须毛癣菌复合体:美国中部64只犬的回顾性研究(1997-2020) ...

王帆

Trichophyton mentagrophytes complex: A retrospective study of 64 dogs from the Central United States (1997–2020)

须毛癣菌复合体:美国中部64只犬的回顾性研究(1997-2020)

Jason B. Pieper | Daniel G. Bowden | Darren J. Berger | James O. Noxon | Sandra L. Grable | Karen L. Campbell

 

翻译：王思权 校对：王帆

 

Abstract

Background: There are limited clinical studies evaluating the Trichophyton mentagrophytes complex, with most reports confined to small case studies. Additionally, the studies are dated and provide limited information on response to newer or currently available therapies.

Hypothesis/Objectives: The aim of the study was to determine if there is a breed prevalence, lesion distribution and seasonality associated with the T.mentagrophytes complex for dogs evaluated in the central United States. An additional aim of the study was to evaluate response to therapies because there are minimal data available on clinical response with newer systemic antifungal drugs.

Animals: A total of 64 canine medical records were evaluated that had a previous diagnosis of T.mentagrophytes complex infection. Materials and Methods: A retrospective study of medical records to evaluate signalment, time of onset of clinical signs, clinical presentation and therapeutic management.

Results: A higher incidence of T.mentagrophytes complex infection was observed in the American Kennel Club (AKC) Sporting group (43%) and Terrier group (20%). A seasonal influence was noted, with the onset of clinical signs being highest in October. Lesions most often affected the muzzle (48%), followed by the head excluding the pinnae (21%). Ketoconazole, itraconazole and terbinafine appeared equivalent as systemic therapeutic options to treat T.mentagrophytes complex infections.

Conclusions and Clinical Relevance: This study identified patterns in breeds, seasonality and lesion distribution for the T.mentagrophytes complex in dogs from the central United States. Additionally, the study found several reasonable and reliable treatment options for systemic therapy.

摘要

背景: 评价须毛癣菌复合体的临床研究有限，大多数报告仅限于小规模病例研究。此外，这些研究是过时的，而新的或目前可用疗法反应的新信息有限。

假设/目的: 这项研究的目的是评估确定美国中部须毛癣菌复合体的犬种流行率、病变分布和季节性。这项研究的另一个目的是评估治疗反应，因为关于新型全身性抗真菌药物的临床反应数据很少。

动物: 共评估了64份犬病历，这些病例之前曾被诊断为须毛癣菌复合体感染。

材料和方法: 对病历进行回顾性研究，以评估特征、临床症状发作时间、临床表现和治疗管理。

结果: AKC 运动犬组(43%)和㹴类组(20%)的须毛癣菌复合体感染发生率较高。存在季节性影响，临床症状在10月份发病率最高。病变最常发生在口鼻部(48%)，其次是头部，不包括耳廓(21%)。酮康唑、伊曲康唑和特比萘芬应该可以作为全身治疗须毛癣菌复合体感染的选择。

结论和临床相关性: 这项研究确定了美国中部须毛癣菌复合体的犬种、季节性和病变分布模式。此外，该研究还发现了几种合理可靠的全身性治疗方案。

 

KEYWORDS

关键词

antifungal, dermatophytosis, dog, ringworm, treatment, Trichophyton

抗真菌、皮肤癣菌病、犬、圈癣、治疗、毛癣菌属

 

INTRODUCTION

介绍

Dermatophytosis is an important zoonotic infectious disease that affects dogs worldwide. It has been reported to affect younger dogs more commonly. Clinical signs can include alopecia, erythema, papules, scaling and crusting, which are usually nonpruritic. Lesions typically are well-demarcated, with inflammation on the periphery, and located on the face and limbs. Lesions can progress to being generalised over time.

皮肤癣菌病是一种重要的人畜共患传染病，在世界范围内均有发生。据报道，它更容易影响年轻的犬。临床症状包括脱毛、皮肤发红、丘疹、皮屑和结痂，通常不伴有瘙痒症状。病变通常界限清晰，周围有炎症，位于面部和四肢。随着时间的推移，病变可发展为全身性。

 

The most prevalent causative fungal species for dermatophytosis is variable depending on the region or country. Frequent causative agents include Microsporum canis, M.gypseum and the Trichophyton mentagrophytes complex. In most countries, M.canis has been the most reported causative agent. However,the T.mentagrophytes complex has been noted to be the most prevalent cause of dermatophytosis in India,and the second most common cause of dermatophytosis in Croatia, UK, Iran and Puerto Rico. In the southern United States, Brazil and Italy, the T.mentagrophytes complex is the third most reported cause of dermatophytosis. While some of these prevalence studies were performed more recently worldwide, most of the studies originating in the United States are 30–70years old, indicating a need for updated information.

