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Malassezia Infections

Presentation Developed By: Courtney Madden, Megan Lileas & Nita Gupta

Malassezia Infections

 Alternate Names:   Pityrosporum

 Obsolete name for this genus

 Yeast Infections

  (Images courtesy of http://www.buyaldaracream.com/buy-diflucan.htm and http://208.88.129.137/product/catalog/product_detail.aspx?id=36&prodid=154&seachproducts=K)

Malassezia Taxonomy

 Kingdom: Fungi  Phylum: Basidiomycota  Class: Hymenomycetes  Order: Tremellales  Family: Filobasidiaceae  Genus: Malassezia

Malassezia Infections   Etiologic Agent and Taxonomy

(11 species):   Malassezia furfur-most

common   Malassezia globosa   Malassezia obtusa-rarely

recovered   Malassezia restricta   Malassezia sloofiae   Malassezia sympodialis   Malassezia pachydermatis   Malassezia dermatis   Malassezia japonica   Malassezia nana   Malassezia yamatoensis

Malassezia   A colononizing yeast found

on dermis and other body surfaces of humans and animals

  Most species require long fatty-acid chains to grow well (lipophilic)-except M. pachydermatis

  Normal skin flora- colonies found on up to 90% of adults (www.doctorfungus.com)

  Cells are globular to ellipsoidal in shape

  Conidia (asexual spore off hyphae branch) is primary form

 

Malassezia Geographical Distribution   (Image courtesy of www.dsc.dicovery.com)

  More common in adults   More common in tropical

areas with up to a 40-60% infection rate (Clinical Mycology)

  Japan- M. sympodialis, M. furfur

  Spain- M. sympodialis, M. globosa

  M. globosa- commonly seen in the scalps of UK residents

  M. furfur- tropical areas

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Malassezia Life Cycle   No telomere phase   Yeast cells and hyphae   Found as colony on skin in

budding forms   Raised and smooth in

cultures   Get dry and wrinkled as

they age   During an infection change

to mycelial form   In temperate regions

clusters of hyphae suggesting form differs depending of location

Malassezia Life Cycle (Image courtesy of http://www.mycology.adelaide.edu.au/

Mycoses/Superficial/Malassezia_infections/)   Asexually reproduction only   Collarettes   Usually single buds

  Mature in about 5 days in 30-37 degree climate

  Vary in color from creamy yellow to brown or orange-beige

Epidemiology   Patients who are affected

by immuno-suppressant conditions such as AIDS are at a higher risk of contracting an infection

  Adults carry more Malassezia than children

  An increase in Malassezia is found on teenagers because the increased activity in sebaceous glands provides nutrition for the lipophilic yeast

  (images courtesy of http://dailynewsstore.blogspot.com/2009/11/aids-pictures.html & http://www.medindia.net/beauty/facepimples.asp)

Epidemiology   (Images courtesy of http://www.kaboodle.com & http://

getpregnant2day.com/getting-pregnant/)   People receiving antibiotics or steroid treatment are more susceptible

  Higher risk in pregnant women and diabetics

  Common in tropics   Relapses may occur with

anti-dandruff or anti-fungal drugs

  Neonatals who are on parenteral nourishment with lipids

Pathogenesis: Pityriasis versicolor   Occurs in healthy and

immune compromised people   Very common fungal

disease that stays a very long time on skin

  M. globosa & M. sympodialis   Budding yeasts   Occurs in hot, humid

climates

  Skin rash on the trunk that is usually discolored, slightly reddish brown

  Treatment with dandruff medications or anti-fungals

  (Image courtesy of http://www.patient.co.uk/doctor/ Pityriasis-Versicolor.htm)

Pathogenesis: Pityriasis Versicolor   Occurs in healthy and immuno-compromised patients

  Also known as Tinea Versicolor   Caused by the excessive growth of Pityrosporum orbiculare

(Malassezia furfur). Also caused by M. globosa and M. sympodialis

  Profuse perspiration and an abundance of oil produced in skin allows fungi to grow

  Appear as discolored flaky patches on the skin   The color of the patches will change with sun exposure   Treatment with dandruff medications or anti-fungals   Commonly affected areas: chest, back, upper arm, neck   Skin pigmentation changes may last after fungus is treated

