Malassezia pachydermatis fungemia in a preterm neonate resistant to fluconazole and flucytosine

Al‐Sweih, Noura; Ahmad, Suhail; Joseph, Leena; Khan, Sanaullah; Khan, Ziauddin

doi:10.1016/j.mmcr.2014.04.004

Cited by 52 publications

(35 citation statements)

References 22 publications

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“…Our assay included the echinocandin class as well as griseofulvin. The data showed that Malassezia is resistant to these antifungals, which is in line with literature reports (3,23). The azoles itraconazole, posaconazole, and voriconazole appeared to be the most effective antifungals against Malassezia spp.…”

Section: Discussionsupporting

confidence: 92%

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Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method

et al. 2017

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Malassezia is a genus of lipid-dependent yeasts. It is associated with common skin diseases such as pityriasis versicolor and atopic dermatitis and can cause systemic infections in immunocompromised individuals. Owing to the slow growth and lipid requirements of these fastidious yeasts, convenient and reliable antifungal drug susceptibility testing assays for Malassezia spp. are not widely available. Therefore, we optimized a broth microdilution assay for the testing of Malassezia that is based on the CLSI and EUCAST assays for Candida and other yeasts. The addition of ingredients such as lipids and esculin provided a broth medium formulation that enabled the growth of all Malassezia spp. and could be read, with the colorimetric indicator resazurin, by visual and fluorescence readings. We tested the susceptibility of 52 strains of 13 Malassezia species to 11 commonly used antifungals. MIC values determined by visual readings were in good agreement with MIC values determined by fluorescence readings. The lowest MICs were found for the azoles itraconazole, posaconazole, and voriconazole, with MIC 90 values of 0.03 to 1.0 g/ml, 0.06 to 0.5 g/ml, and 0.03 to 2.0 g/ml, respectively. All Malassezia spp. were resistant to echinocandins and griseofulvin. Some Malassezia spp. also showed high MIC values for ketoconazole, which is the most widely recommended topical antifungal to treat Malassezia skin infections. In summary, our assay enables the fast and reliable susceptibility testing of Malassezia spp. with a large panel of different antifungals.

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Section: Discussionsupporting

confidence: 92%

“…Malassezia is the most common fungal genus of the healthy human skin microbiome (2). Additionally, a pathogenic role is attributed to these yeasts in common skin diseases such as pityriasis versicolor, atopic dermatitis, and seborrheic dermatitis, and they can cause severe systemic infections in neonates and immunocompromised individuals (3,4).…”

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confidence: 99%

Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method

et al. 2017

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“…Their incidence seems to be higher in some autoimmune disorders, such as psoriasis or atopic dermatitis (10–12). Although rare, some cases of fungemia and other invasive infections (peritoneal and biliary infections) (13, 14) have been described since the 1980s (13–15). These infections have no specific clinical signs and therefore remain difficult to diagnose.…”

Section: Introductionmentioning

confidence: 99%

Performance of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identifying Clinical Malassezia Isolates

et al. 2017

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The genus Malassezia comprises commensal yeasts on human skin. These yeasts are involved in superficial infections but are also isolated in deeper infections, such as fungemia, particularly in certain at-risk patients, such as neonates or patients with parenteral nutrition catheters. Very little is known about Malassezia epidemiology and virulence. This is due mainly to the difficulty of distinguishing species. Currently, species identification is based on morphological and biochemical characteristics. Only molecular biology techniques identify species with certainty, but they are time-consuming and expensive. The aim of this study was to develop and evaluate a matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) database for identifying Malassezia species by mass spectrometry. Eighty-five Malassezia isolates from patients in three French university hospitals were investigated. Each strain was identified by internal transcribed spacer sequencing. Forty-five strains of the six species Malassezia furfur, M. sympodialis, M. slooffiae, M. globosa, M. restricta, and M. pachydermatis allowed the creation of a MALDI-TOF database. Forty other strains were used to test this database. All strains were identified by our Malassezia database with log scores of >2.0, according to the manufacturer's criteria. Repeatability and reproducibility tests showed a coefficient of variation of the log score values of <10%. In conclusion, our new Malassezia database allows easy, fast, and reliable identification of Malassezia species. Implementation of this database will contribute to a better, more rapid identification of Malassezia species and will be helpful in gaining a better understanding of their epidemiology.

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“…Antifungal susceptibility of Malassezia species using agar and broth dilution alternative methods has been studied . Currently, few antifungal susceptibility tests are performed using disc diffusion methods, but only when studying the non‐lipid‐dependent species, M. pachydermatis …”

Section: Introductionmentioning

confidence: 99%

Antifungal susceptibility testing of Malassezia yeast: comparison of two different methodologies

Rojas

Córdoba

Sosa

et al. 2016

Mycoses

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All Malassezia species are lipophilic; thus, modifications are required in susceptibility testing methods to ensure their growth. Antifungal susceptibility of Malassezia species using agar and broth dilution methods has been studied. Currently, few tests using disc diffusion methods are being performed. The aim was to evaluate the in vitro susceptibility of Malassezia yeast against antifungal agents using broth microdilution and disc diffusion methods, then to compare both methodologies. Fifty Malassezia isolates were studied. Microdilution method was performed as described in reference document and agar diffusion test was performed using antifungal tablets and discs. To support growth, culture media were supplemented. To correlate methods, linear regression analysis and categorical agreement was determined. The strongest linear association was observed for fluconazole and miconazole. The highest agreement between both methods was observed for itraconazole and voriconazole and the lowest for amphotericin B and fluconazole. Although modifications made to disc diffusion method allowed to obtain susceptibility data for Malassezia yeast, variables cannot be associated through a linear correlation model, indicating that inhibition zone values cannot predict MIC value. According to the results, disc diffusion assay may not represent an alternative to determine antifungal susceptibility of Malassezia yeast.

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Malassezia pachydermatis fungemia in a preterm neonate resistant to fluconazole and flucytosine

Cited by 52 publications

References 22 publications

Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method

Antifungal Susceptibility Testing of Malassezia spp. with an Optimized Colorimetric Broth Microdilution Method

Performance of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry for Identifying Clinical Malassezia Isolates

Antifungal susceptibility testing of Malassezia yeast: comparison of two different methodologies

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