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A new approach to the diagnosis and study of Malassezia infections

The paper by Kolecka et al. on the use of matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) may sound an abstruse and unnecessarily complex system for diagnosis. However, it is proving both a reliable and increasingly used technique that can provide a rapid and highly accurate confirmation of the diagnosis of a wide variety of infections. In the study the authors used the method, which depends on the ability of a laser beam to vaporize organisms releasing subcellular constituents such as functional and structural molecules including proteins and peptides which are then subject to analysis, in this case through mass spectrometry. The fingerprint produced is highly specific and provides an accurate way of identifying microorganisms in both clinical material and from culture. It is also an alternative to molecular genetic tests based on the polymerase chain reaction (PCR). The latter method was the comparator for this study, where nucleotide sequences from the internal transcribed spacer (ITS) region were utilized as probes. The use of MALDI-TOF has been examined in other infections such as those caused by bacteria, mycobacteria, moulds, dermatophytes and Candida. Although it has not replaced conventional diagnosis in infections such as dermatophytosis, it is increasingly used as a primary laboratory identification tool in yeast infections. The benefit of the technique is that although the equipment is expensive to purchase it can be applied to the diagnosis of a wide variety of infections and running costs are thereby substantially reduced. MALDI-TOF has other uses. Because it can be deployed to identify microbial proteomes it can be used to understand the sequence of events such as gene expression that underlie infection over time. For instance, there have been studies of the production of lipases by Malassezia spp. during the course of infection. In the latter study the lipase was purified using MALDI-TOF technology and then its biochemical and kinetic features characterized. The same technique can also be used to study in vitro drug sensitivity. In this case the sensor is used to detect concentrations of target protein that may be affected by the drug at varying times after exposure to the drug. In this paper the authors have created a novel and important database of the main mass spectra of Malassezia species. They showed that MALDI-TOF is a robust, rapid and reproducible method for the identification and discrimination of Malassezia species. These findings are a major step forward in facilitating the quick and correct identification of Malassezia species in skin disease. It is also crucial for healthcare providers managing neonates and other individuals suffering from Malassezia sepsis, a potentially fatal infection, and will allow the introduction of appropriate treatment at an early stage. However, by utilizing this method it will also be possible to understand the role of different Malassezia species in diseases such as seborrhoeic dermatitis and atopic dermatitis affecting the head and neck.