引起皮肤癣菌病最常见的真菌种类因地区或国家而异。常见病原体包括犬小孢子菌、石膏样小孢子菌和须毛癣菌复合体。在大多数国家，犬小孢子菌是报道最多的病原体。然而，在印度，须毛癣菌复合体被认为是导致皮肤癣菌病的最常见病因，在克罗地亚、英国、伊朗和波多黎各，它是导致皮肤癣菌病的第二大常见病因。在美国南部、巴西和意大利，须毛癣菌复合体是皮肤癣菌病的第三大病因。虽然其中一些流行病学研究是最近在世界范围内进行的，但大多数起源于美国的研究已经有30 - 70年的历史，这表明需要更新信息。

 

Some fungal organisms are identified as either the sexual (teleomorph) stage or the asexual or conidial form (anamorph) stage, if the sexual stage is not identified or known. This has been the previous convention with all of the organisms discussed below identified only as T.  mentagrophytes. Now, these organisms have been organised into the T.  mentagrophytes complex. Trichophyton mentagrophytes complex is composed of either the teleomorph stage, Arthroderma benhamiae, A.  vanbreuseghemii and A. simii, or the anamorph stage, T. interdigitale, T. erinacei and T.  quinckeanum.  With traditional fungal culture methods, a diagnosis of T.  mentagrophytes complex is commonly obtained. While it would be best to identify the organism using molecular identification, many older—and some newer studies—still refer to it as the T. mentagrophytes complex instead of identifying it into a subclass. The types of molecular testing needed to identify these subclasses include PCR and matrix-associated laser desorption/ionisation-time of flight (MALDI-ToF) mass spectrometry. These types of molecular tests are more commonly performed in research or specialised diagnostic laboratories. Both techniques have been successful in diagnosing T. mentagrophytes complex infections; however, in a comparison of diagnostic methods for clinicallyaffected animals, fungal culture had the highest sensitivity at 90.2%, while the specificity was 89.2%. PCR had a sensitivity of 85.3% with a specificity of 70.7%, and MALDI-ToF had the highest specificity at 97.2%. One limitation of MALDI-ToF testing is the requirement that the organism first is grown in culture, which requires more time for results. Even with this technology available, not all diagnostic laboratories are utilising it for identifying dermatophytes.

有些真菌微生物能明确属于有性(有性型)阶段，或明确是无性或分生形态(无性型)阶段，包括性阶段不确定或不知道。这是以前的惯例，下面讨论的所有微生物仅被确定为须毛癣菌。现在，这些微生物已经被组归为须毛癣菌复合体。须毛癣菌复合体，既包括有性阶段的笨黑末节皮真菌(Arthroderma benhamiae)、万博节皮菌（A. vanbreuseghemii）和西米节皮菌（A. simii），也包括无性阶段指间毛癣菌(T. interdigitale)、刺猬毛癣菌（T. erinacei）和昆克毛癣菌（T. quinckeanum）。用传统的真菌培养方法，通常可以诊断出须毛癣菌复合体。虽然最好是用分子鉴定来鉴定这种生物，但许多较老的研究——以及一些较新的研究——仍然将其称为须毛癣菌复合体，而不是将其确定为一个子类。识别这些亚类所需的分子检测类型包括PCR和基质相关激光解吸/电离飞行时间(MALDI-ToF)质谱。这些类型的分子测试更常在研究或专门的诊断实验室中进行。这两种技术都成功地诊断了须毛癣菌复合体感染;然而，在临床感染动物的诊断方法的比较中，真菌培养的灵敏度最高，为90.2%，特异性为89.2%。PCR的敏感性为85.3%，特异性为70.7%，其中MALDI-ToF的特异性最高，为97.2%。MALDI-ToF测试的一个局限性是要求微生物首先在培养物中培养，这需要更多的时间才能得到结果。即使有了这种技术，也不是所有的诊断实验室都利用它来识别皮肤癣菌。

 

The primary aim of this study was to evaluate the medical records of dogs diagnosed with dermatophytosis associated with the T.mentagrophytes complex in order to provide updated information for this infection in the central United States. A more specific aim was to identify if trends exist with regard to signalment, clinical signs, lesion location, seasonality and response to various therapies.

