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Query: UMLS:C0036690 (sepsis)
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The genus Malassezia contains three member species: Malassezia furfur and Malassezia sympodialis, both obligatory lipophilic, skin flora yeasts of humans, and Malassezia pachydermatis, a nonobligatory lipophilic, skin flora yeast of other warm-blooded animals. Several characteristics suggest the basidiomycetous nature of these yeasts, although a perfect stage has not been identified. Classically, these organisms are associated with superficial infections of the skin and associated structures, including pityriasis versicolor and folliculitis. Recently, however, they have been reported as agents of more invasive human diseases including deep-line catheter-associated sepsis. The latter infection occurs in patients, primarily infants, receiving parenteral nutrition (including lipid emulsions) through the catheter. The lipids presumably provide growth factors required for replication of the organisms. It is unclear how deep-line catheters become colonized with Malassezia spp. Skin colonization with M. furfur is common in infants hospitalized in neonatal intensive care units, whereas colonization of newborns hospitalized in well-baby nurseries and of older infants is rarely observed. Catheter colonization, which may occur without overt clinical symptoms, probably occurs secondary to skin colonization, with the organism gaining access either via the catheter insertion site on the skin or through the external catheter hub (connecting port). There is little information on the colonization of hospitalized patients by M. sympodialis or M. pachydermatis. Diagnosis of superficial infections is best made by microscopic examination of skin scrapings following KOH, calcofluor white, or histologic staining. Treatment of these infections involves the use of topical or oral antifungal agents, and it may be prolonged. Diagnosis of Malassezia catheter-associated sepsis requires detection of the organism in whole blood smears or in buffy coat smears of blood drawn through the infected catheter or isolation of the organism from catheter or peripheral blood or the catheter tip. Culture of M. furfur from blood is best achieved with Isolator tubes and plating onto a solid medium supplemented with a lipid source. Appropriate treatment of patients requires removal of the infected catheter with or without temporary stoppage of lipid emulsions; administration of antifungal therapeutic agents does not appear to be necessary. Because many patients who develop Malassezia catheter-associated sepsis have severe underlying illnesses, caution must be exercised in attributing all clinical deterioration to Malassezia infection. Our better understanding of how these organisms cause disease awaits the development of a useful typing scheme for epidemiologic studies and further studies on microbial virulence factors and the role of the immune response in pathogenesis.
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PMID:Human infections due to Malassezia spp. 157 83

Malassezia furfur is a saprophytic fungus that is part of the normal cutaneous microflora of adults. It frequently causes tinea versicolor and less often, a distinctive folliculitis. In infants and occasionally in adults the fungus is associated with a sepsis syndrome that heralds a deep-seated infection. These entities, their diagnosis, and their treatment are discussed.
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PMID:Malassezia furfur. 264 34

Malassezia furfur, a normal skin flora yeast, generally associated with very mild superficial skin infections, has become an opportunistic pathogen in patients with deep-line vascular catheters. The use of intravenous fat emulsions appears to have altered the microenvironment of the catheter and allowed colonization and subsequent infection. Dissemination of the organism appears to be limited to the lungs, which may have been previously altered by vascular lipid deposition. Because of the serious underlying disease(s) of patients with M. furfur catheter sepsis, it is difficult to determine the exact role of the organism in the overall status of the patients. At the very least, however, catheter removal or discontinuance of the fat emulsion therapy may be required. Antifungal therapy without either of these two steps has not been shown to be efficacious. Physicians must maintain a high index of suspicion of M. furfur catheter sepsis in the appropriate clinical setting, and laboratory investigators must be prepared to provide appropriate diagnostic methods.
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PMID:Epidemiology, diagnosis, and management of Malassezia furfur systemic infection. 311 73

Growth of Malassezia furfur in the intravascular catheter used for administration of lipid emulsion resulted in occlusion of deep intravascular Silastic catheters in 12 infants in 2 intensive care nurseries. At the time of occlusion visible growth was noted in the clear catheter which was connected to the Silastic intravascular line. Five infants showed clinical signs suggestive of sepsis. The yield of M. furfur from blood cultures and catheter tips was low even when oil enrichment was used. The highest yield of M. furfur was found in the connecting catheter (11 of 11). The source from and the route by which M. furfur entered the catheter remain unclear. The potential portals of entry include the proximal and distal ends of the connecting catheter as well as the colonized skin of the infants and caretakers.
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PMID:Malassezia furfur: a cause of occlusion of percutaneous central venous catheters in infants in the intensive care nursery. 312 16

