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Malassezia Fungaemia — SCE Infectious Diseases MCQ

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HardFungal InfectionsMalassezia FungaemiaSCE Infectious Diseases

A 45-year-old woman develops fever and rigors while receiving total parenteral nutrition (TPN) through a Hickman line. Blood cultures from the line grow Malassezia furfur. What is the key management step specific to this organism?

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Correct answer: B — Stop the lipid component of TPN — Malassezia requires exogenous lipid for growth

Malassezia furfur (and M. pachydermatis) are lipid-dependent yeasts that cause catheter-related fungaemia almost exclusively in patients receiving IV lipid emulsions (TPN). The key management step is discontinuing the lipid component of TPN (and removing the catheter). Systemic antifungals (Amphotericin B or Fluconazole) may be needed for persistent infection. Echinocandins have limited activity against Malassezia. The lipid dependence is unique among fungal pathogens and is the diagnostic and therapeutic clue.

Reference: ESCMID 2024 – Candida/yeast guidelines; IDSA 2016 – Catheter-related infections