BACKGROUND: Trichophyton mentagrophytes ITS genotype VII (TMVII) has recently been identified in France as the causative agent of dermatophyte infections transmitted during sexual activity among men who have sex with men (MSM). OBJECTIVES: Our objective was to provide new insights into the epidemiology, clinical presentation and treatment of TMVII infections based on cases diagnosed from October 2022 to September 2023 in three medical mycology laboratories in Paris. Additionally, we aimed to perform molecular characterization of TMVII strains collected in Paris, as well as in Switzerland. METHODS: We identified all isolates from skin and hair belonging to the T. mentagrophytes complex by sequencing the ITS region. For isolates corresponding to TMVII, clinical data were retrieved from medical records. For all available TMVII strains that we isolated since January 2021, we sequenced tef1α and tubb and determined the MAT locus idiomorph. RESULTS: We identified 32 cases of TMVII Infections. All cases occurred in men, 30 of whom reported having sex with men. Fifteen cases were sporadic cases including four among sex workers. The other 17 cases belonged to a single cluster involving a tantric masseur who infected 15 clients and his roommate. The median time from massage to lesion onset was 16 [2-52] days. Except for one patient, all other patients received systemic antifungal treatment with terbinafine. We observed five patients whose cultures remained positive even after 3-4 weeks of treatment and five patients experienced a relapse of the infection after discontinuing antifungal treatment. All French isolates exhibited identical tef1α and tubb sequences, as well as the same MAT idiomorph locus. They displayed variations in the tef1α sequence compared to isolates from Switzerland and the Czech Republic. CONCLUSIONS: We confirm the active circulation of TMVII among MSM in France, which is associated with challenges in diagnosis, treatment and prevention.

Bioclinic Laboratory Madeleine Groupe Inovie Paris France

Cerballiance Paris France

Department of Botany Faculty of Science Charles University Prague Czech Republic

Department of Dermatology Tenon Hospital Assistance Publique Hôpitaux de Paris CNRS Centre d'Immunologie et des Maladies Infectieuses Cimi Paris INSERM Sorbonne Université Paris France

Department of Dermatology Tenon Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Dermatology University Hospital Zurich University of Zurich Zurich Switzerland

Department of Infectious Diseases La Pitié Salpêtrière Hospital Assistance Publique Hôpitaux de Paris INSERM Sorbonne University Paris France

Department of Infectious Diseases La Pitié Salpêtrière Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Infectious Diseases Saint Antoine Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Infectious Diseases Tenon Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Parasitology and Mycology La Pitié Salpêtrière Hospital Assistance Publique Hôpitaux de Paris CNRS Centre d'Immunologie et Des Maladies Infectieuses Cimi Paris INSERM Sorbonne Université Paris France

Department of Parasitology and Mycology La Pitié Salpêtrière Hospital Assistance Publique Hôpitaux de Paris INSERM Sorbonne University Paris France

Department of Parasitology and Mycology La Pitié Salpêtrière Hospital Assistance Publique Hôpitaux de Paris Paris France

Department of Parasitology and Mycology Saint Antoine Hospital Assistance Publique Hôpitaux de Paris INSERM Sorbonne University Paris France

Department of Parasitology and Mycology Saint Louis Hospital Assistance Publique Hôpitaux de Paris Paris France

Immunobiology of Aspergillus Institut Pasteur Université Paris Cité Paris France

Laboratory of Fungal Genetics and Metabolism Institute of Microbiology The Czech Academy of Sciences Prague Czech Republic

National Reference Laboratory for Dermatophytes Institute for Microbiology and Infection Immunology Charité University Medicine Berlin Berlin Germany

Policlinique Baudelaire Saint Antoine Hospital Assistance Publique Hôpitaux de Paris Paris France

Service de Parasitologie Mycologie Hôpital Saint Antoine AP HP Centre de Recherche Saint Antoine CRSA INSERM Sorbonne Université Paris France

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