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Malassezia furfur--disseminated infection in premature infants
Y H Shek1, M C Tucker, A L Viciana
1Department of Pathology, Georgetown University School of Medicine, Washington, D.C. 20007.
Abstract:
Three infants, born prematurely, died after clinical illnesses of 67, 65, and 60 days from infection by Malassezia furfur. Each infant had been nourished with lipid emulsions delivered through deep-line catheters. The infections, all discovered at autopsy, were characterized by massive involvement of lungs. Two of the three had endocardial vegetations containing M. furfur; all three had lesions in liver, kidney, and spleen, and two had lesions in adrenal, pancreas, and colon. In addition, one of the infants had acute meningoencephalitis caused by M. furfur. In some of the distant organs, yeast cells of M. furfur were growing in the lumina of small vessels, filling the lumina, but causing no vasculitis or infarction. In addition to these benign collections of yeasts within vessels, there were acute inflammatory lesions as well. These were consolidation, vasculitis, granulomatous inflammation, septic thrombosis, and septic infarction of lung and foci of necrosis and inflammation in kidney and liver. Two previously reported autopsies described neonates with lesions in lung and heart. The authors' three cases for which autopsies were performed had lesions in lung and heart too but, in addition, had dissemination with acute lesions in kidney and liver. Finally, one patient had a severe meningoencephalitis caused by M. furfur.
Insights
Premature infants receiving lipid emulsions via deep-line catheters developed fatal Malassezia furfur infections. Autopsies revealed widespread organ involvement, including lungs, liver, kidneys, and brain, highlighting a critical risk in neonatal intensive care.
Area of Science:
- Medical Mycology
- Neonatal Pathology
- Infectious Diseases
Background:
- Premature infants often require intensive nutritional support, including lipid emulsions delivered via central venous catheters.
- Catheter-associated bloodstream infections are a significant concern in neonatal intensive care units.
- Malassezia furfur is a lipophilic yeast that can cause systemic infections, particularly in vulnerable neonates.
Observation:
- Three premature infants experienced prolonged clinical illnesses (60-67 days) culminating in death.
- Autopsies revealed disseminated Malassezia furfur infections with massive pulmonary involvement.
- Histopathological examination showed M. furfur in lungs, heart (endocardial vegetations), liver, kidneys, spleen, adrenal glands, pancreas, and colon.
Findings:
- Malassezia furfur caused systemic infections with widespread organ damage, including acute inflammatory lesions like consolidation, vasculitis, septic thrombosis, and infarction.
- Yeast cells were observed within the lumina of small vessels in distant organs, causing obstruction without vasculitis.
- One infant developed severe meningoencephalitis due to M. furfur, indicating central nervous system involvement.
Implications:
- Lipid emulsion formulations and deep-line catheter use in premature infants pose a risk for disseminated Malassezia furfur infections.
- Early recognition and prompt management are crucial to prevent severe morbidity and mortality associated with M. furfur fungemia in neonates.
- This study underscores the importance of considering fungal infections in critically ill premature infants, especially those with prolonged catheter use and unexplained clinical deterioration.