Until recently, Malassezia furfur was thought to be a pathogen only in tinea versicolor. More recently, this lipophilic yeast has been recovered from sick neonates with catheter-related infections. Malassezia fungemia was studied in seven patients, and the salient features of this infection in patients described in the literature were reviewed. Major risk factors include prolonged hospitalization, the presence of central venous catheters, and the use of intravenous fat emulsions. It is difficult to identify specific manifestations of fungemia in these complex cases occurring in patients with severe underlying disease; however, neonates often present with the signs and symptoms of sepsis and thrombocytopenia, whereas fever may be the only manifestation in adults. Some patients are asymptomatic. When symptoms are present, they resolve upon removal of the colonized catheter. The role of the lipophilic nature of Malassezia in the pathogenesis of infection is apparent from the ability of intravenous fat emulsions to support the growth of the fungus in vitro. A special solid medium that can be used to determine the true prevalence of malassezia fungemia has been devised. M. furfur must be considered in the differential diagnosis of opportunistic infections in patients receiving central hyperalimentation and should be sought by the culture of blood on appropriate medium.
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PMID:Malassezia fungemia in neonates and adults: complication of hyperalimentation. 312 78

Malassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection with M furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.
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PMID:Malassezia furfur skin colonization in infancy. 328 20

Malassezia pachydermatis, a yeast that has not previously been implicated as a cause of human disease, was isolated from cultures of blood from three infants. All infants were 25-27 w of gestational age and had multiple underlying medical problems. The infants had been hospitalized for at least six weeks, had received broad-spectrum antibiotics, and had received parenteral lipid nutrition via a central venous catheter. In one patient, fungemia was accompanied by clinical and laboratory evidence of Broviac catheter infection. During a three-year period, M. pachydermatis was also recovered from fungal cultures of an additional 30 patients, 85% of whom were infants. A pathogenic role for M. pachydermatis recovered from sources other than blood or catheters was not established. Risk factors for and symptoms in infants with M. pachydermatis fungemia appeared to be similar to those described for Malassezia furfur sepsis.
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PMID:Clinical and microbiological features of infection with Malassezia pachydermatis in high-risk infants. 337 21

Malassezia furfur has been increasingly associated with Broviac-catheter-related sepsis in infants receiving fat emulsions for parenteral alimentation. We examined by scanning electron microscopy the appearance of M. furfur attached to Broviac catheter segments mock-infected in vitro and to Broviac catheters removed from two infants with catheter-related sepsis. In vitro attachment occurred equally on external and internal surfaces of the catheters. Although some organisms were attached next to surface defects in the catheters, we could not determine if such defects were preferential sites of attachment. In the patient catheters, a dense coating of yeast cells was found adhering to the luminal surface, most abundantly near the tip. No organisms were seen on the external surface of the catheters. These findings show the need to examine the mechanisms of intraluminal catheter colonization in order to understand better the pathogenesis of M. furfur infections.
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PMID:Scanning electron microscopy of Malassezia furfur attachment to Broviac catheters. 359 89

Malassezia furfur was recovered from blood cultures obtained through an indwelling line in seven severely ill infants hospitalized in a neonatal intensive care unit. While two of the patients were asymptomatic, the other patients had signs and symptoms compatible with sepsis. One patient had evidence of endocarditis.
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PMID:Malassezia furfur fungemia in infancy. 365 98

Malassezia furfur, a recently described agent of catheter-associated sepsis, requires long-chained fatty acids for in vitro growth. To determine optimum conditions for recovery of the organism from blood culture, we compared a radiometric (BACTEC) with a lysis centrifugation-direct agar plating (Isolator) blood culture method. When blood culture isolates of M. furfur were suspended in phosphate-buffered saline and used as inocula, the BACTEC system detected the organisms radiometrically only when bottles were supplemented with lipid compounds; detection was often delayed (greater than or equal to 72 h) when small inoculum sizes were tested. The Isolator pediatric tube system detected growth of M. furfur within 48 h of plating onto a lipid-supplemented agar medium. Simulated blood culture experiments showed that the addition of whole human blood and Intralipid to the BACTEC 6B bottle was associated with rapid lysis of erythrocytes, accumulation of a chocolate brown sediment in the bottles, and fungicidal activity to the M. furfur isolates. In contrast, suspensions of M. furfur in whole human blood were stable for at least 8 h in Isolator tubes and quantitatively recoverable after plating onto agar. Of the two systems studied, the Isolator tube system provided a more suitable procedure for isolation of M. furfur from blood culture.
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PMID:Methods for optimal recovery of Malassezia furfur from blood culture. 377 59


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