- 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, to fungemia in the immunocompromised host [1-4].
The epidemiology, clinical manifestations, diagnosis and treatment of Malassezia infections will be discussed here. The clinical manifestations, diagnosis, and treatment of tinea versicolor are discussed elsewhere. (See "Tinea versicolor (Pityriasis versicolor)".)
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 (PCR) and restriction endonuclease analysis [2,5-7].
Malassezia species mainly colonize the skin and occasionally the respiratory tract [7,8]. 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 [9,10]. 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. 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 .
- Crespo-Erchiga V, Florencio VD. Malassezia yeasts and pityriasis versicolor. Curr Opin Infect Dis 2006; 19:139.
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- Jahagirdar BN, Morrison VA. Emerging fungal pathogens in patients with hematologic malignancies and marrow/stem-cell transplant recipients. Semin Respir Infect 2002; 17:113.
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- Gaitanis G, Magiatis P, Hantschke M, et al. The Malassezia genus in skin and systemic diseases. Clin Microbiol Rev 2012; 25:106.
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- Jatoi A, Hanjosten K, Ross E, Mason JB. A prospective survey for central line skin-site colonization by the pathogen Malassezia furfur among hospitalized adults receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr 1997; 21:230.
- Gupta AK, Kohli Y, Li A, et al. In vitro susceptibility of the seven Malassezia species to ketoconazole, voriconazole, itraconazole and terbinafine. Br J Dermatol 2000; 142:758.
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- Chryssanthou E, Broberger U, Petrini B. Malassezia pachydermatis fungaemia in a neonatal intensive care unit. Acta Paediatr 2001; 90:323.
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- Morrison VA, Weisdorf DJ. The spectrum of Malassezia infections in the bone marrow transplant population. Bone Marrow Transplant 2000; 26:645.
- Cholongitas E, Pipili C, Ioannidou D. Malassezia folliculitis presented as acneiform eruption after cetuximab administration. J Drugs Dermatol 2009; 8:274.
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- Archer-Dubon C, Icaza-Chivez ME, Orozco-Topete R, et al. An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection. Int J Dermatol 1999; 38:453.
- Rhie S, Turcios R, Buckley H, Suh B. Clinical features and treatment of Malassezia folliculitis with fluconazole in orthotopic heart transplant recipients. J Heart Lung Transplant 2000; 19:215.
- Schleman KA, Tullis G, Blum R. Intracardiac mass complicating Malassezia furfur fungemia. Chest 2000; 118:1828.
- Kessler AT, Kourtis AP, Simon N. Peripheral thromboembolism associated with Malassezia furfur sepsis. Pediatr Infect Dis J 2002; 21:356.
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- Ascioglu S, Rex JH, de Pauw B, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34:7.
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- Sugita T, Tajima M, Ito T, et al. Antifungal activities of tacrolimus and azole agents against the eleven currently accepted Malassezia species. J Clin Microbiol 2005; 43:2824.
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- Hill MK, Goodfield MJ, Rodgers FG, et al. Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole. Arch Dermatol 1990; 126:1071.
- Shemer A, Kaplan B, Nathansohn N, et al. Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study. Isr Med Assoc J 2008; 10:417.