Microsporum canis complex infections in the United Arab Emirates: Clinical, molecular, and antifungal susceptibility profiles.

Microsporum canis complex infections remain a major cause of pediatric dermatophytosis, yet molecular epidemiologic and antifungal susceptibility data from the Arabian Gulf are scarce, with no contemporary regional assessment since 1981-1988. We characterized the clinical, molecular, and antifungal susceptibility profiles of M. canis complex isolates in Abu Dhabi and assessed concordance between phenotypic and ITS-based identification. Fifty-two clinical dermatophyte isolates collected through passive surveillance at the UAEU Fungal Reference Laboratory (September 2024-December 2025) underwent phenotypic identification, ITS sequencing, and antifungal susceptibility testing (CLSI M38). Clinical data were available for 48 patients. ITS sequencing identified 47 isolates (90.4%) as M. canis and 5 (9.6%) as the M. audouinii clade, with phenotypic discordance in 9.6% of isolates (including one M. canis misidentified as Trichophyton rubrum). The cohort was predominantly pediatric (79.2% ≤12 years; 54.2% female). Tinea capitis predominated (60.4%), followed by tinea corporis (20.8%) and multifocal disease (16.7%). Cat exposure was reported in 50% and infected household contact in 27.1%. All isolates showed low minimum inhibitory concentrations (MICs ; terbinafine MIC₅₀/₉₀ 0.015/0.03; itraconazole ≤ 0.03/0.06; voriconazole ≤ 0.03/≤0.03; griseofulvin 0.125/0.25; fluconazole 4/8 µg/ml). Despite this, 81.2% (26/32) of patients with follow-up experienced treatment failure or recurrence, with no clear MIC-outcome association. This first molecular and antifungal characterization of M. canis complex infections in the UAE over three decades showed that ITS sequencing corrected phenotypic identification in nearly 10% of cases. High recurrence despite low MICs suggests limited predictive value of in vitro susceptibility, supporting species-directed management, molecular confirmation, species-directed management, and One Health strategies.