Malassezia species infection of the synovium after total knee arthroplasty surgery

Leylabadlo, Hamed Ebrahimzadeh; Zeinalzadeh, Elham; Akbari, Najibeh Asl Rahnemaii; Kafil, Hossein Samadi

doi:10.3205/dgkh000279

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…However, Malassezia has rarely been identified as a pathogen involved in spinal infections, with its main association being chronic infections such as Crohn’s disease, cytokine release syndrome, and respiratory diseases except for skin disorders [ 7 ]. Upon retrospective analysis of all previous cases since 2010, we have identified only eight documented instances of Malassezia infection, including four patients with endocardial infection [ 59 , 60 ], three patients with pulmonary infection [ 61 , 62 ], one patient with liver infection [ 63 ], and one patient with synovial infection [ 64 ] (Table 3 ). However, no reports of spinal infections caused by Malassezia were found.…”

Section: Discussionmentioning

confidence: 99%

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

Peng,

Lin,

Zou

et al. 2024

BMC Infect Dis

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Background Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports. Case presentation A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up. Conclusions M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

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