First case of neonatal bloodstream infection caused by Malassezia furfur in mainland China diagnosed via metagenomic next-generation sequencing: A case report.

The present study reports, to the best of our knowledge, the first case of neonatal bloodstream infection caused by Malassezia furfur in mainland China identified using metagenomic next-generation sequencing (mNGS). Traditional microbiological methods have failed to identify causative organisms, highlighting the diagnostic limitations of neonatal sepsis with atypical presentations. Using this case as a clinical entry point, a systematic review was conducted to consolidate the epidemiological, clinical and prognostic characteristics of previously reported neonatal Malassezia infections and critically evaluate current diagnostic challenges. This case suggests the need to expand the pathogen spectrum of neonatal sepsis, particularly among extremely preterm and extremely low-birth-weight infants. Furthermore, it demonstrates the transformative potential of mNGS as an adjunctive diagnostic modality capable of identifying rare, fastidious organisms that evade conventional detection. Integrating mNGS into routine clinical workflows may not only facilitate early and precise pathogen identification but also redefine clinical decision-making paradigms in neonatal infectious disease management.