[Malassezia furfur colonising the respiratory tract of mechanically ventilated neonates].
BACKGROUND
Ventilated neonates are prone to acquire ventilator-associated pneumonia (VAP). Consequently early diagnosis of pneumonia is required. Beside bacteria, fungi are suspected as a cause of VAP. However, fungal colonisation and infection of the lung have not been studied systematically. The purpose of this study was to evaluate pulmonary fungal colonisation in ventilated neonates and premature infants.


METHODS
187 tracheal aspirates (TA) from 29 ventilated neonates (23-35 weeks gestational age) were investigated. TAs were evaluated microscopically and by culture. Data were matched with clinical signs of VAP or sepsis.


RESULTS
Candida species were not detected in TA or culture. In contrast, Malassezia furfur (Mf), a lipophilic fungus, was detected from the 10th, 21st and 31st postnatal days onwards in TAs of 3 out of 17 extremely prematures (gestational age at birth < 25 weeks). The presence of Mf was associated with clinical deterioration either immediately or a few days after the first positive Mf smear. Topic steroids were more frequently applied to Mf-positive ELBW infants (p = 0.03). In vitro, natural surfactant was demonstrated to be a sufficient substrate for Mf in culture.


CONCLUSIONS
This is the first report on Mf lung colonisation of ELBWI during mechanical ventilation. Because Mf is generally not detected in standard cultures it appears to be an overlooked, potentially pathogenic fungus in prematures. Mf must be considered in the differential diagnosis of VAP in ELBWI exposed to topical steroids, especially when natural surfactant was administered.
Flemmer
A W
AW
Neonatologie der Kinderklinik am Perinatalzentrum Grosshadern, Ludwig-Maximilian-Universität München. flemmer@med.uni-muenchen.de
Yilmaz
E
E
Mittal
R
R
Müller-Edenborn
B
B
Haas
A
A
Holzinger
A
A
Schulze
A
A
D006801:Humans; D007231:Infant, Newborn; D008172:Lung Diseases, Fungal / Q000382:microbiology*; D008290:Malassezia / Q000302:isolation & purification*; D011014:Pneumonia / Q000382:microbiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012137:Respiratory System / Q000382:microbiology*; D014010:Tinea Versicolor / Q000382:microbiology*