Saline‐Filled Breast Implant Contamination with<i>Curvularia</i>Species among Women Who Underwent Cosmetic Breast Augmentation

Kainer, Marion A.; Keshavarz, Homa; Jensen, Bette; Arduino, Matthew J.; Brandt, Mary E.; Padhye, A. A.; Jarvis, William R.; Archibald, Lennox K.

doi:10.1086/430613

Cited by 26 publications

(10 citation statements)

References 10 publications

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“…Curvularia species are common in dead plant material and may cause a variety of human mycoses, including fungal keratitis, invasive sinusitis (215), onychomycosis, black grain eumycotic mycetoma (378), endocarditis (104), subcutaneous disease (813), and peritonitis (98,241,631) as well as systemic infections (175,177). Additional reports involved fatal cerebral phaeohyphomycosis in an immunocompetent individual (121), endophthalmitis (579), and contaminated salinefilled breast implants (392). Clinical isolates include C. geniculata, C. lunata, C. pallescens, C. senegalensis, C. brachyspora, C. clavata, C. verruculosa, and C. inaequalis (Fig.…”

Section: Pleosporalesmentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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Section: Pleosporalesmentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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“…Our preliminary results based on sequencing of seven isolates not related to the outbreak suggest that diversity is readily identifiable in genome analysis of background isolates. Specifically, the two most closely related strains, B6177 and B6171, both recovered from an outbreak in Alabama (23), are separated from each other by 20,043 SNPs, which is considerably higher than the 0 to 2 SNPs separating any two of the outbreak strains. However, more data are needed to assess the genetic diversity among other strains of E. rostratum in the environment.…”

Section: Discussionmentioning

confidence: 88%

“…Seven unrelated E. rostratum isolates from the culture collection of the Centers for Disease Control (CDC) were used as controls. Some of these isolates were previously described (23). All isolates were identified to species by microscopic examination and DNA sequencing as previously described (8).…”

Section: Methodsmentioning

confidence: 99%

Whole-Genome Analysis of Exserohilum rostratum from an Outbreak of Fungal Meningitis and Other Infections

et al. 2014

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Exserohilum rostratum was the cause of most cases of fungal meningitis and other infections associated with the injection of contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC). Until this outbreak, very few human cases of Exserohilum infection had been reported, and very little was known about this dematiaceous fungus, which usually infects plants. Here, we report using whole-genome sequencing (WGS) for the detection of single nucleotide polymorphisms (SNPs) and phylogenetic analysis to investigate the molecular origin of the outbreak using 22 isolates of E. rostratum retrieved from 19 case patients with meningitis or epidural/spinal abscesses, 6 isolates from contaminated NECC vials, and 7 isolates unrelated to the outbreak. Our analysis indicates that all 28 isolates associated with the outbreak had nearly identical genomes of 33.8 Mb. A total of 8 SNPs were detected among the outbreak genomes, with no more than 2 SNPs separating any 2 of the 28 genomes. The outbreak genomes were separated from the next most closely related control strain by ϳ136,000 SNPs. We also observed significant genomic variability among strains unrelated to the outbreak, which may suggest the possibility of cryptic speciation in E. rostratum. Beginning in September, 2012, the United States experienced one of the largest outbreaks of health care-associated infections ever reported. More than 13,000 people were exposed to three lots of contaminated methylprednisolone acetate (MPA) produced by a single compounding pharmacy, and Ͼ750 developed fungal infections following their MPA injections (1-3). Infections included meningitis, as well as localized epidural, paraspinal, and peripheral joint infections, complicated by arachnoiditis and abscess formation (4, 5). Although several fungal species were implicated in the outbreak, the vast majority of infections were caused by Exserohilum rostratum, a saprobic mold found in soil and plant debris worldwide (2, 6-10). Most species of Exserohilum are plant pathogens. Exserohilum rostratum and the species formerly known as Exserohilum longirostratum and Exserohilum mcginnisii are morphologically similar and are the only species known to cause human infections; however, their taxonomic status remains under investigation (11-13).DNA fingerprinting has been used as an epidemiological tool to answer questions pertaining to strain relatedness (14, 15). However, no methodologies for DNA fingerprinting of E. rostratum existed at the time of the outbreak. While whole-genome sequencing (WGS) is a relatively new tool of molecular epidemiology, it has quickly been embraced as a mechanism for inferring phylogenetic relationships among organisms. This has translated to the recent use of whole-genome single nucleotide polymorphism (SNP) typing (whole-genome sequence typing [WGST]) as a mechanism for inferring relatedness of both bacteria (16)(17)(18)(19) and fungi (20, 21) during outbreak investigations. One of the benefits of WGST is that prior knowledge of the genome i...

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“…In several reports, the rate of such frustrating complications has been presented as 30% of cases. 5 According to Wright et al's study, the first reported fungal infection was on a saline field prosthesis in the subpectoral area. Curvularia spp was cultured in the prosthesis fluid when it was removed.…”

Section: Discussionmentioning

confidence: 99%

“…He concluded that operating room equipment defects, poor ventilation, use of an open system during saline injection into the prosthesis, and finally the long operative time were the possible underlying causes for this outbreak. 5 Ulrik and Matzen, besides investigating the physical structure of the tissue expanders, concentrated on the probable leakage location of the tissue expanders. Their study showed that when entering the needle into the port, if the injection needle does not enter from the port's apex and the injection is performed with an oblique approach, there is a probability that the unilateral opening would not function properly and that this would lead to fluid return from inside out.…”

Section: Discussionmentioning

confidence: 99%

Fungal Colonization Within A Tissue Expander

Motamedoshariati

2012

Annals of Plastic Surgery

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Fungal contamination derived from prosthetic substances is not common, although because of the following reasons the number of cases has increased in the recent years: increased life expectancy, and therefore a greater number of surgical candidates; higher rates of underlying diseases, which are accompanied by immunosuppressive disorders that can cause a higher susceptibility for such infections. Most reports of infection in breast prosthesis and tissue expanders are bacterial infections, and fungi cases are still rare. Hereby, we report a case of Aspergillus colonization in a tissue expander of a patient with an old burn scar. This fungal growth inside saline-filled tissue expander was asymptomatic and not troublesome. It also caused no changes in the patient's treatment course.

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Saline‐Filled Breast Implant Contamination withCurvulariaSpecies among Women Who Underwent Cosmetic Breast Augmentation

Abstract: Surgeons should always use closed systems to inflate breast implants. Surgery center infection control measures must include moisture control and balanced ventilation systems.

Cited by 26 publications

References 10 publications

Melanized Fungi in Human Disease

Melanized Fungi in Human Disease

Whole-Genome Analysis of Exserohilum rostratum from an Outbreak of Fungal Meningitis and Other Infections

Fungal Colonization Within A Tissue Expander

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