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Ringworm Fungal Infections Are Common In The US And Are Becoming Increasingly Resistant To Treatment – 6 Questions Answered

The World Health Organization considers antimicrobial resistance to be one of the most serious threats for global health. Similar to the way bacteria have developed resistance to antibiotics, fungal infections throughout the world are becoming more drug-resistant and more deadly.

In early 2023, the New York State Department of Health reported two cases of severe tinea, a contagious type of ringworm infection. The Centers for Disease Control and Prevention later reported that they were caused by a species of fungus that has been spreading throughout South Asia over the past decade.

The Conversation spoke with Rodney Rohde, a medical laboratory professional and public health microbiologist, about the prevalence of ringworm and the growing threat of antifungal resistance around the world.

1. What is ringworm and how common is it?

When one hears the term ringworm, it likely conjures images of a nasty parasitic worm infection. However, a ringworm infection is a common infection of the skin caused by a fungus. Experts state that about 20%-25% of the population will experience a ringworm infection at any given time.

Fungi can be found almost anywhere – soil, plants, surfaces, on the skin and in our bodies, and even in the air. Research shows that there are up to 40 types of fungus that can cause these ringworm infections, with the most common types being from the genuses Trichophyton, Microsporum or Epidermophyton.

Medical terms for ringworm are "tinea" and "dermatophytosis." Tinea and dermatophytosis are synonyms for a contagious fungal infection of the skin. Other names for ringworm are based on its location on the body – for example, ringworm on the feet is commonly called athlete's foot, and ringworm associated with the groin area is referred to as jock itch. These are characterized by a persistent itchy rash that can appear flaky and cracked.

While anyone can be infected, ringworm is most commonly picked up in the following circumstances:

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– A weakened immune system or an autoimmune disease like lupus.

– Playing a high-contact sport, like wrestling; this ringworm is called tinea gladiatorum.

– Profuse sweating, also known as hyperhidrosis.

– The use of public showers or locker rooms.

– Handling or working with infected animals.

– Living in a subtropical or tropical region.

2. How can you recognize ringworm?

The hair, skin and nails of either fingers or toes are the likely landing spots for a ringworm infection. Signs and symptoms of an infection usually depend on which part of the body is affected, but generally may include hair loss and red, scaly, cracked skin. However, the most well-known sign that gives this infection its ironic and misplaced name – ringworm – is the hallmark ring-shaped rash.

3. How does ringworm spread?

Many fungi can be seen with the naked eye, such as common mushrooms or bread mold.

Fungi can grow in two forms: yeasts, which are single round cells, and molds, which are made up of many cells forming long, thin, hairlike threads called hyphae. Some of them can exhibit both forms of growth and thrive in decaying organic material like soil or a plant. But fungi can also grow in unexpected places, such as on wallpaper.

Fungi are relatively easily transmitted because of their ability to survive on a diversity of surfaces, including medical devices.

Fungal transmission occurs via three primary routes: by coming into close contact with another person who has a ringworm infection; by touching an infected animal, be it livestock, pets or wildlife; or by contacting an infected surface.

Some types of fungi can thrive where it's warm and humid. Ringworm occurs more frequently in tropical areas and during hot, humid summers.

4. How can you reduce the likelihood of getting it?

Some of the best ways to reduce or prevent a ringworm or other fungal infection include:

– Wash hands with soap and warm water.

– Have your pets checked regularly for ringworm.

– Wear shoes and socks that are made of lightweight, breathable materials to reduce moisture.

– Avoid walking barefoot in wet or humid areas like locker rooms or public showers.

– Clip fingernails and toenails regularly to keep them short and clean.

– Change socks and underwear at least once a day, since bacteria and fungi like most, humid environments.

– Avoid sharing clothing, towels, sheets or other personal items with others.

– For athletes involved in close contact sports like wrestling, shower immediately after practice or a match and keep all sports gear and uniform clean.

– Do not share sports gear such as helmets with other players.

5. What treatments are there?

A dermatologist can typically diagnose a ringworm infection visually, but in some cases a small skin scraping, hair or nail sample may be needed for microscopic examination.

There are several treatment options, including antifungal medications prescribed by a physician or dermatologist or over-the-counter products sold as a cream or ointment. A dermatologist may also prescribe an oral pill such as griseofulvin or terbinafine.

Popular over-the-counter products include clotrimazole, sold as Lotrimin or Mycelex, or topical miconazole. For more severe cases, a doctor might prescribe options such as itraconazole medications or tolnaftate.

Finally, in some cases a person may need to use antifungal shampoo and soap to clean themselves and sterilize bedding and clothing.

But treatments don't always work.

6. Why is antifungal resistance a growing problem?

Antimicrobial resistance, including antifungal resistance, is an ongoing global emergency. Experts estimate that drug-resistant infections caused roughly 1.3 million deaths around the world in 2019. By 2050 that figure could rise to 10 million deaths each year.

Over the past 10 years, South Asia has been experiencing an epidemic of antifungal-resistant ringworm caused by the spread of a novel species of fungus called Trichophyton indotineae, which causes skin disease in both animals and humans. Experts believe that inappropriate use of topical antifungal and corticosteroid medications is likely driving its spread.

In February 2023, a New York City dermatologist reported to public health officials two cases in which unrelated patients with severe tinea caused by Trichophyton indotineae were not improving with oral antifungal treatment. A CDC report found that those were the first cases of tinea from that species in the U.S. One of the two patients had no recent international travel history, suggesting that it could be a case of local transmission of Trichophyton indotineae in the U.S.

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. The Conversation is trustworthy news from experts, from an independent nonprofit. Try our free newsletters.

