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Background: Emerging terbinafine resistance in Trichophyton species has been reported globally. The prevalence in clinical samples from patients with treatment failure is unknown in Denmark., Objectives: Prospective study of terbinafine resistance in Trichophyton isolates from patients with recalcitrant skin or nail infections., Patients/methods: Clinical samples (nails or skin scrapings) from patients with recalcitrant infections were included. Isolates were tested with the EUCAST broth microdilution method, E.Def 11.0 and DermaGenius Resistance Multiplex PCR kit (PathoNostics, The Netherlands)., Results: Thirty-three isolates were included in the study, 27 (81.8%) T. rubrum, 2 (6.1%) T. interdigitale, 1 (3.0%) T. mentagrophytes and 3 (9.1%) T. indotineae. Sixteen of 31 isolates (52%) were terbinafine resistant with the EUCAST broth microdilution method, 13 T. rubrum and 3 T. indotineae. Two isolates did not grow in the broth culture medium. The DermaGenius Resistance Multiplex PCR kit showed mutations associated with terbinafine resistance in 11 isolates. All of the 11 isolates with detected mutations by PCR also displayed terbinafine resistance by the EUCAST method., Conclusions: Terbinafine resistance was detected in 52% of Trichophyton isolates from recalcitrant infections by the EUCAST broth microdilution. T. rubrum was the most common species among the resistant isolates (81.3%). The DermaGenius Resistance Multiplex PCR kit was a reliable tool for the detection of mutations associated with terbinafine resistance and is suitable as an initial screening for terbinafine resistance before results from EUCAST broth microdilution testing is available. Susceptibility testing of Trichophyton spp. from skin and nail samples is highly relevant from patients with terbinafine treatment failure., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

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., (© 2024 The Author(s). Mycoses published by Wiley‐VCH GmbH.)

We report a fatal aspergillosis case in which STRAf typing and whole-genome sequencing substantiated in vivo emergence of an azole-resistant Aspergillus fumigatus with a 120-bp tandem repeat in the promoter region of cyp51A. This event, previously restricted to the environment, challenges current understanding of azole resistance development in A. fumigatus.