Epidemiology of Mucormycosis in India
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Mucormycosis is an emerging healthcare problem in the Indian population. The epidemiology of the disease is distinct with very high incidence among uncontrolled diabetics. The patients present commonly as rhino-orbito-cerebral mucormycosis, which is easy to diagnose. But, the mortality rate remains high (nearly 50 %), as the patients attend the healthcare facility late in the course of the disease after extensive spread of infection. Isolated renal mucormycosis in young apparently healthy individuals is a new form of the disease. The spectrum of etiological agents causing mucormycosis is also unique as Apophysomyces elegans is the second most common pathogen after Rhizopus oryzae. Many new agents are identified causing the disease.
KeywordsMucormycosis Zygomycosis Epidemiology Diabetes Renal disease Mucoraceous fungi Apophysomyces elegans Rhizopus Nosocomial Transplant Hematology Immunocompetent host Computational model
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A Chakrabarti declares no conflicts of interest.
M Dhaliwal declares no conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.•• Petrikkos G, Skiada A, Lortholary O, et al. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis. 2012;54 Suppl 1:S23–34. This review details the emerging epidemiology and the clinical forms of mucormycosis and highlights the difference of epidemiology between the two regions.PubMedCrossRefGoogle Scholar
- 3.Sugar AM. Agents of mucormycosis and related species. In: Mandell G, Bennett J, Dolin R, editors. Principles and practices of infectious diseases. 4th ed. New York: Churchill Livingstone; 1995. p. 2311–21.Google Scholar
- 9.Shpitzer T, Keller N, Wolf M, et al. Seasonal variations in rhino-cerebral Mucor infection. Ann Otol Rhinol Laryngol. 2005;114:695–8.Google Scholar
- 12.•• Marak RS, Misra R, Ansari MS, et al. Successful medical management of renal zygomycosis: a summary of two cases and a review of the Indian literature. Med Mycol. 2010;48:1088–95. This review deals with isolated renal mucormycosis problem, its epidemiology, diagnosis and management.PubMedCrossRefGoogle Scholar
- 23.• Chakrabarti A, Sood P, Denning D. Estimating fungal infection burden in India using computational models: Mucormycosis burden as a case study [Poster number 1044]. Presented at the 23rd ECCMID conference. Berlin, Germany; April 27–30, 2013. This poster elucidates mucormycosis burden in India using a contextual computational model.Google Scholar
- 25.Kontoyiannis DP, Lionakis MS, Lewis RE, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005;191:1350–60.Google Scholar
- 26.Husain S, Alexander BD, Munoz P, et al. Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi. Clin Infect Dis. 2003;37:221–9.Google Scholar
- 28.• Skiada A, Pagano L, Groll A, et al. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect. 2011;17:1859–67. This paper highlights the epidemiology of mucormycosis in Europe.PubMedCrossRefGoogle Scholar
- 32.The IDF Diabetes Atlas. 4th ed. Brussels: International Diabetes Federation; 2009.Google Scholar
- 38.Chakrabarti A, Ghosh A, Prasad GS, et al. Apophysomyces elegans: an emerging zygomycete in India. J Clin Microbiol. 2003;41:783–8.Google Scholar
- 41.Thomas AJ, Shah S, Mathews MS, et al. Apophysomyces elegans - renal mucormycosis in a healthy host: a case report from south India. Indian J Med Microbiol. 2008;26:269–71.Google Scholar
- 46.Yu J, Li RY. Primary renal zygomycosis due to Rhizopus oryzae. Med Mycol. 2006;44:461–6.Google Scholar
- 49.Misra PC, Srivastava KJ, Lata K. Apophysomyces, a new genus of the Mucorales. Mycotaxon. 1979;8:377–82.Google Scholar
- 51.Cooter RD, Lim IS, Ellis DH, et al. Burn wound zygomycosis caused by Apophysomyces elegans. J Clin Microbiol. 1990;28:2151–3.Google Scholar
- 52.•• Chakrabarti A, Shivaprakash MR, Curfs-Breuker I, et al. Apophysomyces elegans: epidemiology, amplified fragment length polymorphism typing, and in vitro antifungal susceptibility pattern. J Clin Microbiol. 2010;48:4580–5. This is a detailed study on the strain typing, in-vitro antifungal susceptibility and clinical manifestations of the diseases caused by Apophysomyces elegans in India.Google Scholar
- 53.Alvarez E, Stchigel AM, Cano J, et al. Molecular phylogenetic diversity of the emerging mucoralean fungus Apophysomyces: proposal of three new species. Rev Iberoam Micol. 2010;27:80–9.Google Scholar
- 54.Padhye AA, Ajello L. Simple method of inducing sporulation by Apophysomyces elegans and Saksenaea vasiformis. J Clin Microbiol. 1988;26:1861–3.Google Scholar
- 55.Chakrabarti A, Marak RS, Shivaprakash MR, et al. Cavitary pulmonary zygomycosis caused by Rhizopus homothallicus. J Clin Microbiol. 2010;48:1965–9.Google Scholar
- 56.Hemashettar BM, Patil RN, O'Donnell K, et al. Chronic rhinofacial mucormycosis caused by Mucor irregularis (Rhizomucor variabilis) in India. J Clin Microbiol. 2011;49:2372–5.Google Scholar
- 57.Sivakumar S, Mathews MS, George B. Cunninghamella pneumonia in postbone marrow transplant patient: first case report from India. Mycoses. 2005;48:360–2.Google Scholar
- 58.Xess I, Mohapatra S, Shivaprakash MR, et al. Evidence implicating Thamnostylum lucknowense as an etiological agent of rhino-orbital mucormycosis. J Clin Microbiol. 2012;50:1491–4.Google Scholar