Abstract：
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：奥杜氏小孢子菌最近又开始流行。皮肤癣菌感染很难治疗，这就提出了一个问题，如果我们用最有效的抗真菌（AF）药物治疗奥杜氏支原体感染。
目的：本研究的目的是调查丹麦头癣（TC）的暴发，应对疫情管理中的挑战，并对以前的疫情和最低抑制浓度（MIC）进行两次审查。
方法：我们使用Wood\的光，文化,直接显微镜,和PCR筛选和抗真菌药敏试验（AFST）的治疗优化。我们进行了两次评论，以使用肉汤微量稀释法探索奥杜尼氏分枝杆菌的暴发和MIC值。
结果：在接受筛选的73个人中，10人确认了奥杜尼氏杆菌感染。在4例（66％）中观察到对灰黄霉素的临床抗性。虽然以前的疫情显示出很高的灰黄霉素疗效，我们的研究支持特比萘芬，氟康唑和伊曲康唑在我们难以治疗的病例中。AFST指导了AF的选择。通过文献检索,我们发现了五起奥杜尼氏杆菌爆发，其中管理的差异包括使用伍德光和预防性局部房颤治疗。来自文献的特比萘芬MIC值范围为0.002至0.125mg/L。
结论：使用Wood的光照和预防措施对限制感染很重要。文献缺乏灰黄霉素对奥杜尼尼的MIC数据，但表明对特比萘芬敏感。奥杜尼分枝杆菌治疗的临床疗效是矛盾的，有利于特比萘芬和灰黄霉素。AFST可以在疑难病例的治疗中发挥关键作用，但是缺乏AAST和MIC断点的标准化限制了其实用性。
目的：本研究的目的是调查丹麦头癣（TC）的暴发，应对疫情管理中的挑战，并对以前的疫情和最低抑制浓度（MIC）进行两次审查。
方法：我们使用Wood\的光，文化,直接显微镜,和PCR筛选和抗真菌药敏试验（AFST）的治疗优化。我们进行了两次评论，以使用肉汤微量稀释法探索奥杜尼氏分枝杆菌的暴发和MIC值。
结果：在接受筛选的73个人中，10人确认了奥杜尼氏杆菌感染。在4例（66％）中观察到对灰黄霉素的临床抗性。虽然以前的疫情显示出很高的灰黄霉素疗效，我们的研究支持特比萘芬，氟康唑和伊曲康唑在我们难以治疗的病例中。AFST指导了AF的选择。通过文献检索,我们发现了五起奥杜尼氏杆菌爆发，其中管理的差异包括使用伍德光和预防性局部房颤治疗。来自文献的特比萘芬MIC值范围为0.002至0.125mg/L。
结论：使用Wood的光照和预防措施对限制感染很重要。文献缺乏灰黄霉素对奥杜尼尼的MIC数据，但表明对特比萘芬敏感。奥杜尼分枝杆菌治疗的临床疗效是矛盾的，有利于特比萘芬和灰黄霉素。AFST可以在疑难病例的治疗中发挥关键作用，但是缺乏AAST和MIC断点的标准化限制了其实用性。
