TY - JOUR
T1 - Exploring treatment and antifungal resistance in an outbreak of tinea caused by Microsporum audouinii
AU - Johansen, Claus Dall
AU - Shen, Julia Jia Rui
AU - Astvad, Karen Marie Thyssen
AU - Jemec, Gregor Borut Ernst
AU - Christensen, Jens Jørgen
AU - Saunte, Ditte Marie Lindhardt
N1 - © 2024 The Author(s). Mycoses published by Wiley‐VCH GmbH.
PY - 2024/7
Y1 - 2024/7
N2 - BACKGROUND: Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent.OBJECTIVES: The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC).METHODS: We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method.RESULTS: Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard-to-treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L.CONCLUSION: Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness.
AB - BACKGROUND: Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent.OBJECTIVES: The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC).METHODS: We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method.RESULTS: Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard-to-treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L.CONCLUSION: Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness.
KW - Antifungal Agents/pharmacology
KW - Humans
KW - Microsporum/drug effects
KW - Disease Outbreaks
KW - Microbial Sensitivity Tests
KW - Drug Resistance, Fungal
KW - Male
KW - Female
KW - Denmark/epidemiology
KW - Adult
KW - Child
KW - Terbinafine/pharmacology
KW - Middle Aged
KW - Tinea Capitis/drug therapy
KW - Griseofulvin/pharmacology
KW - Child, Preschool
KW - Adolescent
KW - Young Adult
KW - Tinea/drug therapy
KW - Itraconazole/pharmacology
KW - Aged
KW - Fluconazole/pharmacology
UR - http://www.scopus.com/inward/record.url?scp=85197105912&partnerID=8YFLogxK
U2 - 10.1111/myc.13760
DO - 10.1111/myc.13760
M3 - Journal article
C2 - 38943042
SN - 0933-7407
VL - 67
SP - e13760
JO - Mycoses
JF - Mycoses
IS - 7
M1 - e13760
ER -