RESUMO
Raw milk cheeses are commonly consumed in France and are also a common source of foodborne outbreaks (FBOs). Both an FBO surveillance system and a laboratory-based surveillance system aim to detect Salmonella outbreaks. In early August 2018, five familial FBOs due to Salmonella spp. were reported to a regional health authority. Investigation identified common exposure to a raw goats' milk cheese, from which Salmonella spp. were also isolated, leading to an international product recall. Three weeks later, on 22 August, a national increase in Salmonella Newport ST118 was detected through laboratory surveillance. Concomitantly isolates from the earlier familial clusters were confirmed as S. Newport ST118. Interviews with a selection of the laboratory-identified cases revealed exposure to the same cheese, including exposure to batches not included in the previous recall, leading to an expansion of the recall. The outbreak affected 153 cases, including six cases in Scotland. S. Newport was detected in the cheese and in the milk of one of the producer's goats. The difference in the two alerts generated by this outbreak highlight the timeliness of the FBO system and the precision of the laboratory-based surveillance system. It is also a reminder of the risks associated with raw milk cheeses.
Assuntos
Queijo/microbiologia , Surtos de Doenças , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Infecções por Salmonella/microbiologia , Salmonella/classificação , Animais , Controle de Doenças Transmissíveis , Doenças Transmitidas por Alimentos/epidemiologia , França/epidemiologia , Cabras , Humanos , Infecções por Salmonella/epidemiologiaRESUMO
Attributing foodborne illnesses to food sources is essential to conceive, prioritize, and assess the impact of public health policy measures. The Bayesian microbial subtyping attribution model by Hald et al. is one of the most advanced approaches to attribute sporadic cases; it namely allows taking into account the level of exposure to the sources and the differences between bacterial types and between sources. This step forward requires introducing type and source-dependent parameters, and generates overparameterization, which was addressed in Hald's paper by setting some parameters to constant values. We question the impact of the choices made for the parameterization (parameters set and values used) on model robustness and propose an alternative parameterization for the Hald model. We illustrate this analysis with the 2005 French data set of non-typhi Salmonella. Mullner's modified Hald model and a simple deterministic model were used to compare the results and assess the accuracy of the estimates. Setting the parameters for bacterial types specific to a unique source instead of the most frequent one and using data-based values instead of arbitrary values enhanced the convergence and adequacy of the estimates and led to attribution estimates consistent with the other models' results. The type and source parameters estimates were also coherent with Mullner's model estimates. The model appeared to be highly sensitive to parameterization. The proposed solution based on specific types and data-based values improved the robustness of estimates and enabled the use of this highly valuable tool successfully with the French data set.
RESUMO
From January to September 2013, a marked increase in notifications of Salmonella Paratyphi A infections among travellers returning from Cambodia occurred in France. An investigation revealed 35 cases without a common source: 21 in France, five in Germany, three in the Netherlands, one in Norway, one in the United Kingdom, four in New-Zealand. Data suggest an ongoing event that should trigger further investigation. Travellers to Cambodia should observe preventive measures including good personal hygiene and food handling practices.
Assuntos
Notificação de Doenças/estatística & dados numéricos , Febre Paratifoide/diagnóstico , Febre Paratifoide/epidemiologia , Salmonella paratyphi A/isolamento & purificação , Viagem , Adolescente , Adulto , Idoso , Camboja , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Febre Paratifoide/transmissão , Vigilância da População , Adulto JovemRESUMO
Genotyping of important medical or veterinary prokaryotes has become a very important tool during the last decades. Rapid development of fragment-separation and sequencing technologies has made many new genotyping strategies possible. Among these new methods is multilocus variable-number tandem repeat analysis (MLVA). Here we present an update on the use of MLVA in eight European countries (Denmark, France, Germany, Ireland, Italy, the Netherlands, Norway and Sweden). Researchers in Europe have been active in developing and implementing a large array of different assays. MLVA has been used as a typing tool in several contexts, from aiding in resolving outbreaks of foodborne bacteria to typing organisms that may pose a bioterrorist threat, as well as in scientific studies.
