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J. Fungi 2018, 4(2), 46; https://doi.org/10.3390/jof4020046

Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India

1
Departments of Microbiology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India
2
Pathology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India
3
Otorhinolaryngology, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India
4
General Surgery, Government Medical College Hospital, Sector 32-B, Chandigarh, PIN 160030, India
5
Mycology Reference Laboratory, Spanish National Center for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
6
Mycology Unit, Medical School and IISPV, Universitat Rovira I Virgili, 43201 Reus, Spain
*
Author to whom correspondence should be addressed.
Received: 15 March 2018 / Revised: 31 March 2018 / Accepted: 2 April 2018 / Published: 6 April 2018
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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. View Full-Text
Keywords: Mucormycosis; Rhizopus; Saksenaea; Apophysomyces; Lichtheimia Mucormycosis; Rhizopus; Saksenaea; Apophysomyces; Lichtheimia
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Chander, J.; Kaur, M.; Singla, N.; Punia, R.P.S.; Singhal, S.K.; Attri, A.K.; Alastruey-Izquierdo, A.; Stchigel, A.M.; Cano-Lira, J.F.; Guarro, J. Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India. J. Fungi 2018, 4, 46.

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