epoxidase (<i>SQLE</i>) and the ergosterol 11B (<i>ERG11B</i>) genes. A total of 79/99 samples showed a positive culture. In 76 of these isolates, <i>T. mentagrophytes</i> ITS genotype VIII (<i>T. indotineae</i>) could be reliably identified both by culture and molecular testing. Resistance testing revealed terbinafine resistance in 49 and itraconazole resistance in 21 patients. Among these, 11 patients were resistant to both the antifungal agents. Mutations L393S, L393F, F397L, and F397I of the <i>SQLE</i> gene were associated with terbinafine resistance. Resistance to itraconazole could not be explained by mutations in the <i>ERG11B</i> gene. Infections with <i>T. mentagrophytes</i> ITS genotype VIII (<i>T. indotineae</i>) have become a public health issue with potentially global ramifications. About 62% of samples from Bangladesh showed resistance to terbinafine, making oral itraconazole the most effective drug currently available, although resistance to itraconazole and both terbinafine and itraconazole also exists.