本研究的主要目的是评估诊断为与须毛癣菌复合体相关的皮肤癣菌病的犬的医疗记录，以便为美国中部的这种感染提供最新信息。更具体的目的是确定是否存在信号、临床症状、病变位置、季节性和对各种治疗的反应方面的趋势。

 

MATERIALS AND METHODS

材料与方法
Study design

研究设计
This was a retrospective study of the medical records of privately owned dogs.

这是一项对家养犬的医疗记录的回顾性研究。

 

Dogs

犬

For inclusion, dogs had to be diagnosed via fungal culture with dermatophytosis caused by the T. mentagrophytes complex, between 1 January 1997 and 31 December 2020. Medical records were searched at Iowa State University (USA) and University of Illinois (USA). Additionally, fungal culture logbooks from the University of Illinois Veterinary Teaching Hospital dermatology specialty service were searched. These cases were diagnosed through the veterinary diagnostic laboratory at each respective institution or through point-of-care hospital fungal cultures with microscopic examination of macroconidia by the dermatology specialty service.Signalment,time of onset of clinical signs, clinical presentation, and therapeutic management were obtained from the medical records.

为了纳入研究，必须在1997年1月1日至2020年12月31日期间通过真菌培养诊断犬患有由须毛癣菌复合体引起的皮肤癣菌病。检索了爱荷华州立大学(美国)和伊利诺伊大学(美国)的医疗记录。此外，还检索了伊利诺伊大学兽医教学医院皮肤科专科服务的真菌培养日志。这些病例通过各自机构的兽医诊断实验室进行诊断，或通过皮肤科专科服务的护理点医院真菌培养和大分生孢子显微镜检查进行诊断。从病历中获取特征、临床症状出现的时间、临床表现和治疗管理。

 

Breeds were grouped into American Kennel Club (AKC) breed groups: Sporting group (included Labrador retriever, Weimaraner, Vizsla, English setter, springer spaniel and German shorthaired pointer); Non-sporting group (included shiba inu and Dalmatian); Terrier group (included Fox terrier, American pit bull terrier, Jack Russell terrier, rat terrier and Welsh terrier); Herding group (included Border collie, Shetland sheepdog, German shepherd dog, Belgian Tervuren and Belgian Malinois); Working group (included Siberian husky and Akita inu); Toy group (included Papillon, Yorkshire terrier and Chihuahua).

犬种分为美国养犬俱乐部(AKC)犬种组:运动犬组(包括拉布拉多寻回犬、威玛拉犬、维兹拉犬、英国塞特犬、施普林格西班牙猎犬和德国短毛猎犬);非运动犬组(包括柴犬和达尔马提亚);梗犬组(包括猎狐梗、美国比特犬、杰克罗素梗、鼠梗、威尔士梗);牧羊组(包括边境牧羊犬、设得兰牧羊犬、德国牧羊犬、比利时特尔伍伦犬和比利时马里诺犬);工作犬组(包括西伯利亚哈士奇和秋田犬);玩具犬组(包括蝴蝶犬、约克夏梗和吉娃娃)。

 

The onset of clinical signs as noted by the owner was categorised by the month when lesions were first observed. The months were grouped into the appropriate season in the central United States as follows: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November).

根据患犬首次观察到病变的月份，对患犬出现临床症状进行分类。在美国中部，这些月份按适当的季节分组如下:冬季(12月、1月和2月)，春季(3月、4月和5月)，夏季(6月、7月和8月)和秋季(9月、10月和11月)。

 

Locations of lesions were divided into the following body areas: muzzle, head, pinnae, neck, body, legs, paws and tail. The percentage of dogs with clinical signs in those regions was reported. Some dogs had lesions in multiple body areas. The distribution was further classified as localised (contained within one body area), multifocal (contained to two body areas) or generalised (present in three or more body regions).

病变部位分为以下机体部位:口鼻、头部、耳廓、颈部、机体、腿部、爪子和尾巴。报告了在这些地区有临床症状的犬的百分比。一些犬在机体的多个部位都有病变。该分布进一步分为局灶性(包含在一个机体区域内)、多灶性(包含在两个机体区域内)或全身性(存在于三个或三个以上的机体区域)。

 

Treatments were evaluated by looking at both topical and systemic therapy. As a consequence of the wide variety of topical therapies, they were grouped into general categories based on their mechanism of action. Further evaluation of topical therapy was not performed. The following information was evaluated for systemic therapy: dosage in mg/kg per day, time to first negative fungal culture, treatment duration, and whether the resolution was determined by negative fungal culture or by clinical signs.

