Skip to main content

Epidemiology of Mucormycosis in India


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.

This is a preview of subscription content, access via your institution.

Fig 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 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.

    PubMed  Article  Google Scholar 

  2. 2.

    Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–53.

    PubMed  Article  Google Scholar 

  3. 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 

  4. 4.

    •Rammaert B, Lanternier F, Zahar JR, et al. Healthcare-associated mucormycosis. Clin Infect Dis. 2012;54 Suppl 1:S44–54. This paper documents all healthcare procedure associated mucormycosis, which is an emerging problem in hospitals.

    PubMed  Article  Google Scholar 

  5. 5.

    Chakrabarti A, Das A, Mandal J, et al. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol. 2006;44:335–42.

    PubMed  Article  Google Scholar 

  6. 6.

    Chakrabarti A, Chatterjee SS, Das A, et al. Invasive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J. 2009;85:573–81.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Al-Ajam MR, Bizri AR, Mokhbat J, et al. Mucormycosis in the Eastern Mediterranean: a seasonal disease. Epidemiol Infect. 2006;134:341–6.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Funada H, Matsuda T. Pulmonary mucormycosis in a hematology ward. Intern Med. 1996;35:540–4.

    PubMed  Article  CAS  Google Scholar 

  9. 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 

  10. 10.

    Nithyanandam S, Jacob MS, Battu RR, et al. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol. 2003;51:231–6.

    PubMed  Google Scholar 

  11. 11.

    Chakrabarti A, Das A, Sharma A, et al. Ten years' experience in zygomycosis at a tertiary care centre in India. J Infect. 2001;42:261–6.

    PubMed  Article  CAS  Google Scholar 

  12. 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.

    PubMed  Article  Google Scholar 

  13. 13.

    Diwakar A, Dewan RK, Chowdhary A, et al. Zygomycosis–a case report and overview of the disease in India. Mycoses. 2007;50:247–54.

    PubMed  Article  Google Scholar 

  14. 14.

    Prabhu RM, Patel R. Mucormycosis and entomophthoramycosis: a review of the clinical manifestations, diagnosis and treatment. Clin Microbiol Infect. 2004;10 Suppl 1:31–47.

    PubMed  Article  Google Scholar 

  15. 15.

    Chakravarti A, Bhargava R, Bhattacharya S. Cutaneous mucormycosis of nose and facial region in children: a case series. Int J Pediatr Otorhinolaryngol. 2013;77:869–72.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Chander J, Kaur J, Attri A, et al. Primary cutaneous zygomycosis from a tertiary care centre in north-west India. Indian J Med Res. 2010;131:765–70.

    PubMed  CAS  Google Scholar 

  17. 17.

    Ramesh V, Ramam M, Capoor MR, et al. Subcutaneous zygomycosis: report of 10 cases from two institutions in North India. J Eur Acad Dermatol Venereol. 2010;24:1220–5.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Bhansali A, Bhadada S, Sharma A, et al. Presentation and outcome of rhino-orbital-cerebral mucormycosis in patients with diabetes. Postgrad Med J. 2004;80:670–4.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Godara SM, Kute VB, Goplani KR, et al. Mucormycosis in renal transplant recipients: predictors and outcome. Saudi J Kidney Dis Transpl. 2011;22:751–6.

    PubMed  CAS  Google Scholar 

  20. 20.

    Patra S, Vij M, Chirla DK, et al. Unsuspected invasive neonatal gastrointestinal mucormycosis: a clinicopathological study of six cases from a tertiary care hospital. J Indian Assoc Pediatr Surg. 2012;17:153–6.

    PubMed  Article  Google Scholar 

  21. 21.

    Yamazaki T, Kume H, Murase S, et al. Epidemiology of visceral mycoses: analysis of data in annual of the pathological autopsy cases in Japan. J Clin Microbiol. 1999;37:1732–8.

    PubMed  CAS  Google Scholar 

  22. 22.

    Chamilos G, Luna M, Lewis RE, et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica. 2006;91:986–9.

    PubMed  Google Scholar 

  23. 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.

  24. 24.

    Bitar D, Van Cauteren D, Lanternier F, et al. Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006. Emerg Infect Dis. 2009;15:1395–401.

    PubMed  Article  Google Scholar 

  25. 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. 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 

  27. 27.

    Stelzmueller I, Lass-Floerl C, Geltner C, et al. Zygomycosis and other rare filamentous fungal infections in solid organ transplant recipients. Transpl Int. 2008;21:534–46.

    PubMed  Article  Google Scholar 

  28. 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.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Saegeman V, Maertens J, Meersseman W, et al. Increasing incidence of mucormycosis in University Hospital, Belgium. Emerg Infect Dis. 2010;16:1456–8.

    PubMed  Article  Google Scholar 

  30. 30.

