Preventing and managing antifungal-resistant ringworm requires a comprehensive approach involving individual hygiene practices and collaboration with facilities management.
Antifungal-Resistant Ringworm: Overview
Ringworm, or dermatophytosis, is a common fungal infection affecting the skin, nails, and scalp.
While most cases of ringworm are treatable with antifungal medications, there have been reports of antifungal-resistant strains of the fungi causing the infection.
Antifungal resistance occurs when the fungi responsible for ringworm develop mechanisms to evade or survive the effects of the antifungal drugs.
This can happen due to several factors, including inappropriate or prolonged use of antifungal medications, incomplete treatment, or overuse of these drugs in specific settings.
Furthermore, certain fungi strains may naturally resist specific antifungal agents.
Antifungal-resistant ringworm can present a challenge in treatment, as the standard treatment medications may be less effective against these resistant strains.
In such cases, alternative antifungal drugs or combination therapies may be necessary to achieve a successful outcome.
Recent Cases in the News
Per the U.S. Centers for Disease Control and Prevention (CDC), two cases of antifungal-resistant ringworm were recently documented in New York.
According to the CDC;
On February 28, 2023, a New York City dermatologist notified public health officials of two patients who had severe tinea that did not improve with oral terbinafine treatment, raising concern for potential T. indotineae infection; these patients shared no epidemiologic link.
Patient A, a woman aged 28 years, developed a widespread pruritic eruption during summer 2021. She had a first dermatologic evaluation in December 2021, at which time she was in her third trimester of pregnancy.
Patient B, a woman aged 47 years with no major medical conditions, developed a widespread, pruritic eruption in summer 2022 while in Bangladesh. 
Prevention and Management Strategies from a Facilities Management Perspective
In addition to individual preventive measures, facilities management plays a crucial role in minimizing the risk of ringworm and managing antifungal-resistant cases within various settings.
Cleaning and Sanitation Protocols
- Establish comprehensive cleaning protocols that prioritize high-touch surfaces and communal areas.
- Use effective disinfectants recommended for antifungal activity to target surfaces where fungi may reside.
- Train cleaning staff on proper techniques and the importance of maintaining cleanliness and hygiene.
Adequate Ventilation and Air Circulation
- Ensure proper ventilation in enclosed areas to minimize humidity and moisture, which can create an environment conducive to fungal growth.
- Regularly inspect and maintain HVAC systems to prevent mold growth and improve air quality.
Education and Training Programs
- Conduct educational programs for staff, emphasizing the importance of personal hygiene, cleanliness, and infection control measures.
- Provide training on recognizing the signs and symptoms of ringworm and reporting suspected cases promptly.
Adequate Facilities Design
- Design facilities with easy-to-clean surfaces, minimizing areas where dirt and fungi can accumulate.
- Consider using antimicrobial materials or coatings in high-risk areas such as showers, locker rooms, and changing rooms.
- Implement routine inspections to identify and address areas prone to fungal growth, such as damp or poorly ventilated spaces.
- Promptly repair any leaks or water intrusions that could create a suitable environment for fungi to thrive.
Prompt Response to Reported Cases
- Establish a protocol for reporting suspected ringworm cases to facility management.
- Follow appropriate measures for isolation, cleaning, and disinfection of affected areas to prevent the spread of infection.
- Encourage affected individuals to seek medical attention and complete the prescribed treatment.
Collaboration with Healthcare Professionals
- Foster a partnership with local healthcare providers and seek their guidance on preventive measures and outbreak management.
- Stay informed about the latest recommendations and guidelines related to ringworm prevention and control.
Communication and Awareness
- Implement communication channels to disseminate information on ringworm prevention, symptoms, and treatment.
- Display educational posters or signage in relevant areas to promote awareness and proper hygiene practices.
References & Resources
- Caplan AS, Chaturvedi S, Zhu Y, et al. Notes from the Field: First Reported U.S. Cases of Tinea Caused by Trichophyton indotineae — New York City, December 2021–March 2023. MMWR Morb Mortal Wkly Rep 2023;72:536–537. DOI: http://dx.doi.org/10.15585/mmwr.mm7219a4.
- Uhrlaß S, Verma SB, Gräser Y, Rezaei-Matehkolaei A, Hatami M, Schaller M, Nenoff P. Trichophyton indotineae—An Emerging Pathogen Causing Recalcitrant Dermatophytoses in India and Worldwide—A Multidimensional Perspective. Journal of Fungi. 2022; 8(7):757. https://doi.org/10.3390/jof8070757
- Chowdhary A, Singh A, Kaur A, Khurana A. The emergence and worldwide spread of the species Trichophyton indotineae causing difficult-to-treat dermatophytosis: A new challenge in the management of dermatophytosis. PLoS Pathog. 2022;18(9):e1010795. Published 2022 Sep 29. doi:10.1371/journal.ppat.1010795
- Zhang, W. (2022, November 7). CDC Reports First US Cases of Severe Drug-Resistant Ringworm. ScienceAlert. Retrieved from https://www.sciencealert.com/cdc-first-us-cases-of-severe-drug-resistant-ringworm-identified
Preventing and managing antifungal-resistant ringworm requires a multifaceted approach involving individuals and facilities management.
By practicing good hygiene, seeking prompt medical attention, and adhering to prescribed treatments, individuals can minimize the risk of infection and improve outcomes.
Effective facility cleaning is critical in preventing the spread of antifungal-resistant ringworm and other illnesses by eliminating fungal spores and maintaining a clean, hygienic environment that minimizes the risk of transmission.
Outsourcing is a proven method for onboarding highly in-demand cleaning and disinfection services and experience for a fraction of the price of maintaining a similar service in-house.
If you would like more information regarding the effectiveness of high-performance infection prevention and control measures, or if you would like to schedule a free, no-obligation on-site assessment of your facility's custodial needs, contact us today for a free quote!
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