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Pathogenesis: Pityriases Folliculitis   Localized papules, pimple,

and pustules often show up after sun exposure

  Hair follicles become infected and inflammed by the fungi Pityrosporum orbiculare (more severe condition of pityriasis versicolor)

  Common in hot, humid tropical climates where UV rays are stronger

  Heat & friction irritates follicles

  Often chronic and undiagnosed for years

  Occurs mostly in immuno-compromised patients and diabetics

  Mild cases treated with imidazole

  More severe cases-ketoconazole or itraconazole (all are anti-fungals) (Image courtesy of http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Malassezia_infections/)

Pathogenesis: Seborrheic Dermatitis   More commonly known as

dandruff   M. Yamatoensis   Inflammatory skin conditions   Known as cradle cap when

appears in infants   White-yellowish scales appear on

or near oily areas of skin   This condition can run in families

and appear more commonly in patients with neurological conditions and immune compromised

 Chronic (life-long) condition  May affect scalp and inner ear   Not due to poor hygiene  Scale color varies depending on environmental conditions (Image courtesy of http://www.dermatitisseborrheic.net/ & http://emedicbuzz.com/tag/seborrheic-dermatitis/)

Pathogenesis: Catheter-Related Fungemia in Neonates   (image courtesy of http://infections.consultantlive.com/

display/article/1145625/1394106)   Opportunistic systematic infection

  Infection in newborns   Presence of venous

catheters   Prolonged

hospitalization   Most common in

patients receiving lipid replacement therapy (helps increase weight)

Pathogenesis: Atopic Dermatitis   M. globosa and M. restricta

cause the condition   Stays inflammed for a long

period of time   May be blisters or red

irritated skin that crusts over   Sometimes ear discharge or

bleeding may occur   According to the American

Society for Microbiology, patients with atopic dermatitis produce Malassezia specific immunoglobulin E (IgE) whereas healthy patients do not

  Furthermore anti-fungals can improve symptoms of atopic dermatitis

  (images courtesy of http://prescriptionworld.org/ and http://www.cssd.us/body.cfm?id=499)

Pathogenesis

Acne Vulgaris Dacrocystitis   More commonly known as

acne   Whiteheads, blackheads,

pimples, pustules   When follicles in skin

become clogged   Swelling and inflammation

  Inflammation of the lacrimal sac in the inner ear

  Redness and discharge   (Images courtesy http://www.eyesurgeononline.com/

services.html & http://www.getacnehomeremedies.info)

Pathogenesis

Seborrheic Blepharitis Psoriasis

  Chronic inflammation of the eyelid

  Burning, sensitivity, irritation, blurred vision

  (image from http://www.e-psoriasis.com/app/diagnosis.asp)

  Age 15-35   Skin infection and

irritation   Have red skin with yellow

flaky scales   Severe in people with

weak immune system   Some types genetic, some

caused from fungus

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Pathogenesis

Onchyomycosis Confluent & Reticulated Papillomatosis

  Nail infection   Athlete's foot, jock itch,

ringworm   Need heat and humidity   (image from http://www.myfootshop.com)

  Skin infection on the trunk or chest

  Forms brown scaly papules over skin

  (images from http://www.dermis.net)

Case Study   Clinical Aspects of Patients

with Pityriasis Versicolor at a Tropical Center for Dermatology   Malassezia spp. Originally

found M. furfur to be the only causative agent, now 13 species in Malassezia genus.

  Study used 116 subjects: varying in age, race, gender, skin type, occupation, and clinical features of disease

  Subjects were not allowed to use any type of medication within 30 days of study.

  All had a positive direct mycological examination and filled out questionaire to aid in why and how people become infected

Image from: health.allrefer.com

Case Study: Findings and Factors   Most commonly affected ages: 10-20 (33.6%=39/116)

  Resulting from greater development of sebaceous gland, which produce more sebum (oil)

  Found higher frequency in males in this study (others have showed no predominance in genders)

  Race and occupation had little to no relevance   Factors involved: genetic inheritance, elevated

temperatures, humidity, use of oils/moisturizers, immunosuppression, malnutrition, and chemical composition of sebum.

