Abstract
Mucormycosis is an emerging opportunistic fungal infection. Increasing immunocompromization, widespread use of antibacterial and antifungal agents (such as voriconazole prophylaxis), carcinomas, transplantation and lifestyle diseases such as diabetes are the main contributors to this situation. The predominant clinical manifestations of mucormycosis vary from host to host, with rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal infections being the most common. In India, the prevalence of mucormycosis is approximately 0.14 cases/1000 population, which is about 70 times the worldwide-estimated rate for mucormycosis. The present study was undertaken over a period of five years (January 2009–December 2014) to determine the prevalence of mucormycosis. The samples suspected of mucormycosis were examined by direct KOH wet mount and cultured on Sabouraud’s dextrose agar without actidione and on blood agar as per standard mycological techniques. Histopathological correlation was done for most of the cases. Antifungal susceptibility testing was performed by the EUCAST reference method. We identified a total of 82 cases of mucormycosis out of a total of 6365 samples received for mycological culture and examination during the said time period. Out of these, 56 were male patients and 27 were females. Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections. The fungi isolated were Rhizopus arrhizus (17), Apophysomyces variabilis (12), R. microsporus (9), Lichtheimia ramosa (8), Saksenaea erythrospora (5), Syncephalastrum racemosus (4), R. homothallicus (2), Rhizomucor pusillus (1), Mucor irregularis (1) and A. elegans (1). The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. Most of the patients (50) recovered, but 25 died. The rest of the patients left against medical advice. “Nip in the Bud” should be the mantra for clinicians/surgeons for a favorable prognosis. Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management.
Highlights
Mucorales are ubiquitous fungi and are commonly found in decaying organic matter
Over a study period of five years, a total of 82 patients were diagnosed to be suffering from mucormycosis based on microbiological and/or histopathological examination (HPE) of the clinical samples
Rhizopus was the genus most commonly isolated from the patients and most recognized in our study, R. arrhizus being the species most common, other species of the genus, such as
Summary
Mucorales are ubiquitous fungi and are commonly found in decaying organic matter. They have been isolated in the laboratories as contaminants for a long time. Changing host environments are causing their emergence as potential pathogenic organisms leading to high morbidity and very high and quick mortality. The disease caused by them has been reported all over the world and associated with immunocompromization states like carcinomas or immunosuppressive therapy, it affects a newer range of susceptible hosts like diabetics, neutropenics, patients on desferroxamine therapy, etc. Chakrabarti et al have estimated a prevalence of 0.14 per 1000 cases of diabetics in India, which is about 80 times the prevalence of mucormycosis in developed countries. If we consider that currently the number of diabetics in India is nearly 62 million and they are likely to cross the 100 million mark by 2030, the burden of mucormycosis in India in future can be well imagined [2]
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