Heidi Splete / 2024 年 11 月 13 日 / Medscape 醫學新聞 / 專題

根據美國疾病管制與預防中心發病率和死亡率每週報告（MMWR）發表的一篇論文，一種被稱為須毛癬菌基因型VII ( Trichophyton mentagrophytes genotype VII, TMVII) 的皮癬菌已被確定為美國四名成年人新出現的性傳播真菌感染的原因。

TMVII 是一種性傳播真菌，可引起生殖器癬；紐約市哥倫比亞大學歐文醫學中心的傳染病專家 Jason E. Zucker 博士及其同事寫道，這種真菌可能會被誤認為是濕疹、牛皮癬或其他皮膚病。

「包括 TMVII 在內的皮癬菌感染是透過直接皮膚接觸傳播的」，通訊作者、紐約大學格羅斯曼醫學院皮膚科醫生 Avrom S. Caplan 醫學博士在接受採訪時說。

「據我們所知，在美國，僅 MSM（男男性行為者）感染，但歐洲有報告稱非 MSM 患者感染 TMVII，其中包括前往東南亞從事性旅遊的患者，或性伴侶為感染TMVII 的人」，他說道。

這四名患者於2024年4月至2024年7月期間被診斷出患有癬，真菌培養和DNA測序確定TMVII為感染原因。所有四名患者都是來自紐約市、年齡在 30 至 39 歲之間的順性別男性，他們報告最近與其他男性有性接觸；一名是性工作者，另兩人彼此發生性行為，另一名則報告最近去過歐洲。

四名患者均在臉部、臀部或生殖器上出現皮疹；作者寫道，所有患者均已成功接受抗真菌藥物治療。

卡普蘭告訴 Medscape 醫學新聞，患有生殖器病變且性活躍的個體應去看診醫療保健提供者，並應考慮 TMVII，特別是在身體其他部位出現鱗狀、發癢或發炎的皮疹時。

此外，「如果有人來接受醫學評估，並且臀部、臉部或其他地方有癬，特別是如果他們性活躍，則應該考慮 TMVII 的問題，並且還應該詢問患者其他可能的生殖器病變」，他說。 「任何被診斷患有 STI（性傳播感染）的患者，包括 MSM 患者，都應該接受適當的其他 STI 評估，包括 TMVII」，他強調。

卡普蘭告訴 Medscape 醫學新聞，需要持續監測和監控來追蹤 TMVII 並更好地了解新出現的感染。他說，臨床醫生可以透過美國皮膚病學會網站中皮癬菌登記處找到有關新興的一般疾病或特別的皮癬菌疾病的更多資訊。

卡普蘭補充說：「我們還需要能更好地取得測試和更快速的確認性檢測，以檢測新興的皮癬菌菌株並監測其抗真菌抗藥性模式」。 「目前，我們沒有證據顯示 TMVII 存在抗真菌抗藥性，這也是它與T indotineae”  印度毛癣菌［註：Trichophyton indotineae，是一種新型的皮癬菌，常對第一線抗真菌藥–特比萘芬（Terbinafine）耐藥甚至多重耐藥，對皮癬菌病的診療帶來挑戰］ 的區別」，他指出。

鼓勵報告並識別新的感染

田納西州孟菲斯田納西大學健康科學中心副教授兼傳染病專家 Shirin A. Mazumder 醫學博士在接受採訪時說：「新出現的感染可以模仿非傳染性疾病的過程，這會使診斷變得具有挑戰性」。

Mazumder指出：「如果沒有報告病例並且疾病沒有廣泛傳播，監測新出現的感染可能會很困難」。她補充說，透過病例報告對臨床醫生進行教育，並鼓勵他們向公共衛生部門報告異常病例，有助於克服這項挑戰。

Mazumder 告訴 Medscape Medical News，在臨床環境中，皮膚損傷對局部類固醇的應用若沒有反應或惡化可能是 TMVII 的危險信號。 「由於 TMVII 的皮膚表現與濕疹或牛皮癬等非感染性疾病非常相似，因此在考慮診斷 TMVII 之前可能已經嘗試過使用局部皮質類固醇」，她說。

此外，位置對於診斷也很重要。 TMVII 病灶發生在臉部、生殖器、四肢、軀幹和臀部。 Mazumder 補充說，獲得完整的性史很重要，因為真菌可以透過性接觸經由密切接觸而傳播。

Mazumder 告訴 Medscape 醫學新聞，治療 TMVII 感染的最有效治療方法仍有待確定。她說：「治療考慮因素，例如口服和局部抗真菌藥物的聯合治療相對於單獨口服抗真菌藥物的治療，以及最佳治療持續時間等需要進一步研究」。

「確定接觸者之間的傳播率、何時是最具傳染性、一旦被感染時要多久會被認為具有傳染性，以及再感染率等問題可能會受益來自進一步的研究」，她補充道。

Mazumder 說，雖然目前的病例是在 MSM 中報告的，但隨著更多病例的報告，確定 TMVII 如何影響其他患者群體將會很有趣。 「進一步了解不同程度的免疫抑制如何影響 TMVII 病程，是另一個重要的考慮因素」，她說。

最後，確定 TMVII 感染的長期後遺症率和細菌合併感染率，將有助於更好地了解 TMVII，她說道。

研究人員沒有需要揭露的財務衝突。 Mazumder 沒有需要揭露的財務衝突。

引用此內容：MSM 中出現新的性傳播真菌感染 – Medscape – 2024 年 11 月 13 日。

New Sexually Transmitted Fungal Infection Emerges in MSM

Heidi Splete / November 13, 2024 / Medscape Medical News / Features

A dermatophyte known as Trichophyton mentagrophytes genotype VII (TMVII) has been identified as the cause of an emerging sexually transmitted fungal infection in four adults in the United States, according to a paper published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).