Assuntos
Variação Genética , Bactérias Gram-Negativas/genética , Bactérias Gram-Positivas/genética , Repetições Minissatélites , Tipagem de Sequências Multilocus , Análise por Conglomerados , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Europa (Continente) , Genótipo , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/classificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Filogenia , Análise de Sequência de DNARESUMO
An outbreak due to the emerging monophasic Salmonella Typhimurium 4,5,12:i:- occurred in four schools in Poitiers in October 2010. Food trace-back investigation led to the identification of beef burgers as the cause of the outbreak and their subsequent withdrawal. The Institute for Public Health Surveillance conducted a retrospective epidemiological investigation to assess the extent of the outbreak and describe cases. Self-administered questionnaires were completed by students and personnel attending each of the four schools affected. Clinical cases were defined as anyone having eaten at the school when the beef burgers were served and reporting diarrhoea or fever with at least one digestive symptom (nausea, vomiting or abdominal pain), within five days after the incriminated school meal or with unknown date of onset within a 15-day period after the incriminated school meal. Of 1,559 persons exposed, 554 clinical cases were identified corresponding to an overall attack rate of 35.5%. Of 554 clinical cases, a total of 286 (53%) sought medical care and 31 (6%) were hospitalised for more than 24 hours. This multi-school outbreak is one of the biggest food-borne outbreaks of monophasic Salmonella Typhimurium 4,5,12:i:- described in France. Prompt notification of cases and rapid identification and withdrawal of the incriminated batch of beef burgers was crucial to limit the extension of this outbreak.
Assuntos
Surtos de Doenças , Produtos da Carne/intoxicação , Intoxicação Alimentar por Salmonella/epidemiologia , Intoxicação Alimentar por Salmonella/microbiologia , Salmonella typhimurium , Adolescente , Criança , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Notificação de Doenças , Feminino , Contaminação de Alimentos/estatística & dados numéricos , Serviços de Alimentação/estatística & dados numéricos , França/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Produtos da Carne/microbiologia , Vigilância da População , Estudos Retrospectivos , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
An outbreak of the monophasic variant of Salmonella enterica serotype 4,[5],12:i:- occurred in November and December 2011 in France. Epidemiological investigation and food investigation with the help of supermarket loyalty cards suggested dried pork sausage from one producer as the most likely source of the outbreak. Despite the absence of positive food samples, control measures including withdrawal and recall were implemented.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Microbiologia de Alimentos , Carne/microbiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella enterica/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Métodos Epidemiológicos , Feminino , França/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/transmissão , Salmonella enterica/classificação , Sorotipagem , Suínos , Adulto JovemRESUMO
Eight cases of diarrhoea, including two cases of haemolytic uraemic syndrome (HUS), were identified among 22 French tourists who travelled to Turkey in September 2011. A strain of Escherichia coli O104:H4 stx2-positive, eae-negative, hlyA-negative, aggR-positive, ESBL-negative was isolated from one HUS case. Molecular analyses show this strain to be genetically similar but not indistinguishable from the E. coli O104:H4 2011 outbreak strain of France and Germany. Although the source of infection was not identified, we conclude that the HUS cases had probably been infected in Turkey.
