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.