    Pagano L, Valentini CG, Posteraro B, et al. Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology). J Chemother. 2009;21:322–9.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Kontoyiannis DP. Decrease in the number of reported cases of zygomycosis among patients with diabetes mellitus: a hypothesis. Clin Infect Dis. 2007;44:1089–90.

    PubMed  Article  Google Scholar 

  32. 32.

    The IDF Diabetes Atlas. 4th ed. Brussels: International Diabetes Federation; 2009.

  33. 33.

    Ingram CW, Sennesh J, Cooper JN, et al. Disseminated zygomycosis: report of four cases and review. Rev Infect Dis. 1989;11:741–54.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Weng DE, Wilson WH, Little R, et al. Successful medical management of isolated renal zygomycosis: case report and review. Clin Infect Dis. 1998;26:601–5.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Chugh KS, Sakhuja V, Gupta KL, et al. Renal mucormycosis: computerized tomographic findings and their diagnostic significance. Am J Kidney Dis. 1993;22:393–7.

    PubMed  CAS  Google Scholar 

  36. 36.

    Gupta KL, Radotra BD, Sakhuja V, et al. Mucormycosis in patients with renal failure. Ren Fail. 1989;11:195–9.

    PubMed  Article  Google Scholar 

  37. 37.

    Gupta KL, Joshi K, Sud K, et al. Renal zygomycosis: an under-diagnosed cause of acute renal failure. Nephrol Dial Transplant. 1999;14:2720–5.

    PubMed  Article  CAS  Google Scholar 

  38. 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 

  39. 39.

    Singh SK, Wadhwa P, Sakhuja V. Isolated bilateral renal mucormycosis. Urology. 2004;63:979–80.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Sharma R, Shivanand G, Kumar R, et al. Isolated renal mucormycosis: an unusual cause of acute renal infarction in a boy with aplastic anaemia. Br J Radiol. 2006;79:e19–21.

    PubMed  Article  CAS  Google Scholar 

  41. 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 

  42. 42.

    Dhua AK, Sinha S, Sarin YK, et al. Isolated mucormycosis in a post-pyeloplasty kidney in an immuno-competent child. J Indian Assoc Pediatr Surg. 2012;17:132–4.

    PubMed  Article  Google Scholar 

  43. 43.

    Khandelwal D, Gadodia A, Sood R, et al. Disseminated zygomycosis with renal involvement simulating malignancy in a diabetic patient. Indian J Urol. 2012;28:347–9.

    PubMed  Article  Google Scholar 

  44. 44.

    Jianhong L, Xianliang H, Xuewu J. Isolated renal mucormycosis in children. J Urol. 2004;171:387–8.

    PubMed  Article  Google Scholar 

  45. 45.

    Lin CY, Lee SC, Lin CC, et al. Isolated fatal renal mucormycosis in a patient with chronic obstructive pulmonary disease and tuberculosis. Int J Clin Pract. 2003;57:916–8.

    PubMed  CAS  Google Scholar 

  46. 46.

    Yu J, Li RY. Primary renal zygomycosis due to Rhizopus oryzae. Med Mycol. 2006;44:461–6.

    Google Scholar 

  47. 47.

    Gupta KL, Khullar DK, Behera D, et al. Pulmonary mucormycosis presenting as fatal massive haemoptysis in a renal transplant recipient. Nephrol Dial Transplant. 1998;13:3258–60.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Gupta K, Nada R, Joshi K, et al. Can ascending infection from bladder serve as the portal of entry for primary renal zygomycosis? Mycopathologia. 2010;170:357–60.

    PubMed  Article  Google Scholar 

  49. 49.

    Misra PC, Srivastava KJ, Lata K. Apophysomyces, a new genus of the Mucorales. Mycotaxon. 1979;8:377–82.

    Google Scholar 

  50. 50.

    Meis JF, Chakrabarti A. Changing epidemiology of an emerging infection: zygomycosis. Clin Microbiol Infect. 2009;15 Suppl 5:10–4.

    PubMed  Article  Google Scholar 

  51. 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. 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.

  53. 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. 54.

    Padhye AA, Ajello L. Simple method of inducing sporulation by Apophysomyces elegans and Saksenaea vasiformis. J Clin Microbiol. 1988;26:1861–3.

  55. 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. 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. 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. 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 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

A Chakrabarti declares no conflicts of interest.

M Dhaliwal declares no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information



Corresponding author

Correspondence to Arunaloke Chakrabarti.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chakrabarti, A., Dhaliwal, M. Epidemiology of Mucormycosis in India. Curr Fungal Infect Rep 7, 287–292 (2013).

Download citation


  • Mucormycosis
  • Zygomycosis
  • Epidemiology
  • Diabetes
  • Renal disease
  • Mucoraceous fungi
  • Apophysomyces elegans
  • Rhizopus
  • Nosocomial
  • Transplant
  • Hematology
  • Immunocompetent host
  • Computational model