title: The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus.
abstract: Zygomycosis is an emerging infection worldwide. A study was conducted to understand its spectrum in the Indian scenario. All patients diagnosed for invasive zygomycosis at a tertiary care center in north India from 2000-2004, were retrospectively analyzed. A total of 178 cases (mean average of 35.6 cases/year) of zygomycosis were diagnosed. Rhino-orbito-cerebral type (54.5%) was the commonest presentation followed by cutaneous (14.6%), disseminated (9.0%), and gastrointestinal (8.4%) zygomycosis. Renal and pulmonary zygomycosis were seen in 6.7% patients each. Uncontrolled diabetes mellitus (in 73.6% of cases) was the significant risk factor in all types (Odds Ratio 1.5-8.0) except renal zygomycosis. Breach of skin was the risk factor in 46.2% patients with cutaneous zygomycosis. However, no risk factor could be detected in 11.8% patients. Antemortem diagnosis was possible in 83.7% cases. The commonest (61.5%) isolate was Rhizopus oryzae followed by Apophysomyces elegans in 27% patients. Combination of debridement surgery and amphotericin B therapy was significantly better in survival of the patients (P<0.005) than amphotericin B alone (79.6% vs. 51.7% survival). Thus, a rising trend of invasive zygomycosis was observed in patients with uncontrolled diabetes mellitus in India. Consistent diagnosis of renal zygomycosis in apparently healthy hosts and the emergence of A. elegans in India demand further study.
authors.affiliation: Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. chakrab@sancharnet.in
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Ashim
authors.initials: A
authors.lastname: Das
authors.forename: Jharna
authors.initials: J
authors.lastname: Mandal
authors.forename: M R
authors.initials: MR
authors.lastname: Shivaprakash
authors.forename: Varghese K
authors.initials: VK
authors.lastname: George
authors.forename: Bansidhar
authors.initials: B
authors.lastname: Tarai
authors.forename: Pooja
authors.initials: P
authors.lastname: Rao
authors.forename: Naresh
authors.initials: N
authors.lastname: Panda
authors.forename: Subhash C
authors.initials: SC
authors.lastname: Verma
authors.forename: Vinay
authors.initials: V
authors.lastname: Sakhuja
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D012233:Rhizopus / Q000302:isolation & purification; D012307:Risk Factors; D020096:Zygomycosis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy