Epidemiology, diagnosis, and management of Malassezia furfur systemic infection.

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.