Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Invasive Malassezia infections

Denis Spelman, MBBS, FRACP, FRCPA, MPH
CO Morrissey, MB, BCh, FRACP, Grad Dip (Clin Epi), PhD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


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 [9].


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 [11].

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 [13]. M. furfur was recovered from the lumen in 32 percent of percutaneous central venous catheters in a neonatal intensive care unit in one series [12] but not from the insertion sites in 928 adults receiving total parenteral nutrition [14].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 02, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Crespo-Erchiga V, Florencio VD. Malassezia yeasts and pityriasis versicolor. Curr Opin Infect Dis 2006; 19:139.
  2. Ben Salah S, Makni F, Marrakchi S, et al. Identification of Malassezia species from Tunisian patients with pityriasis versicolor and normal subjects. Mycoses 2005; 48:242.
  3. Jahagirdar BN, Morrison VA. Emerging fungal pathogens in patients with hematologic malignancies and marrow/stem-cell transplant recipients. Semin Respir Infect 2002; 17:113.
  4. Ashbee HR, Evans EG. Immunology of diseases associated with Malassezia species. Clin Microbiol Rev 2002; 15:21.
  5. Gupta AK, Kohli Y, Faergemann J, Summerbell RC. Epidemiology of Malassezia yeasts associated with pityriasis versicolor in Ontario, Canada. Med Mycol 2001; 39:199.
  6. Gupta AK, Kohli Y, Summerbell RC. Molecular differentiation of seven Malassezia species. J Clin Microbiol 2000; 38:1869.
  7. Gaitanis G, Magiatis P, Hantschke M, et al. The Malassezia genus in skin and systemic diseases. Clin Microbiol Rev 2012; 25:106.
  8. Ilahi A, Hadrich I, Neji S, et al. Real-Time PCR Identification of Six Malassezia Species. Curr Microbiol 2017; 74:671.
  9. Denis J, Machouart M, Morio F, et al. Performance of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Identifying Clinical Malassezia Isolates. J Clin Microbiol 2017; 55:90.
  10. Smolinski KN, Shah SS, Honig PJ, Yan AC. Neonatal cutaneous fungal infections. Curr Opin Pediatr 2005; 17:486.
  11. Ashbee HR, Leck AK, Puntis JW, et al. Skin colonization by Malassezia in neonates and infants. Infect Control Hosp Epidemiol 2002; 23:212.
  12. Aschner JL, Punsalang A Jr, Maniscalco WM, Menegus MA. Percutaneous central venous catheter colonization with Malassezia furfur: incidence and clinical significance. Pediatrics 1987; 80:535.
  13. Angiolella L, Leone C, Rojas F, et al. Biofilm, adherence, and hydrophobicity as virulence factors in Malassezia furfur. Med Mycol 2017.
  14. 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.
  15. 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.
  16. Papavassilis C, Mach KK, Mayser PA. Medium-chain triglycerides inhibit growth of Malassezia: implications for prevention of systemic infection. Crit Care Med 1999; 27:1781.
  17. Chryssanthou E, Broberger U, Petrini B. Malassezia pachydermatis fungaemia in a neonatal intensive care unit. Acta Paediatr 2001; 90:323.
  18. Chang HJ, Miller HL, Watkins N, et al. An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers' pet dogs. N Engl J Med 1998; 338:706.
  19. Morrison VA, Weisdorf DJ. The spectrum of Malassezia infections in the bone marrow transplant population. Bone Marrow Transplant 2000; 26:645.
  20. Cholongitas E, Pipili C, Ioannidou D. Malassezia folliculitis presented as acneiform eruption after cetuximab administration. J Drugs Dermatol 2009; 8:274.
  21. Barber GR, Brown AE, Kiehn TE, et al. Catheter-related Malassezia furfur fungemia in immunocompromised patients. Am J Med 1993; 95:365.
  22. 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.
  23. Ilahi A, Hadrich I, Goudjil S, et al. Molecular epidemiology of a Malassezia pachydermatis neonatal unit outbreak. Med Mycol 2017.
  24. Schleman KA, Tullis G, Blum R. Intracardiac mass complicating Malassezia furfur fungemia. Chest 2000; 118:1828.
  25. Kessler AT, Kourtis AP, Simon N. Peripheral thromboembolism associated with Malassezia furfur sepsis. Pediatr Infect Dis J 2002; 21:356.
  26. Gidding H, Hawes L, Dwyer B. The isolation of Malassezia furfur from an episode of peritonitis. Med J Aust 1989; 151:603.
  27. 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.
  28. 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.
  29. Shparago NI, Bruno PP, Bennett J. Systemic Malassezia furfur infection in an adult receiving total parenteral nutrition. J Am Osteopath Assoc 1995; 95:375.
  30. Kolecka A, Khayhan K, Arabatzis M, et al. Efficient identification of Malassezia yeasts by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Br J Dermatol 2014; 170:332.
  31. Vuran E, Karaarslan A, Karasartova D, et al. Identification of Malassezia species from pityriasis versicolor lesions with a new multiplex PCR method. Mycopathologia 2014; 177:41.
  32. Cornu M, Goudjil S, Kongolo G, et al. Evaluation of the (1,3)-β-D-glucan assay for the diagnosis of neonatal invasive yeast infections. Med Mycol 2017.
  33. Arendrup MC, Boekhout T, Akova M, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20 Suppl 3:76.
  34. Leong C, Buttafuoco A, Glatz M, Bosshard PP. Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method. J Clin Microbiol 2017; 55:1883.
  35. Galvis-Marín JC, Rodríguez-Bocanegra MX, Pulido-Villamarín ADP, et al. [In vitro antifungal activity of azoles and amphotericin B against Malassezia furfur by the CLSI M27-A3 microdilution and Etest(®) methods]. Rev Iberoam Micol 2017; 34:89.
  36. Rojas FD, Córdoba SB, de Los Ángeles Sosa M, et al. Antifungal susceptibility testing of Malassezia yeast: comparison of two different methodologies. Mycoses 2017; 60:104.
  37. Marcon MJ, Durrell DE, Powell DA, Buesching WJ. In vitro activity of systemic antifungal agents against Malassezia furfur. Antimicrob Agents Chemother 1987; 31:951.
  38. 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.
  39. Tragiannidis A, Bisping G, Koehler G, Groll AH. Minireview: Malassezia infections in immunocompromised patients. Mycoses 2010; 53:187.