通过观察外部治疗和全身治疗来评估治疗。由于各种各样的外部治疗，因此根据作用机制分为几大类。未对外部治疗进行进一步评估。对系统性治疗的以下信息进行了评估:每天mg/kg的剂量，真菌培养首次阴性的时间，治疗持续时间，以及是由真菌培养阴性还是由临床症状决定的缓解。

 

Statistical methods

统计学方法

All data were evaluated for normality with a Shapiro– Wilk test. Seasonal variation was evaluated with a chi-square test. Post hoc analysis with binomial tests was used to compare the seasons in pairs. Treatments were assessed using non-normal data, and it was further evaluated with a Kruskal–Wallis test to determine if there was a statistically significant difference. Statistical significance was noted with p ≤0.05. Spss Statistics v.27 (IBM Corp.) was used for all statistical evaluations.

所有数据均用Shapiro - Wilk检验进行正态性评估。季节变化采用卡方检验。采用二项检验的事后分析对季节进行配对比较。采用非正态数据对治疗进行评估，并采用Kruskal-Wallis检验进一步评估，以确定是否有统计学意义上的差异。p≤0.05，差异有统计学意义。Spss统计v.27(IBM Corp.)用于所有统计评估。

 

RESULTS

结果

Dogs

犬

There was a total of 64 dogs identified and included in the study. They consisted of 33 males (12 intact, 21 neutered) and 31 females (five intact, 26 neutered). The mean age was 4.4years old, with an age range of 0.5– 11years; the age was unknown in seven dogs. When evaluating the breed based on the AKC breed groups, there was a significantly higher proportion of dogs in the Sporting group at 43%, followed by the Terrier group at 20%, as seen in Figure 1. There were seven dogs with an unknown breed; those cases were excluded from this evaluation. Most cases had a localised distribution (42%) or multifocal distribution (38%), with generalised distribution being the least common (20%). Lesions predominantly affected the muzzle (48%) and head, excluding the pinnae (21%), as shown in Figure 2.

总共有64只犬被确定并纳入了这项研究。他们包括33只雄性(12只未去势，21只已去势)和31只雌性(5只未绝育，26只已绝育)。平均年龄4.4岁，年龄范围0.5 ~ 11岁;7只犬的年龄未知。在根据AKC品种组评估犬种时，运动犬组的犬种比例明显更高，为43%，其次是梗犬组，为20%，如图1所示。那里有七只品种不明的犬;这些病例被排除在本次评估之外。大多数病例为局灶性(42%)或多灶性(38%)，最不常见的是全身性(20%)。病变主要发生在口鼻部(48%)和头部，不包括耳廓(21%)，如图2所示。

 

Seasonality

季节性

When evaluating the month in which clinical signs were first noted by the owner (Figure 3), October had the highest incidence at 14 dogs (21.8%). June had the lowest incidence, with only one dog affected (1.5%). When the months were grouped in into seasons, autumn had the highest incidence, with 25 dogs (39.1%), while summer was the lowest at 10 dogs (15.6%). A significant seasonality was found (p=  0.045) through the years. Post hoc analysis of the seasons showed a significant difference between autumn and summer (p = 0.017).

在评估宠主第一次注意到临床症状的月份时(图3)，10月份发病率最高，有14只犬(21.8%)。6月发病率最低，只有一只犬感染(1.5%)。如果按季节划分，秋季发病最多，有25只(39.1%)，而夏季最低，有10只(15.6%)。多年间存在显著的季节性(p= 0.045)。季节的事后分析显示秋季和夏季有显著差异(p = 0.017)。

 

Treatment

治疗

No treatment information was available for five cases. One dog received no therapy and had resolution within two months, based on negative fungal culture. Topical therapy was used in 53 dogs, which accounted for 91.3% of the cases. The most common topical therapy included: an antifungal cream (38%), antifungal shampoo (33%) and lime sulfur dips (25%). Seven dogs received antifungal cream or shampoo as the sole treatment for localised (three dogs), multifocal (two dogs) or generalised distribution (two dogs). These topical treatments included miconazole cream once to twice daily (three dogs), terbinafine cream once to twice daily (three dogs), and ketoconazole and chlorhexidine shampoo every three days (one dog). Two dogs (28.6%) had negative cultures and clinical resolution with topical therapy only. One of these dogs had a localised lesion on the muzzle, while the other dog had multifocal lesions on the head and muzzle. The remaining 46 dogs (79%) received combination therapy of both topical and systemic treatment.