It was written by: Rodney E. Rohde, Texas State University.

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Rodney E. Rohde has received funding from the American Society of Clinical Pathologists, American Society for Clinical Laboratory Science, U.S. Department of Labor (OSHA), and other public and private entities/foundations. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See https://rodneyerohde.Wp.Txstate.Edu/service/.

Mom Battles Fungal Meningitis After Cosmetic Surgery At Mexico Clinic Linked To Deadly Outbreak

An Arizona woman is fighting for her life after contracting fungal meningitis following a plastic surgery procedure at a private clinic in Matamoros, Mexico.

Alondra Lomas is one of nine confirmed cases of the life-threatening infection in an outbreak the Centers for Disease Control and Prevention says is tied to cosmetic surgery clinics in the Mexican city that borders Brownsville, Texas. So far, at least seven women have died – one in Mexico and six Americans, according to the CDC.

The fatalities, Lomas says, include another woman she says she befriended in Mexico and who had plastic surgery at the same clinic just two hours after her own procedure.

When asked what her greatest fear is, an emotional Lomas told "Impact x Nightline" from her hospital room, "Death. And I only say that because I have not seen one lady leave. I have not seen no girl go home yet."

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The latest "Impact" episode, "If Looks Could Kill," explores the medical tourism industry in Mexico, the destination for some patients who travel from the U.S. Seeking less expensive medical care, including elective cosmetic surgery. Mexico was the second most popular destination for medical tourism around the world in 2020, according to Patients Beyond Borders. Thailand was the No. 1 most popular destination.

Lomas, a mother of two, sought out plastic surgery, specifically liposuction and a so-called Brazilian butt lift, after she says two C-section births left her with sagging skin on her stomach area.

The surgeon she chose, Dr. Luis Manuel Rivera de Anda, offered a variety of cosmetic surgeries at what seemed like bargain prices, Lomas said. At first, Lomas says she was nervous and scared, but then started to feel happy at the prospect of being able to "get the body that [she] wants."

Alondra Lomas, who contracted fungal meningitis linked to a cosmetic surgery clinic in Mexico, is shown in her hospital bed in Phoenix.

ABC News

Lomas flew to Brownsville, Texas, then crossed the border to Matamoros. Dr. Rivera worked out of Clinica K-3, Lomas said. Like many Mexican clinics, surgery there is done using epidurals for anesthesia.

After the procedure, Lomas says she began to experience headaches and back pain while home in Arizona until it finally got so bad that she couldn't walk. Lomas immediately reached out to the surgical coordinator and doctor, but she says they didn't have any real answers. Throughout April, the symptoms would come and go.

Lomas said she began to experience worsening symptoms, including fatigue and hallucinations. On May 7, she went to St. Joseph's Medical Center in Phoenix, where she was diagnosed with fungal meningitis.

"The doctors told me that if I didn't go in time, I could have died within 24 hours because this is a fatal infection," Lomas said.

Meningitis occurs when an infection causes inflammation in the protective membranes that surround the brain and spinal cord. Most of the time, the infection is viral or bacterial. Fungal meningitis is much more rare. Symptoms like backaches, headaches and sensitivity to light usually appear gradually, making it harder to diagnose.

MORE: What is fungal meningitis after 2 Americans die from the infection contracted in Mexico

Getting treatment as early as possible is critical to survival, according to Dr. Tom Chiller, who runs the fungal disease branch of the CDC.

By May 11, the CDC had enough cases in the U.S. To notify Mexican officials about the outbreak, linking them to cosmetic surgery in Matamoros. They identified two private clinics – Riverside Surgical Center and Clinica K-3, where Lomas had her surgery.

"The strongest hypothesis right now is that a batch of these drugs used for anesthesia, either epidural or spinal anesthesia, were contaminated," Dr. Vicente Joel Hernandez Navarro, state secretary of health for Tamaulipas, Mexico, told "Impact."

Both Clinica K-3 and Riverside have been shut down, Navarro said, adding that 10 other clinics are being investigated and currently closed for failing to comply with health requirements.

Both clinics linked to the outbreak, along with Dr. Rivera, did not respond to a request for comment.

A shuttered Clinica K-3 is shown in Matamoros, Mexico.

ABC News

The CDC has issued an alert, telling anyone who had procedures under epidural anesthesia at the two clinics between Jan. 1 and May 13 of this year to go to their local emergency room and get tested for meningitis. The CDC is tracking about 200 people they know had surgery in Matamoros and could be at risk.

This isn't the first time Mexico has dealt with an outbreak. Just six months ago, there were 80 confirmed cases of fungal meningitis linked to a medical center in the Mexican state of Durango, the New York Times reported. Thirty-nine women died.

The issue isn't limited to Mexico. In 2012, dozens died after 14,000 people were exposed to tainted steroid injections in the U.S, according to the CDC.

After more than a month in the hospital, Lomas said her treatment didn't appear to be working, so doctors performed brain surgery to create a port that delivers the anti-fungal medication directly to the infection. It appears the surgery worked, she says, but she's not out of the woods yet.

"So I try to, you know, stay positive, because I need to be there for my children, you know? I don't wanna have another party in the hospital because my son's birthday is in August. I wanna be able to go home and be present," Lomas said.

"Impact x Nightline" is now streaming on Hulu. The episode was produced by ABC News' Knez Walker, Stephanie Fasano, Zach Fannin, Caroline Pahl, Jaclyn Skurie, Anne Laurent, Tara Guaimano and Candace Smith Chekwa.

Fungal Meningitis Outbreak Kills 7 People; CDC Urges Testing

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