Malassezia furfur fungaemia in infants receiving intravenous lipid emulsions. A rarity or just underestimated?

Malassezia furfur fungaemia is reported in six preterm infants receiving a parenteral fat emulsion through a deep central venous catheter. The fungus was detected in blood cultures drawn through the catheter. The features of these cases are compared to those reported since 1981, when M. furfur was described for the first time as a cause of deep tissue infection. Clinical signs such as fever, in spite of broad-spectrum antibiotics, and the presence of pulmonary infiltrates, associated with leucocytosis and thrombocytopenia in neonates with cardiac or pulmonary disease should raise the suspicion of M. furfur fungaemia. The laboratory should be informed of this possibility since routine blood culture techniques are not appropriate for the isolation of this lipid-dependent organism. Treatment of the condition consists in removal of the catheter and discontinuation of the lipid administration. Effects and choice of antifungal therapy should be further investigated.