Assuntos
Surtos de Doenças , Infecções por Escherichia coli/epidemiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Escherichia coli Shiga Toxigênica/isolamento & purificação , Viagem , Idoso , Diarreia/diagnóstico , Diarreia/epidemiologia , Infecções por Escherichia coli/diagnóstico , Feminino , França/epidemiologia , Síndrome Hemolítico-Urêmica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologiaRESUMO
BACKGROUND: In spring 2019, an outbreak of Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC HUS) occurred in France. Epidemiological investigations made by Santé publique France in connection with microbiological investigations at the national reference center for STEC promptly identified a common exposure to consumption of raw cow's milk cheese, and confirmed a cluster affiliation of the E. coli O26:H11 outbreak strain. Here, we report the clinical characteristics of the patients, the treatment used, as well as the outcome at 1 month. METHOD: Patients with STEC HUS linked to the E. coli O26:H11 outbreak strain were identified from the national surveillance network of pediatric STEC HUS cases coordinated by Santé publique France. Clinical data were analyzed from the patients' hospital records obtained from the treating physicians. RESULTS: Overall, 20 pediatric cases of STEC HUS linked to the outbreak strain were identified. Their median age of the patients was 16 months (range: 5-60). Most of them presented with diarrhea but none had received prior antibiotherapy. A total of 13 patients required dialysis; 10 patients and four patients had central nervous system (CNS) and cardiac involvement, respectively. No deaths occurred. At the 1-month follow-up, only two patients had a decreased glomerular filtration rate, below 80 mL /min/1.73m2 and four had hypertension. One patient had neurological sequelae. CONCLUSION: The E. coli O26:H11 strain identified as the cause of an STEC HUS outbreak in France in spring 2019 is notable for the initial severe clinical presentation of the patients, with a particularly high frequency of CNS and cardiac involvement similar to the German E. coli O104:H4 outbreak described in 2011. However, despite the initial severity, the 1-month outcome was favorable in most cases. The patients' young age in this outbreak highlights the need to improve information and caregiver awareness regarding consumption of at-risk foods by young children as key preventive measures against STEC infections.
Assuntos
Infecções por Escherichia coli , Síndrome Hemolítico-Urêmica , Escherichia coli Shiga Toxigênica , Animais , Bovinos , Diarreia/complicações , Surtos de Doenças , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Feminino , Síndrome Hemolítico-Urêmica/complicações , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/epidemiologia , HumanosRESUMO
We report two cases of bacteremia caused by the Salmonella enterica serotype Gambia in our children's hospital, with one fatal outcome. The isolates showed indistinguishable genotypes and infrequent resistance markers: CTX-M-3 extended-spectrum ß-lactamase and armA methyltransferase. This is the first report of S. Gambia exhibiting CTX-M-3 and armA markers involved in serious infections.
Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Infecções por Salmonella/microbiologia , Salmonella enterica/efeitos dos fármacos , Salmonella enterica/enzimologia , beta-Lactamases/genética , tRNA Metiltransferases/genética , Técnicas de Tipagem Bacteriana , DNA Bacteriano/genética , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Evolução Fatal , Feminino , Gâmbia , Genótipo , Humanos , Lactente , Masculino , Tipagem Molecular , Salmonella enterica/genética , Salmonella enterica/isolamento & purificaçãoRESUMO
In May 2010, a nationwide excess of infections with the specific monophasic variant Salmonella enterica serotype 4,12:i:- was investigated in France. Subtyping with multilocus variable number of tandem repeats analysis revealed a distinct epidemic strain within this excess. Epidemiological investigations identified a dried pork sausage sold by a particular chain of supermarkets as the likely vehicle of transmission. The suspected batches have been withdrawn and recalled.
Assuntos
Surtos de Doenças , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella enterica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Salmonella enterica/classificação , Sorotipagem , Adulto JovemRESUMO
A total of 273 Escherichia coli isolates from raw and treated municipal wastewaters were investigated to evaluate the frequency and persistence of antibiotic resistance and to detect the occurrence of conjugative R plasmids and integrons. The highest resistance rates were against ampicillin (22.71%), tetracycline (19.41%), sulfamethoxazole (16.84%) and streptomycin (14.28%). Multiple antibiotic resistance was present in 24.17% of the isolates. Several multiple antibiotic-resistant isolates proved to be able to transfer en bloc their resistance patterns by conjugative R plasmids with different molecular sizes and restriction profiles. Class 1 integrons of 1 or 1.5 kbp were found in 5 out of 24 representative multiresistant E. coli isolates. Although wastewater treatments proved to be effective in eliminating Salmonella spp. and in reaching WHO microbiological standards for safe use of wastewater in agriculture, they were ineffective in reducing significantly the frequency of plasmid-mediated multiple antibiotic resistance in surviving E. coli. Since multiple antibiotic-resistant bacteria carrying integrons and conjugative R plasmids can constitute a reservoir of antibiotic-resistance genes in wastewater reclaimed for irrigation, risks for public health should be considered. Bacterial strains carrying R plasmids and integrons could contaminate crops irrigated with reclaimed wastewater and transfer their resistances to the consumers' intestinal bacteria.