5例患犬无治疗信息。其中一只犬没有接受任何治疗，两个月内就治愈，基于真菌培养阴性检查结果。53只犬使用了外部治疗，占病例的91.3%。最常见的外部治疗包括:抗真菌乳膏(38%)，抗真菌香波(33%)和石硫合剂(25%)。7只犬接受了抗真菌乳膏或香波作为局灶性(3只犬)、多灶性(2只犬)或全身性(2只犬)的唯一治疗。这些外部治疗包括咪康唑乳膏每天1 - 2次(3只犬)，特比萘芬乳膏每天1 - 2次(3只犬)，酮康唑和氯己定香波每三天一次(1只犬)。2只犬(28.6%)培养呈阴性，仅用外部治疗即可临床症状治愈。其中一只犬的口周上有一个局灶性病变，而另一只犬的头部和口鼻部上有多灶性病变。其余46只犬(79%)接受外部和全身治疗的联合治疗。

 

Table 1 shows the data for systemic therapy with ketoconazole, itraconazole and terbinafine. There was no significant difference between these treatments, with regard to the time to first negative fungal culture (p = 0.743), treatment duration (p = 0.650) and overall resolution (p = 0.740).

表1为酮康唑、伊曲康唑、特比萘芬全身性治疗的数据。在真菌培养首次阴性的时间(p = 0.743)、治疗持续时间(p = 0.650)和总体分辨率(p = 0.740)方面，这些处理之间没有显著差异。

 

The remaining three dogs received griseofulvin at a mean dose of 22.4  mg/kg every 12h (range 17.3– 25mg/kg every 12h). None of these cases had a fungal culture performed to confirm microbiological cure; the owners reported complete resolution of clinical signs in two of the cases. This information was obtained without a specific timeline for how long the medication was given or time to resolution. As a result of this lack of information and limited number of cases, griseofulvin was not evaluated with the other systemic therapies.

其余3只犬接受灰黄霉素，平均剂量为每12小时22.4 mg/kg(范围为17.3 - 25mg/kg每12小时)。这些病例均未进行真菌培养以确认微生物治愈;宠主报告说，其中两个病例的临床症状完全消失。这些信息是在没有给出具体服药时间或治愈时间的情况下获得的。由于缺乏信息和病例数量有限，灰黄霉素未与其他全身疗法进行评估。

 

DISCUSSION

讨论

This retrospective study evaluated the T.mentagrophytes complex in dogs from two central United States universities over a 23year period. It revealed some important information on breed prevalence, time of year and systemic treatment options. Some of this information has not changed compared to reports from the previous 60–70years. One important finding was the higher incidence in breeds from the Sporting group. The most common breed in that category was the Labrador retriever, which is not surprising given that it is one of the most commonly owned breeds and often used for hunting in the central United States. Likewise, this finding was identified in a study from Italy, in which Sporting breeds represented for 67% of all T.mentagrophytes complex infections. However, the Italian study did not report any dogs in the Terrier group being affected. This is interesting as terriers are known to be inquisitive and can be seen hunting in rodent holes, where reservoirs of the T.mentagrophytes complex often are found. A UK study identified Jack Russell terriers (58%) as the breed most likely to have T.mentagrophytes complex infections; mixed breed dogs were identified in 19% of cases, yet purebred dogs were predominant. Similar findings also were reported in a study from Europe.

