Characterization and scanning electron microscopy of Malassezia species isolated from central line tips of neonates on total parenteral nutrition
DOI:
https://doi.org/10.18203/2349-3291.ijcp20233228Keywords:
Malassezia, M. furfur, M. restricta, CRBSI, TPNAbstract
Background: The aim of this study was to demonstrate colonization by Malassezia species in the central lines of very low birth weight newborns on total parental nutrition (TPN). We also aimed to perform scanning electron microscopy (SEM) of central line tip cut sections to document the quality of the biofilm, cell structure, micro-colony characteristics, and the presence of extracellular matrix.
Methods: We collected central line tips of very low birth weight newborns (<1.5 kg) over a one-year period. We included a total of 63 samples, which were cultured on SDA slants with and without olive oil along with controls purchased from CBS Netherlands. We incubated the cultures at 32°C and observed them every two days for three weeks. Once growth occurred, we phenotypically identified the cultures and observed the central line tip cut sections with SEM.
Results: Among the 63 central line tips, two (3.1%) were colonized by Malassezia. We observed a visible biofilm on the tips. We confirmed the phenotypic identification of the isolates as M. furfur and M. restricta by gene sequencing.
Conclusions: Our study revealed Malassezia colonization in the central line used for total parenteral nutrition. Hence, it is important to have a high index of suspicion towards Malassezia catheter-related blood stream infection in newborns on TPN with a clinical picture of fever (in spite of antibiotic therapy), leukocytosis, thrombocytopenia with cardiac disease, and pulmonary infiltrates. The outbreak potential of Malassezia warrants preventive steps, early identification and treatment.
References
Gaitanis G, Magiatis P, Hantschke M, Bassukas ID, Velegraki A: The Malassezia genus in skin and systemic diseases. Clin Microbiol Rev. 2012;25(1):106-41.
Iatta R, Immediato D, Montagna MT, Otranto D, Cafarchia C. In vitro activity of two amphotericin B formulations against Malassezia furfur strains recovered from patients with bloodstream infections. Med Mycol. 2015;53(3):269-74.
Morros J, González-Cuevas T, Ortega A, Almagro M, Hernando M, Giralt G, et al. Colonización cutánea neonatal por Malassezia spp (Cutaneous colonization by Malassezia spp.). An Esp Pediatr. 2002;57(5):452-6.
Ashbee HR, Evans EGV. Immunology of diseases associated with Malassezia species. Clin Microbiol Rev. 2002;15(1):21-57.
Dupuy AK, David MS, Li L, Heider TN, Peterson JD, Montano EA, et al. Redefining the human oral mycobiome with improved practices in amplicon-based taxonomy: discovery of Malassezia as a prominent commensal. PLoS One. 2014;9(3):e90899.
Gross GJ, MacDonald NE, Mackenzie AMR. Neonatal rectal colonization with Malassezia furfur. Can J Infect Dis. 1992;3(1):9-13.
Shattuck KE, Cochran CK, Zabransky RJ, Pasarell L, Davis JC, Malloy MH. Colonization and infection associated with Malassezia and Candida species in a neonatal unit. J Hosp Infect. 1996;34(2):123-9.
Zomorodain K, Mirhendi H, Tarazooie B, Kordbacheh P, Zeraati H, Nayeri F. Molecular analysis of Malassezia species isolated from hospitalized neonates. Pediatr Dermatol. 2008;25(3):312-6.
Persoon IF, Buijs MJ, Özok AR, Crielaard W, Krom BP, Zaura E, Brandt BW. The mycobiome of root canal infections is correlated to the bacteriome. Clin Oral Investig. 2017;21(5):1871-81.
Diaz PI, Dupuy AK, Abusleme L, Reese B, Obergfell C, Choquette L, et al. Using high throughput sequencing to explore the biodiversity in oral bacterial communities. Mol Oral Microbiol. 2012;27(3):182-201.
Jung WH, Croll D, Cho JH, Kim YR, Lee YW. Analysis of the nasal vestibule mycobiome in patients with allergic rhinitis. Mycoses. 2015;58(3):167-72.