Assuntos
Agricultura/métodos , Farmacorresistência Bacteriana/genética , Escherichia coli/genética , Fatores R , Eliminação de Resíduos Líquidos/estatística & dados numéricos , Agricultura/estatística & dados numéricos , Humanos , Integrons , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Microbiologia da Água , Purificação da Água/métodos , Purificação da Água/estatística & dados numéricosRESUMO
Salmonella enterica serotype Muenster (hereafter referred to as S. Muenster) is rare in France and in Europe. In France, a nationwide outbreak of gastrointestinal illness due to S. Muenster occurred during March and April 2008. Twenty-five laboratory-confirmed cases of S. Muenster were documented by telephone using a trawling questionnaire. Four patients were admitted to hospital and no death was recorded. Among the 21 interviewed cases, 16 reported consumption of goat's cheese in the days prior to symptoms. The investigation incriminated goat's cheese from producer X as being the most likely source of the outbreak. S. Muenster was isolated from both cases and the incriminated goat's cheese. The pulsed-field gel electrophoresis profiles of the food isolates of producer X and the isolates from cases were indistinguishable. Following the withdrawal of the contaminated batch of cheese, the number of cases decreased to its usual level. To our knowledge, this is the first published outbreak of S. Muenster associated with food consumption in Europe.
Assuntos
Queijo/microbiologia , Surtos de Doenças , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella enterica/isolamento & purificação , Adulto , Animais , Animais Domésticos , Queijo/efeitos adversos , Criança , Eletroforese em Gel de Campo Pulsado , Feminino , Contaminação de Alimentos , França/epidemiologia , Cabras , Humanos , Masculino , Pessoa de Meia-Idade , Salmonella enterica/classificação , Sorotipagem , Inquéritos e QuestionáriosRESUMO
An outbreak of gastroenteritis involving 26 guests of a wedding dinner occurred in August 2007 in Réunion Island, a French Overseas Department. Salmonella was isolated in 61.5% of cases and the two isolates serotyped were of serovar Weltevreden. We believe this to be the first food-borne outbreak due to S. enterica serovar Weltevreden described in Réunion Island. The epidemiological and environmental investigations of this outbreak did not provide enough evidence to identify a single vehicle of infection. It is necessary to improve surveillance of salmonellosis by multidisciplinary cooperation between clinicians, epidemiologists, microbiologists and veterinarians on Réunion Island.
Assuntos
Surtos de Doenças , Infecções por Salmonella/epidemiologia , Salmonella enterica/isolamento & purificação , Adulto , Estudos de Casos e Controles , Feminino , França/epidemiologia , Humanos , Masculino , Intoxicação Alimentar por Salmonella , Infecções por Salmonella/etiologia , Infecções por Salmonella/fisiopatologiaRESUMO
Salmonella infections are caused by consumption of contaminated food, person-to-person transmission, waterborne transmission and numerous environmental and animal exposures. Specifically, reptiles and other cold blooded animals (often referred to as "exotic pets") can act as reservoirs of Salmonella, and cases of infection have been associated with direct or indirect contact with these animals. Approximately 1.4 million human cases of Salmonella infection occur each year in the United States and it has been estimated that 74,000 are a result of exposure to reptiles and amphibians. Regular case reports of reptile-associated salmonellosis in the US are available for the period 1994-2002. Cases of Salmonella infection attributed to direct or indirect contact with reptiles or other exotic pets have been described in a number of European countries, too but a more comprehensive overview of the magnitude of this problem in Europe is lacking. In total, 160,649 human cases of salmonellosis were reported in 2006 in the then 25 European Union Member States, Bulgaria, Romania, Iceland, Liechtenstein and Norway.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Vigilância da População , Répteis , Medição de Risco/métodos , Salmonelose Animal/epidemiologia , Infecções por Salmonella/epidemiologia , Animais , Europa (Continente)/epidemiologia , Humanos , Incidência , Fatores de RiscoRESUMO
Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France. At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence francaise de securite sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.