这项回顾性研究评估了来自美国中部两所大学23年的犬的须毛癣菌复合体。它揭示了一些关于品种流行率、年份和系统性治疗方案的重要信息。与过去60 - 70年的报告相比，其中一些信息没有变化。一个重要的发现是在运动犬组的品种中发病率较高。在这一类别中最常见的品种是拉布拉多寻回犬，这并不奇怪，因为它是最常见的品种之一，在美国中部经常被用于狩猎。同样，这一发现也在意大利的一项研究中得到了证实，在该研究中，运动犬品种占了所有须毛癣菌复合体感染的67%。然而，意大利的研究并没有报告梗犬组的任何犬患病。这很有趣，因为梗犬是出了名的好奇，可以看到它们在啮齿动物的洞里打猎，那里经常发现须毛癣菌。英国的一项研究发现，杰克罗素梗(58%)是最有可能感染须毛癣菌复合体感染的品种;在19%的病例中发现了杂交犬，但纯种犬占主导地位。欧洲的一项研究也报告了类似的发现。

 

Seasonality was observed in this study for infections caused by the T.mentagrophytes complex, with a higher incidence in autumn, specifically October. In the literature, there are contradictory reports on the seasonality of this infection throughout the world. No seasonality was identified in dogs infected with the T.mentagrophytes complex in an Italian study nor in a study from the southern United States. Likewise, a study in wild animals in the southern United States was unable to identify seasonality for the T.mentagrophytes complex. Another study from 1952 of 83 dogs with the T.mentagrophytes complex, in the southern United States, identified a peak in both November and December compared to other months. Our study established November and December as the months with second and third highest incidences. This increase in autumn may be a consequence of higher population densities of wild rodents and increased activity. It is hypothesised that this may be the cause for the autumn seasonality in the central United States.

本研究观察到须毛癣菌复合体引起的感染具有季节性，秋季发病率较高，特别是10月。在文献中，关于这种感染在世界各地的季节性有相互矛盾的报道。意大利的一项研究和美国南部的一项研究都没有发现感染须毛癣菌复合体的犬的季节性。同样，一项针对美国南部野生动物的研究也无法确定须毛癣菌复合体的季节性。1952年在美国南部对83只患有须毛癣菌复合体的犬进行的另一项研究发现，与其他月份相比，11月和12月都是患病高峰。我们的研究确定11月和12月是发病率第二和第三高的月份。秋季的增加可能是野生啮齿动物种群密度增加和活动增加的结果。据推测，这可能是美国中部秋季季节性的原因。

 

The source for T.mentagrophytes complex infections is rodents. Because dogs are commonly sniffing and potentially tracking close to the ground, it is logical that the majority of lesions appear on the muzzle and head. It previously has been reported that the face is most commonly affected initially and then progresses to the head and ears. Interestingly, some studies have noted a high incidence of feet being affected, this was not found in our study.

须毛癣菌复合体感染的来源是啮齿动物。因为犬通常会嗅探并接近地面，所以大多数病变出现在口鼻和头部是合乎逻辑的。此前有报道称，最初最常见的是面部，然后发展到头部和耳朵。有趣的是，一些研究指出，足部患病的发生率很高，但在我们的研究中没有发现这一点。

 

Topical therapy is frequently used in cases of dermatophytosis to prevent further contamination of the environment, as well as treat the infection, and was used in >90% of our cases. The literature supports the efficacy of a variety of active ingredients incorporated into shampoos with antifungal activity against the T.mentagrophytes complex.16 This investigation found complete resolution with antifungal cream or shampoo in localised and multifocal cases. In vitro susceptibility to systemic antifungals has been evaluated with a variety of techniques including: agar-based disk diffusion, broth microdilution and macrodilution methods, and E-test. All of these reports showed variable results, in general itraconazole, ketoconazole and terbinafine had similar efficacy, while organisms showed reduced susceptibility to fluconazole. This is in line with our findings. Very few studies have evaluated ketoconazole in vivo for dermatophytosis, limited to a case report and a case series of six dogs. This study revealed the efficacy of ketoconazole in comparison to other systemic therapies. While the use of terbinafine has increased, there is a concern for terbinafine resistance resulting from mutations in squalene epoxidase. This could be an explanation for it having the lowest resolution rate for systemic therapies evaluated in our study.

外部治疗经常用于皮肤癣菌病的病例，以防止环境的进一步污染，以及治疗感染，并在我们的病例中使用了90%。文献支持香波中含有的多种活性成分对须毛癣菌复合体具有抗真菌活性这项调查发现，在局灶性和多灶性病例中，使用抗真菌乳膏或香波得到完全缓解。体外对全身抗真菌药物的敏感性已经通过各种技术进行了评估，包括:琼脂基扩散，肉汤微量稀释和宏稀释方法，以及E-test。所有这些报告结果不一，总的来说伊曲康唑、酮康唑和特比萘芬的疗效相似，而微生物对氟康唑的敏感性降低。这与我们的发现一致。很少有研究评估酮康唑在体内治疗皮肤癣菌病，仅限于一份病例报告和6只犬的病例系列。这项研究揭示了酮康唑与其他全身疗法相比的疗效。虽然特比萘芬的使用有所增加，但人们担心角鲨烯环氧氧化酶突变导致特比萘芬耐药。这可能解释了它在我们的研究中评估的系统治疗中具有最低的治愈率。

