- 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 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 .
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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.
- Ashbee HR, Evans EG. Immunology of diseases associated with Malassezia species. Clin Microbiol Rev 2002; 15:21.
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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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- Morrison VA, Weisdorf DJ. The spectrum of Malassezia infections in the bone marrow transplant population. Bone Marrow Transplant 2000; 26:645.
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- 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.
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- 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.
- 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.
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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.