Invasive Malassezia infections
- Denis Spelman, MBBS, FRACP, FRCPA, MPH
Denis Spelman, MBBS, FRACP, FRCPA, MPH
- Adjunct Professor, Monash University
- Alfred Hospital, Victoria, Australia
- CO Morrissey, MB, BCh, FRACP, Grad Dip (Clin Epi), PhD
CO Morrissey, MB, BCh, FRACP, Grad Dip (Clin Epi), PhD
- Adjunct Senior Lecturer, Monash University
- The Alfred Hospital, Victoria, Australia
Malassezia (formerly known as Pityrosporum) species are members of human cutaneous commensal flora, which are associated with a wide spectrum of clinical manifestations from benign skin conditions, such as tinea versicolor and folliculitis, to fungemia in the immunocompromised host [1-4].
The epidemiology, clinical manifestations, diagnosis, and treatment of invasive Malassezia infections will be discussed here. The clinical manifestations, diagnosis, and treatment of tinea versicolor and Malassezia folliculitis are discussed elsewhere. (See "Tinea versicolor (Pityriasis versicolor)" and "Infectious folliculitis", section on 'Fungal folliculitis'.)
Malassezia are lipophilic yeasts that are constituents of the normal human skin flora. These organisms have been classified into at least 14 species, including M. furfur, M. pachydermatis, M. sympodialis, M. slooffiae, M. obtusa, M. globosa, and M. restricta, based upon polymerase chain reaction and restriction endonuclease analysis [2,5-8]. A study has reported reliable species identification by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry following the development of a MALDI-TOF database .
Malassezia species mainly colonize the skin and occasionally the respiratory tract [7,10]. The organisms appear to become part of the normal skin flora by three to six months of age. M. furfur was recovered from the skin in 32 to 64 percent of neonates in neonatal intensive care units in two separate series [11,12]. In one study, duration of stay in the unit and gestational age were factors favoring skin colonization .
Colonization of the skin with Malassezia and subsequent extension to central venous catheters appears more common in neonates than adults. Studies using scanning electron microscopy have demonstrated that some Malassezia spp produce significant biofilms . M. furfur was recovered from the lumen in 32 percent of percutaneous central venous catheters in a neonatal intensive care unit in one series  but not from the insertion sites in 928 adults receiving total parenteral nutrition .
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