 

As a consequence of the retrospective nature of this study, several limitations were present. One is that some of the identification of the T.mentagrophytes complex was performed by trained personnel in the dermatology specialty service instead of a diagnostic laboratory. With trained staff using microscopic as well as macroscopic evaluation in a speciality section, this has a very low chance of error at 3%, as identified in a recent study. In our experience, trained staff with a keen interest in this field are skilled at identifying the T.mentagrophytes complex on culture media, so we do not believe there was fungal species misidentification. Another limitation was the lack of molecular testing on all samples. These tests were not available during the earlier years of this study and the samples were not stored for future use. Indeed, even those cultures evaluated in veterinary diagnostic laboratories did not all have molecular testing performed. As expected in retrospective studies, some data or information were missing from the medical records, especially as some cases were>20years old. This caused gaps in data reporting and evaluation; for example, most cases that failed to completely resolve with the initial therapy were recorded as partial resolution and subsequently switched to another therapy.

由于本研究的回顾性性质，存在一些局限性。一是对须毛癣菌复合体的一些鉴定是由受过训练的皮肤病学专业服务人员进行的，而不是在诊断实验室进行的。正如最近的一项研究所确定的那样，由于训练有素的工作人员在专业科室使用微观和宏观评估，这一错误的几率非常低，只有3%。根据我们的经验，对这一领域有浓厚兴趣的训练有素的工作人员能够熟练地识别培养基上的须毛癣菌复合体，因此我们不认为存在真菌种类的错误识别。另一个限制是缺乏对所有样本的分子检测。这些测试在本研究的前几年是不可用的，样品也没有储存起来以备将来使用。事实上，即使是那些在兽医诊断实验室评估的培养，也并非都进行了分子检测。正如回顾性研究预期的那样，一些数据或信息在医疗记录中缺失，特别是一些病例是＞20岁。这造成了数据报告和评估方面的差距;例如，最初的治疗未能完全缓解大多数病例被记录为部分缓解，随后切换到另一种治疗。

 

CONCLUSIONS

结论

Dogs infected with the T.mentagrophytes complex in the central United States were found to be most commonly from the AKC Sporting and Terrier groups. Additionally, the lesions were most frequently encountered on the muzzle, and the onset of lesions was statistically more common in autumn than in summer. Finally, systemic ketoconazole, itraconazole and terbinafine appear to be equivalent as therapeutic management options for the T.mentagrophytes complex in dogs.

在美国中部感染须毛癣菌复合体的犬被发现最常见的是来自AKC运动犬和梗犬。此外，病变最常出现在口鼻部上，从统计学上看，秋季比夏季发病更常见。最后，全身性使用酮康唑，伊曲康唑和特比萘芬，作为须毛癣菌复合体患犬的治疗管理似乎是等效的。

 

TABLE 1 Comparison of ketoconazole, itraconazole and terbinafine as systemic therapy in all cases. Resolution was based on clinical signs with or without negative fungal culture.

表1所有病例中酮康唑、伊曲康唑、特比萘芬全身性治疗的比较。治愈是根据临床症状，有无阴性真菌培养。

注:三种药物比较无统计学意义。

Note: lack of statistical significance when comparing all three medications.

 

FIGURE 3 Onset of clinical signs in 64 dogs diagnosed wtih Trichophyton mentagrophytes complex, divided by month and further into seasons. Note clinical significance of p = 0.017 when comparing autumn and summer.

图3 64只被诊断为须毛癣菌复合体感染的患犬的临床症状，按月份和季节划分。注意秋季和夏季比较p = 0.017的临床意义。

 

 

FIGURE 2 Lesion distribution in 64 dogs infected with Trichophyton mentagrophytes complex.

图2 64只犬感染须毛癣菌复合体病变分布。

 

 

FIGURE 1 Prevalence of the Trichophyton mentagrophytes complex in 64 dogs AKC breed groups.

图1在64只AKC犬种组中，须毛癣菌复合体的患病率。

 

杨先生

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