Ayhan M, Sancak B, Karaduman A, Arıkan S, Şahin S. Colonization of neonate skin by Malassezia species: Relationship with neonatal cephalic pustulosis. J Am Acad Dermatol. 2007;57(6):1012-8.
Limon JJ, Tang J, Li D, Wolf AJ, Michelsen KS, Funari V, et al. Malassezia Is Associated with Crohn's Disease and Exacerbates Colitis in Mouse Models. Cell Host Microbe. 2019;25(3):377-88.
Azimi PH, Levernier K, Lefrak LM, Malassezia furfur: a cause of occlusion of percutaneous central venous catheters in infants in the intensive care nursery. Pediatr Infect Dis J. 1988;7(2):100-3.
Gupta P, Chakrabarti A, Singhi S, Kumar P, Honnavar P, Rudramurthy SM. Skin Colonization by Malassezia spp. in hospitalized neonates and infants in a tertiary care centre in North India. Mycopathologia. 2014;178(3-4):267-72.
Larocco M, Dorenbaum A, Robinson A. Pickering Recovery of Malassezia pachydermatis from eight infants in a neonatal intensive care nursery: clinical and laboratory features Pediatr Infect. Pediatr Infect Dis J. 1988;7:398-401.
Curvale-Fauchet N, Botterel F, Legrand P, Guillot J, Bretagne S. Frequency of intravascular catheter colonization by Malassezia spp. in adult patients. Mycoses. 2004;47(11-12):491-4.
Houhamdi Hammou L, Benito Y, Boibieux A. An underdiagnosed causative agent of blood culture-negative infective endocarditis. Clin Infect Dis. 2021;73(7):1223-30.
Kessler AT, Kourtis AP, Simon N. Peripheral thromboembolism associated with Malassezia furfur sepsis. Dis J. 2002;21(4):356-7.
Mularoni A, Graziano E, Medaglia AA. Malassezia restricta pneumonia in solid organ transplant recipients: First report of two cases. J Fungi (Basel). 2021;7(12):1057.
Habibi N, Uddin S, Behbehani M. Bacterial and fungal communities in indoor aerosols from two Kuwaiti hospitals. Front Microbiol. 2022;13:955913.
Suzuki T, Hori N, Miyake T, Hori Y, Mochizuki K. Keratitis caused by a rare fungus, Malassezia restricta. Jpn J Ophthalmol. 2007;51(4):292-4.
Augsten R, Pfister W, Wildner K, Voigt U, Oelzner P, Königsdörffer E. Endogenous malassezia endophthalmitis. Klin Monbl Augenheilkd. 2013;230(5):536-7.
Arendrup MC, Boekhout T, Akova M, Meis JF, Cornely OA, Lortholary O. European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group; European Confederation of Medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect. 2014;20(3):76-98.
Zareei M, Roudbar Mohammadi S, Shahbazi S, Roudbary M, Borjian Borujeni Z. Evaluation of the ability of Malassezia species in biofilm formation. Arch Clin Infect Dis. 2018;13(4):e62223.
Rojas F, Mussin J, de Los Angeles Sosa M, Giusiano G. Biofilm, adherence, and hydrophobicity as virulence factors in Malassezia furfur. Med Mycol. 2018;56(1):110-6.
Giusiano G, Mangiaterra M, Garcia Saito V, Rojas F, Gómez V, Díaz MC. Fluconazole and itraconazole resistance of yeasts isolated from the bloodstream and catheters of hospitalized pediatric patients. Chemotherapy. 2006;52(5):254-9.
Rhimi W, Theelen B, Boekhout T, Otranto D, Cafarchia C. Malassezia spp. Yeasts of Emerging Concern in Fungemia. Front Cell Infect Microbiol. 2020;10:370.
Kaneko T, Murotani M, Ohkusu K, Sugita T, Makimura K. Genetic and biological features of catheter-associated Malassezia furfur from hospitalized adults. Med Mycol. 2012;50(1):74-80.
Paul AA, Hoffman KL, Hagan JL, Sampath V, Petrosino JF, Pammi M. Fungal cutaneous microbiome and host determinants in preterm and term neonates. Pediatr Res. 2020;88(2):225-33.
