Mucormycosis: Emerging and devastating fungal infection, continuing further one-year experience from tertiary care hospital, northern India

Author:

J Chander1, N Singla1, N Gulati1, A Bhagat1, G Dhanda1, RPS Punia2, D Aggarwal3,
AK Attri4, A Dass5

Author address:

1Microbiology, Government Medical College Hospital, Chandigarh, India
2Pathology, Government Medical College Hospital, Chandigarh, India
3Pulmonary Medicine, Government Medical College Hospital, Chandigarh, India
4General Surgery, Government Medical College Hospital, Chandigarh, India
5Otorhinolaryngology, Government Medical College Hospital, Chandigarh, India

Full conference title:

9th Advances Against Aspergillosis

Date: 26 February 2020

Abstract:

Purpose: Mucormycosis is an acute angioinvasive emerging and devastating infection caused by fungi belonging to Order Mucorales. This is the third most common opportunistic fungal infection after candidiasis and aspergillosis. It is categorized into six clinical types: rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, disseminated and isolated renal mucormycosis. The fast-growing aseptate hyphae being angioinvasive, invade blood vessels entailing infarction and necrosis. In developing countries like India, it is seen mainly in patients with uncontrolled diabetes mellitus, unlike developed countries where it is seen among patients with underlying hematological malignancies. The study was conducted over a period of one year from November 1, 2018 to October 31, 2019 to understand the extent of clinico-epidemiological profile of further continuing over the ongoing disease in a tertiary care north Indian hospital.

Methods: Among the suspected mucormycosis patients, nasal crust in rhino-orbito-cerebral, sputum/BAL in pulmonary, necrotic tissue in cutaneous, anterior chamber aspirate in ocular and stomach biopsy in gastrointestinal infection were processed for mycological etiology. The direct demonstration of fungus was done by KOH/CFW wet mounts. Histopathology was done by H&E, PAS and GMS stainings. Fungal culture was done on SDA, blood agar, BHIA as per standard mycological protocol. Morphological identification was done by lactophenol cotton blue mount. Further identification of isolates was done by sequencing of ITS region, comparing with those of type strains. Antifungal susceptibility testing was performed for amphotericin B, posaconazole, itraconazole and terbinafine as per the CLSI M38-A2 document.

Results: A total of 32 cases of mucormycosis were reported during this one-year period. Of these, 22  were males and 10 were females patients. Most common presentation was rhino-orbito-cerebral (12), followed by cutaneous (10), pulmonary (8), ocular (1) and gastric (1). Diabetes mellitus was the underlying risk factor in eleven cases of rhino-orbito-cerebral; while only DM (4), DM with trauma (1), bedridden with pelvic fracture (1) were the risk factors in cutaneous. In pulmonary disease the risk factor was diabetes mellitus (5). The sole gastric patient was also having diabetes mellitus. Isolates identified were Rhizopus arrhizus (6) and Apophysomyces variabilis (2) in rhino-orbito-cerebral infection; A. variabilis (4), Rhizopus homothallicus (1), Mucor indicus (1) in cutaneous infection and R. homothallicus (1), R. arrhizus (1), Lichtheimia corymbifera (1) in pulmonary mucormycosis. A solitary case of ocular mucormycosis was seen in diabetic patient. All patients were treated with liposomal amphotericin B with extensive surgical debridement. On AFST of total 17 isolates, amphotericin B was the most sensitive drug and posaconazole was judged as the next best agent for salvage therapy.

Conclusion: Mucormycosis is a growing menace in tropical country like India, which provides potential environmental niche for the survival of these fungi. Now, India is being termed as the diabetic capital of the world with an exponential increase in susceptible population, mucormycosis is also being encountered at an alarmingly increasing level. It is a life-threatening condition invariably proves to be fatal in a short span of time. Hence an early diagnosis, reversal of underlying risk factors, prompt institution of appropriate antifungal therapy and extensive surgical debridement are the key maneuvers for an apt management. The battle with this dreaded infection continues and should never be given up to save the population at risk.

 

Abstract Number: 61

Link to conference website:

Link Conference abstract: 

AAAM 2020

Conference abstracts, posters & presentations

Showing 10 posts of 17325 posts found.

  • Title

    Author

    Year

    Number

    Poster