Assuntos
Surtos de Doenças , Produtos da Carne/microbiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Infecções por Salmonella/epidemiologia , Salmonella enterica , Adulto , Idoso , Animais , Surtos de Doenças/prevenção & controle , França/epidemiologia , Humanos , Produtos da Carne/análise , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/sangue , Intoxicação Alimentar por Salmonella/diagnóstico , Infecções por Salmonella/sangue , Infecções por Salmonella/diagnóstico , Salmonella enterica/isolamento & purificação , SorotipagemRESUMO
Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France. At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence française de sécurité sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.
Assuntos
Diarreia/epidemiologia , Surtos de Doenças , Infecções por Escherichia coli/complicações , Escherichia coli/isolamento & purificação , Doenças Transmitidas por Alimentos/etiologia , Síndrome Hemolítico-Urêmica/epidemiologia , Adulto , Idoso , Toxinas Bacterianas/isolamento & purificação , Diarreia/microbiologia , Resistência Microbiana a Medicamentos , Escherichia coli/classificação , Escherichia coli/genética , Infecções por Escherichia coli/diagnóstico , Feminino , França/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/microbiologia , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Inquéritos e QuestionáriosRESUMO
Shiga toxins (Stxs) are potent cytotoxins that inhibit host cell protein synthesis, leading to cell death. Classically, these toxins are associated with intestinal infections due to Stx-producing Escherichia coli or Shigella dysenteriae serotype 1, and infections with these strains can lead to haemolytic-uraemic syndrome. Over the past decade, there has been increasing recognition that Stx is produced by additional Shigella species. We recently reported the presence and expression of stx genes in Shigella flexneri 2a clinical isolates. The toxin genes were carried by a new stx-encoding bacteriophage, and infection with these strains correlated with recent travel to Haiti or the Dominican Republic. In this study, we further explored the epidemiological link to this region by utilizing the French National Reference Centre for Escherichia coli, Shigella and Salmonella collection to survey the frequency of Stx-producing Shigella species isolated from French travellers returning from the Caribbean. Approximately 21% of the isolates tested were found to encode and produce Stx. These isolates included strains of S. flexneri 2a, S. flexneri Y, and S. dysenteriae 4. All of the travellers who were infected with Stx-producing Shigella had recently travelled to Haiti, the Dominican Republic, or French Guiana. Furthermore, whole genome sequencing showed that the toxin genes were encoded by a prophage that was highly identical to the phage that we identified in our previous study. These findings demonstrate that this new stx-encoding prophage is circulating within that geographical area, has spread to other continents, and is capable of spreading to multiple Shigella serogroups.
Assuntos
Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Toxina Shiga/análise , Shigella dysenteriae/genética , Shigella flexneri/genética , Viagem , Adolescente , Adulto , Região do Caribe , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Prófagos/genética , Toxina Shiga/genética , Shigella dysenteriae/isolamento & purificação , Shigella dysenteriae/virologia , Shigella flexneri/isolamento & purificação , Shigella flexneri/virologia , Adulto JovemRESUMO
BACKGROUND: A type of neonatal cephalic pustulosis that is clinically similar to classic neonatal acne recently has been linked to Malassezia furfur infection. To correlate the mycological and clinical findings in neonates with cephalic pustulosis, we carried out a prospective case-control study in a neonatal unit from February to April 1997 using new techniques for classifying Malassezia species. OBSERVATIONS: Nineteen patients with cephalic pustulosis and 19 controls younger than 45 days were studied among 161 consecutively hospitalized infants. Cultures from swabs and smears of pustules were obtained from patients, and swabs from healthy site-matched skin were obtained from controls. Three patients were excluded from the study because another cause of pustulosis was found. A blank sampling of pustules was obtained from 2 patients. Test results for 6 of 16 patients were positive for Malassezia sympodialis on contralateral nonpustular skin, and 4 of those patients also had positive cultures for M sympodialis. Cultures from 6 to 19 controls were positive (4 for M furfur and 2 for M sympodialis). The prevalence of Malassezia species increased with age, and the severity of the pustulosis was correlated with the isolation of M sympodialis. CONCLUSION: Our data suggest that M sympodialis triggers the severe form of common cephalic pustulosis in infants with this benign disorder.