A Rare Fungal Species, Quambalaria cyanescens, Isolated from a Patient after Augmentation Mammoplasty – Environmental Contaminant or Pathogen?

Abstract

Some emerging but less common human fungal pathogens are known environmental species and could be of low virulence. Meanwhile, some species have natural antifungal drug resistance, which may pose significant clinical diagnosis and treatment challenges. Implant breast augmentation is one of the most frequently performed surgical procedures in China, and fungal infection of breast implants is considered rare. Here we report the isolation of a rare human fungal species, Quambalaria cyanescens, from a female patient in China. The patient had undergone bilateral augmentation mammoplasty 11 years ago and was admitted to Peking Union Medical College Hospital on 15 September 2011 with primary diagnosis of breast infection. She underwent surgery to remove the implant and fully recovered thereafter. During surgery, implants and surrounding tissues were removed and sent for histopathology and microbiology examination. Our careful review showed that there was no solid histopathologic evidence of infection apart from inflammation. However, a fungal strain, which was initially misidentified as “Candida tropicalis” because of the similar appearance on CHROMagar Candida, was recovered. The organism was later on re-identified as Q. cyanescens, based on sequencing of the rDNA internal transcribed spacer region rather than the D1/D2 domain of 26S rDNA. It exhibited high MICs to 5-flucytosine and all echinocandins, but appeared more susceptible to amphotericin B and azoles tested. The possible pathogenic role of Q. cyanescens in breast implants is discussed in this case, and the increased potential for misidentification of the isolate is a cause for concern as it may lead to inappropriate antifungal treatment.

Identification and Characterization of a Rare Fungus, Quambalaria cyanescens, Isolated from the Peritoneal Fluid of a Patient after Nocturnal Intermittent Peritoneal Dialysis

“…Q . cyanescens was also reported as an environmental contaminant associated with pseudoepidemic nosocomial pneumonia [ 14 ], and this rare fungus was recently recovered from a female patient after augmentation mammoplasty [ 16 ].…”

Mycological Diversity Description I

“…Quambalaria pusilla is the only species without DNA data available (Beer et al 2006), but it differs morphologically from Q. fabacearum mainly in the size of the conidiophores (5-25 × 1-2 µm), and primary (4-10 × 1-2 µm) and secondary conidia (1.5-3.5 × 0.5-1.5 µm) (Braun 1998). Besides species of Quambalaria being reported as pathogenic to plants, Q. cyanescens is the only species thus far to be associated with human infections, although they are believed to be opportunistic infections, or as a environmental contaminant (Hoog & Vries 1973;Fan et al 2014). Quambalaria fabacearum is reported here as endophyte, representing the first record from Fabaceae.…”

Microbial biodiscovery: Exploring venomous animal associated microbes as sources of new chemical diversity

“…(CMB-W001) indicated a high similarity with Quambalaria cyanescens strains U100 and U105, which were isolated from beetles. 228 The isolation of a rare fungal strain from wasp with taxonomic links to a rare fungus recovered from insects prompted us to undertake a chemical investigation of 230 Quambalaria cyanescens has been isolated from various sources such as plants, 231 from clinical samples 228 and bark beetles. 232 In clinical samples Quambalaria cyanescens was initially regarded as an opportunistic pathogen, however studies have not confirmed a direct correlation between infection and the fungus.…”

“…232 In clinical samples Quambalaria cyanescens was initially regarded as an opportunistic pathogen, however studies have not confirmed a direct correlation between infection and the fungus. 228 Interestingly, Quambalaria cyanescens has been found in association with different species of beetles around the World including U.S.A, Turkey, Hungary, Bulgaria and Spain. 228 Quambalaria cyanescens has also been isolated from trees of Corymbia spp.…”

“…228 Interestingly, Quambalaria cyanescens has been found in association with different species of beetles around the World including U.S.A, Turkey, Hungary, Bulgaria and Spain. 228 Quambalaria cyanescens has also been isolated from trees of Corymbia spp. in Australia (Table 6.1).…”