Case Study: Involvement   Most common areas

affected are: Trunk and upper limbs

  Degree of involvement was more commonly extensive (4 or more regions)

Table from Anais Brasileiros de Dermatologiaversion ISSN 0365-0596

Case Study: Treatment

  Most commonly and effective were combination of topical and oral medications   Including keratolytic

and azolic antifungal agents

  Recurrence are frequent

  Can become chronic without treatment Image from members.kaiserpermanente.org

References   Aly, R. et al. "Malassezia spp.." DoctorFungus.

N.p., n.d. Web. 08 Jul 2011. <http://www.doctorfungus.org/thefungi/ malassezia.php>.

  Armstrong, D., F. F. Edwards, T. E. Kiehn, A. E. Brown, and G. R. Garber. "Catheter-related Malassezia Furfur Fungemia in Immunocompromised Patients." The American Journal of Medicine 95.4 (1993): 365-70. PubMed.gov. Web. 12 July 2011.

  Berman, Kevin. "Psoriasis - PubMed Health." National Center for Biotechnology Information. 8 Nov. 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/>.

  Berman, Kevin. "Seborrheic Dermatitis - PubMed Health." National Center for Biotechnology Information. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001959/>.

  "Blepharitis-PubMed Health." National Center for Biotechnology Information. May 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/ pubmed/20590417>.

  Cohen, Bernard A. "DermAtlas: Online Dermatology Image Library." Dermatlas: Dermatology Image Atlas with 12474 Dermatology Images. 3 Apr. 2011. Web. 13 July 2011. <http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=2073016827>.

  Ellis, David "Malassezia Infections." The University of Adelaide. N.p., 2011. Web. 08 Jul 2011. <http://www.mycology.adelaide.edu.au/Mycoses/Superficial/Malassezia_infections/>.

  "Malassezia Fungemia in Neonates and Adults: Complication of Hyperalimentation." Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/pubmed/3125578>.

  Morias, Patrícia Motta de; CUNHA, Maria da Graça Souza and FROTA, Maria Zeli Moreira. Clinical aspects of patients with pityriasis versicolor seen at a referral center for tropical dermatology in Manaus, Amazonas, Brazil. An. Bras. Dermatol. [online]. 2010, vol.85, n.6 [cited 2011-07-13], pp. 797-803 . Available from: <http:www.scielo.brscielo.phpscript>

  Oakley, Amanda. "Pityriasis Versicolor (tinea Versicolor, Yeast Infection). DermNet NZ." DermNet NZ. Facts about Skin from New Zealand Dermatological Society. New Zealand Dermatological Society Incorporated, 29 June 2011. Web. 12 July 2011. <http://dermnetnz.org/ fungal/pityriasis-versicolor.html>.

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References   "Pityriasis Versicolor." NetDoctor.co.uk -

The UK's Leading Independent Health Website. Ed. John Pillinger. 10 June 2008. Web. 11 July 2011. <http://www.netdoctor.co.uk/ diseases/facts/pityriasisversicolor.htm>.

  "Seborrheic Dermatitis: MedlinePlus Medical Encyclopedia." National Library of Medicine - National Institutes of Health. Ed. Kevin Berman. Merican Accreditation HealthCare Commission, 18 July 2007. Web. 11 July 2011. <http://www.nlm.nih.gov/medlineplus/ency/article/000963.htm>.

  Sugita, Takashi, Mami Tajima, Hisae Tsubuku, and Ryoji Tsuboi Akemi Nishikawa. "A New Calcineurin Inhibitor, Pimecrolimus, Inhibits the Growth of Malassezia spp. ." Antimicrobial Agents and Chemotherapy 50.8 2897-2898. Web. 11 Jul 2011. <http:// aac.asm.org/cgi/content/full/50/8/2897>.

  Vordick, Linda J. "Atopic Eczema - PubMed Health." National Center for Biotechnology Information. 10 Oct. 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/ pubmedhealth/PMH0001856/>.

  Vordick, Linda J. "Fungal Nail Infection - PubMed Health." National Center for Biotechnology Information. 4 Oct. 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/ pubmedhealth/PMH0002306/>.

  Vorvick, Linda J. "Folliculitis - PubMed Health." National Center for Biotechnology Information. 28 Oct. 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/ pubmedhealth/PMH0001826/>.

  Vorvick, Linda J. "Tinea Versicolor - PubMed Health." National Center for Biotechnology Information. 10 Oct. 2010. Web. 13 July 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002436/>.