As evidenced by outbreak investigations, the cutaneous commensal flora of the patient or health care workers is the usual source of the infecting organism.1,11,56,58 Apart from contamination during insertion or following administration of a contaminated parenteral solution, catheters may become infected by migration of organism from the exit site along the outer catheter wall or from the hub through the lumen of the catheter, adherence of the organism to the catheter material

with biofilm production, resulting in local replication and shedding of the organism in the blood.71,73–77 Microbial selleck screening library and host factors may play a role in localising the organisms to the catheter or in progression to fungaemia and clinical sepsis.62,78 However, even if host defences are able to clear the organism from the blood, the infection may not be resolved until the catheter is removed. Similar to catheter-related candidaemia, catheter-related Malassezia fungaemia has been associated with administration of parenteral lipid emulsions. While the exact mechanisms of this association remain unclear, it is conceivable that lipids administered through the catheter may provide a growth advantage for Selleck Idasanutlin Malassezia.56,58,76,79

On the other hand, parenterally administered lipids may negatively affect host immunity by blocking the reticuloendothelial system, reducing the generation of reactive oxygen species and decreasing phagocytosis by neutrophils in vitro and thereby contribute to clinical disease.73 The clinical signs and symptoms of Malassezia fungaemia and sepsis are generally non-specific. Depending on the severity of the infection, the most commonly reported symptoms in critically ill, premature infants have been fever and respiratory distress; other less frequent symptoms include lethargy,

bradycardia, hepatomegaly, splenomegaly, seizures and cyanosis.22,58,80 Respiratory distress may result in pneumonia or bronchopneumonia with an interstitial appearance on radiography. The main laboratory findings in this setting are leucocytosis or leucopenia, and thrombocytopenia. Affected patients usually are premature, low birth weight infants with multiple co-morbidities, extended hospitalisation, central venous catheters and parenteral nutrition including lipid emulsions.10,21,54,56,81,82 Catheter-associated Malassezia fungaemia is sporadic in immunocompromised the children and in adults and therefore clinical manifestations are not as well described as in infants. Fever appears to be universal;71 other symptoms and findings may include chills and rigours, myalgia, nausea and vomiting, respiratory distress with or without apnea, pneumonia, leucopenia, thrombocytosisis and less frequently, leucocytosis; signs of exit site inflammation are uncommon.2,12,59,71 Similar to the neonatal setting, the most common patient profile includes prolonged hospitalisation, the presence of central venous catheters and the use of intravenous fat emulsions.