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Systemic Malassezia furfur infections in patients receiving intralipid therapy
Abstract:
Systemic infection with Malassezia furfur was first reported in 1981 as a specific complication of Intralipid therapy in a neonate. Six additional patients, including three older than 16 years of age, were identified subsequently. All had received prolonged Intralipid infusion through central venous catheters. Pulmonary infection was documented in tissue in three cases, the clinical presentation was characterized by pulmonary infiltrates, fever, and, in the infants, thrombocytopenia. Two subgroups of patients appear to be at the greatest risk for Malassezia infection: neonates with cardiopulmonary disease and adults with severe gastrointestinal disease and immunosuppression. The documentation of pulmonary arterial lipid deposits in vessels that had been infiltrated by Malassezia organisms and the observation of organisms in small pulmonary thromboemboli suggest that these lipophilic and lipid-dependent organisms are introduced into the bloodstream from venous catheters and require high lipid concentrations to proliferate in tissue.
Insights
Systemic Malassezia furfur infections can occur with Intralipid therapy, particularly in neonates and immunosuppressed adults. These infections present as pulmonary issues and are linked to central venous catheters and lipid concentrations.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Systemic Malassezia furfur infection, first identified in 1981, is a known complication of Intralipid therapy.
- This lipophilic yeast requires high lipid concentrations for proliferation, often associated with lipid-based parenteral nutrition.
Purpose of the Study:
- To identify patient subgroups at highest risk for Malassezia furfur systemic infections.
- To investigate the clinical presentation and pathological mechanisms of Malassezia furfur infections related to Intralipid therapy.
Main Methods:
- Review of clinical data from seven patients with systemic Malassezia furfur infection.
- Analysis of patient history, focusing on Intralipid infusion via central venous catheters.
- Histopathological examination of affected tissues, including pulmonary samples.
Main Results:
- Seven cases of systemic Malassezia furfur infection were identified, including neonates and adults (>16 years).
- Pulmonary infection occurred in three cases, presenting with infiltrates, fever, and thrombocytopenia in infants.
- Risk factors identified include neonates with cardiopulmonary disease and adults with gastrointestinal disease and immunosuppression.
Conclusions:
- Malassezia furfur infections are associated with prolonged Intralipid infusion via central venous catheters.
- Pulmonary arterial lipid deposits and thromboemboli suggest hematogenous spread and lipid-dependent proliferation.
- Prompt recognition and management are crucial for at-risk patient populations.