Deep mycoses in India. A critical review.

Abstract

Available published reports on deep mycoses in India have been critically and exhaustively reviewed. So far there seem to be only 9 cases of actinomycosis reported, mostly of thoracic type and diagnosed on the basis of the presence of “sulphur granules” in the lesions. Nocardiosis and its chief causal agentNocardia asteroides have received particular attention in recent studies. To-date there are 18 authentic cases reported from India and significantly 12 of these have been diagnosed by applying the paraffin bait technique to the isolation ofN. asteroides from sputa and other clinical specimens. In most of these 12 cases timely diagnosis allowed for the successful treatment of the disease with heavy doses of sulphadiazine. Case reports on cryptococcosis which include 26 adequately documented cases, have been published from various parts of the country. Occurrence ofCryptococcus neoformans in soil and its association with old pigeon excreta have also been confirmed by studies done in some northern and western regions of this country. The status of histoplasmosis in India still remains a debatable subject although there is a suggestive evidence that the disease may be endemic in the northeastern parts. There are 9 case reports in which diagnosis has been supported by histopathologic findings and in 3 cultures have also been positive. However, attempts to isolateHistoplasma capsulatum from soil or any other extra-human source have remained futile and the limited surveys have revealed only low skin sensitivity to histoplasmin and none to blastomycin and coccidioidin. As yet there is no authentic case of blastomycosis, coccidioidomycosis or paracoccidioidomycosis reported from India. Two cases of invasive aspergillosis and 6 of bronchopulmonary aspergillomas have been published. In the latterAspergillus fumigatus, A. niger andA. flavus have been found to be the aetiologic agents. In addition, a recent report on a series of 8 patients recognises for the first time the occurrence of allergic aspergillosis in this country. Two cases of phycomycoses, involving the lungs in one and brain in the other case have been described. Diagnosis of bronchopulmonary candidiasis has been claimed in as many as 16 patients by several authors but in none the evidence is unequivocal. The isolation ofCandida viswanathii from the cerebrospinal fluid of two fatal cases is suggestive of the possible aetiologic role of this new yeast in human meningitis. Besides, there are 3 cases of brain mycoses described in Indian literature, two due toCladosporium trichoides while in the third caseUstilago maydis, the causal agent of maize smut, has been implicated.