title: A prospective study of mucormycosis in north India: experience from a tertiary care hospital.
abstract: Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 μg/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC- 0.25 to >8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease.
authors.affiliation: Department of Microbiology, Government Medical College Hospital, Chandigarh, India. drkiran.dks@gmail.com.
authors.forename: Kiran
authors.initials: K
authors.lastname: Bala
authors.affiliation: Department of Microbiology, Government Medical College Hospital, Chandigarh, India.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chander
authors.affiliation: Department of Pathology, Government Medical College Hospital, Chandigarh, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Handa
authors.affiliation: Department of Pathology, Government Medical College Hospital, Chandigarh, India.
authors.forename: Rajpal Singh
authors.initials: RS
authors.lastname: Punia
authors.affiliation: Department of General Surgery, Government Medical College Hospital, Chandigarh, India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Attri
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D009090:Mucorales / Q000145:classification / Q000302:isolation & purification*; D009091:Mucormycosis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Amphotericin B; Apophysomyces; Diabetes mellitus; Mucormycosis; Rhizopus