Mucormycosis - 21 month, 12 centre prospective study in India finds 52% mortality
March 09 2020
Mucormycosis is probably more common in India than elsewhere, partly attributable to uncontrolled diabetes. Dr Patel and colleagues found 465 cases in a 21 month period in 12 medical centres throughout India (Ahmedabad, Delhi, Chandigarh, Vellore, Bangalore, Chennai, Hyderabad and Ludhiana). Rhino-orbital mucormycosis was the most common form of disease (315/465, 67.7%) followed by pulmonary involvement (62/465, 13.3%). Cutaneous mucormycosis (49/465, 10.5%), was related to trauma in 53% of cases. Diabetes was the most important underlying condition (74%) and was uncontrolled in 82% (diabetic ketoacidosis in 15%).
Diagnosis was achieved on direct microscopy in 87%, with culture in 62% and by histopathology in 73%. Rhizopus arrhizus and Apophysomyces variabilis were the most common cultured pathogens.
Mortality was 52% over 90 days and factors associated with death on multivariate analysis included disseminated mucormycosis, rhino-orbital disease with cerebral extension, a shorter duration of symptoms, a shorter duration of antifungal therapy and treatment with conventional amphotericin B (versus liposomal). Combined medical and surgical management was associated with better survival.