TMVII is a sexually transmitted fungus that causes genital tinea; the fungus might be misidentified as eczema, psoriasis, or other dermatologic conditions, Jason E. Zucker, MD, an infectious disease specialist at Columbia University Irving Medical Center, New York City, and colleagues wrote.

“Dermatophyte infections, including TMVII, are spread through direct skin-to-skin contact,” said corresponding author Avrom S. Caplan, MD, a dermatologist at NYU Grossman School of Medicine, New York City, in an interview.

“In the United States, to our knowledge, the infection has only been in MSM [men who have sex with men], but there have been reports of TMVII in Europe in non-MSM patients, including among patients who travelled to Southeast Asia for sex tourism or partners of people who have been infected with TMVII,” he said.

The four patients were diagnosed with tinea between April 2024 and July 2024, and fungal cultures and DNA sequencing identified TMVII as the cause of the infection. All four patients were cisgender men aged 30-39 years from New York City who reported recent sexual contact with other men; one was a sex worker, two had sex with each other, and one reported recent travel to Europe.

All four patients presented with rashes on the face, buttocks, or genitals; all were successfully treated with antifungals, the authors wrote.

Individuals with genital lesions who are sexually active should be seen by a healthcare provider, and TMVII should be considered, especially in the event of scaly, itchy, or inflamed rashes elsewhere on the body, Caplan told Medscape Medical News.

Additionally, “If someone presents for a medical evaluation and has ringworm on the buttocks, face, or elsewhere, especially if they are sexually active, the question of TMVII should arise, and the patient should be asked about possible genital lesions as well,” he said. “Any patient diagnosed with an STI [sexually transmitted infection], including MSM patients, should be evaluated appropriately for other STIs including TMVII,” he emphasized.

Continued surveillance and monitoring are needed to track TMVII and to better understand emerging infections, Caplan told Medscape Medical News. Clinicians can find more information and a dermatophyte registry via the American Academy of Dermatology websites on emerging diseases in general and dermatophytes in particular, he said.

“We also need better access to testing and more rapid confirmatory testing to detect emerging dermatophyte strains and monitor antifungal resistance patterns,” Caplan added. “At this time, we do not have evidence to suggest there is antifungal resistance in TMVII, which also distinguishes it from T indotineae,” he noted.

Encourage Reporting and Identify New Infections

“Emerging infections can mimic noninfectious disease processes, which can make the diagnosis challenging,” said Shirin A. Mazumder, MD, associate professor and infectious disease specialist at The University of Tennessee Health Science Center, Memphis, Tennessee, in an interview.

“Monitoring emerging infections can be difficult if the cases are not reported and if the disease is not widespread,” Mazumder noted. Educating clinicians with case reports and encouraging them to report unusual cases to public health helps to overcome this challenge, she added.

In the clinical setting, skin lesions that fail to respond or worsen with the application of topical steroids could be a red flag for TMVII, Mazumder told Medscape Medical News. “Since the skin findings of TMVII can closely resemble noninfectious processes such as eczema or psoriasis, the use of topical corticosteroids may have already been tried before the diagnosis of TMVII is considered,” she said.

Also, location matters in making the diagnosis. TMVII lesions occur on the face, genitals, extremities, trunk, and buttocks. Obtaining a thorough sexual history is important because the fungus spreads from close contact through sexual exposure, Mazumder added.

The most effective treatment for TMVII infections remains to be determined, Mazumder told Medscape Medical News. “Treatment considerations such as combination treatment with oral and topical antifungal medications vs oral antifungal medication alone is something that needs further research along with the best treatment duration,” she said.

“Determining the rate of transmissibility between contacts, when someone is considered to be the most infectious, how long someone is considered infectious once infected, and rates of reinfection are questions that may benefit from further study,” she added.

Although the current cases are reported in MSM, determining how TMVII affects other patient populations will be interesting as more cases are reported, said Mazumder. “Further understanding of how different degrees of immunosuppression affect TMVII disease course is another important consideration,” she said.

Finally, determining the rate of long-term sequelae from TMVII infection and the rate of bacterial co-infection will help better understand TMVII, she said.

The researchers had no financial conflicts to disclose. Mazumder had no financial conflicts to disclose.

Cite this: New Sexually Transmitted Fungal Infection Emerges in MSM – Medscape – November 13, 2024.