Epidemiology and Antifungal Susceptibility Profiling of Clinical Isolates From a Community Acquired Tinea Imbricata Outbreak Among the Bateq Subtribe in Pahang, Malaysia

Introduction: Tinea imbricata (TI) outbreak poses a significant health burden among indigenous populations in rainforest regions due to their geographical isolation and poor socioeconomic conditions. This study aimed to investigate the epidemiological trends, antifungal susceptibility patterns, and treatment outcomes of TI among the Bateq subtribe in Pahang, Malaysia. Materials and Methods: A cross-sectional survey was conducted between July–October 2023 in five villages within the National Rainforest Park, Malaysia. Socio-demographic characteristics, clinical manifestations, and treatment outcomes were collected through interviews, laboratory investigations, and clinical examinations. Treatment modalities were evaluated for their effectiveness in reducing disease burden. Results: 569 individuals were surveyed, revealing a TI prevalence rate of 7.91% with children aged 15 years and below exhibiting the highest susceptibility (9.22%). Antifungal susceptibility testing of clinical isolates of Trichophyton concentricum demonstrated high sensitivity to terbinafine (GM MIC=0.144 μg/ml, GM MFC=0.198 μg/ml, p<0.05) and griseofulvin (GM MIC=1.741 μg/ml, GM MFC=4.782 μg/ml, p<0.05), while clotrimazole showed moderate activity (GM MIC=5.897 μg/ml, GM MFC=22.291 μg/ml). Fluconazole demonstrated the least potency, with no fungicidal activity observed at concentrations up to 128 μg/ml. Treatment outcomes indicated that combination therapy (terbinafine gel and oral griseofulvin) significantly outperformed terbinafine gel alone, achieving an almost complete lesion resolution (LA reduced to 0.158±0.158 cm² versus 3.684±1.522 cm², p<0.05). Conclusion: These findings provide critical insights into the epidemiology and emerging drug resistant of TI in the Bateq subtribe, highlighting the importance of continued surveillance, monitoring, and adaptation of treatment strategies to combat evolving antifungal resistance patterns.