A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India

Patel, Atul; Kaur, Harsimran; Xess, Immaculata; Michael, Joy S.; Savio, Jayanthi; Rudramurthy, Shivaprakash M; Singh, Rakesh; Shastri, Prakash; Umabala, P; Sardana, Raman; Kindo, Anupama Jyoti; Capoor, Malini R.; Mohan, Sangeetha; Muthu, Valliappan; Agarwal, Ritesh; Chakrabarti, Arunaloke

doi:10.1016/j.cmi.2019.11.021

Cited by 312 publications

(413 citation statements)

References 28 publications

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“…In contrast, the percentages from the European ECMM study were 17% [14], from Italy 18% [27], from France 23% [10] and from Lebanon 35% [31]. In the Indian publications, mucormycosis was the unmasking disease for diabetes mellitus in 12-31% of patients [5,11,22,38].…”

Section: Diabetes Mellitus and Ketoacidosismentioning

confidence: 94%

“…In a recent study comparing North and South India, diabetic ketoacidosis was found in 90% of cases from North India and 10% of cases from South India [29]. Diabetes has been reported as a risk factor for mucormycosis in 73.5% of cases in India [11], 75% [30] in Iran and 72% [12] in Mexico. In contrast, the percentages from the European ECMM study were 17% [14], from Italy 18% [27], from France 23% [10] and from Lebanon 35% [31].…”

Section: Diabetes Mellitus and Ketoacidosismentioning

confidence: 97%

“…Hematological malignancies (HMs) and hematopoietic stem cell transplantation (HSCT) are the most common underlying diseases in mucormycosis in Europe, USA and Australia (Table 1). In India HM was a risk factor in 1-9% [5,11,22,29] and in Iran in 3% [30]. The majority of patients with HM and mucormycosis in various studies had acute myeloid leukemia (48% in the ECMM study [14], 46% in Italy [27], 34% in France [10], 38% in Lebanon [31] and 42% in the global review by Jeong et al [9]).…”

Section: Hematological Malignancy and Hematopoietic Stem Cell Transplmentioning

confidence: 99%

“…In this study, the review was undertaken and reported using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and it included only cases caused by Mucorales [9]. Other relatively large case series were collected either on a national level [10][11][12] or in patients with selected underlying diseases, for example, hematopoietic stem cell transplantation [13]. Registries are another source of valuable information, despite their inherent limitations.…”

Section: Epidemiologymentioning

confidence: 99%

“…Risk factors for mucormycosis vary considerably by geographical area. In studies from Europe [10,14,27] the most common underlying disease was a hematological malignancy, while in India [5,11,20,29], Iran [29,31] and Mexico [12] it was diabetes mellitus. Diabetes was also the leading underlying condition in the study by Stemler et al in countries of the Middle East and North Africa [34].…”

Section: Predisposing Factors/underlying Conditionsmentioning

confidence: 99%

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Epidemiology and Diagnosis of Mucormycosis: An Update

Skiada

Pavleas

Drogari‐Apiranthitou

2020

JoF

450

504

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Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.

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Section: Diabetes Mellitus and Ketoacidosismentioning

confidence: 94%

Section: Diabetes Mellitus and Ketoacidosismentioning

confidence: 97%

Section: Hematological Malignancy and Hematopoietic Stem Cell Transplmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Predisposing Factors/underlying Conditionsmentioning

confidence: 99%

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Epidemiology and Diagnosis of Mucormycosis: An Update

Skiada

Pavleas

Drogari‐Apiranthitou

2020

JoF

450

504

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Father–Son COVID‐19‐associated mucormycosis: Important role of genetic susceptibility in combination with environmental factors

Pourazizi

Eshraghi

Azad

et al. 2022

Clinical Case Reports

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Retracted: Mucormycosis infection in patients with COVID‐19: A systematic review

SeyedAlinaghi

Barzegary

Pashaei

et al. 2022

Health Science Reports

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Introduction Several reports previously described mucormycosis co‐infection in patients with COVID‐19. As mucormycosis and COVID‐19 co‐infection might adversely affect patients' outcomes, we aimed to systematically review the related evidence and the subsequent outcomes. Methods We conducted a systematic review of relevant articles searching the keywords in the online databases of PubMed, Scopus, Embase, Cochrane, and Web of Science. All the records from the start of the pandemic until June 12th, 2021 underwent title/abstract and then full‐text screening process, and the eligible studies were included. We did not include any language or time restrictions for the included studies. Results We found 31 eligible studies reporting 144 total cases of COVID‐19 and mucormycosis co‐infection. The nose, cranial sinuses, and orbital cavity were the most commonly involved organs, although the cerebrum, lungs, and heart were also involved in the studies. Pre‐existing diabetes mellitus (DM), as well as corticosteroid use, were the most commonly identified risk factors, but other underlying conditions and immunomodulatory drug use were also present in several cases. Aspergillus was the most commonly reported micro‐organism that caused further co‐infections in patients with concurrent COVID‐19 and mucormycosis. As most of the studies were case reports, no reliable estimate of the mortality rate could be made, but overall, 33.6% of the studied cases died. Conclusion Early diagnosis of mucormycosis co‐infection in COVID‐19 patients and selecting the right treatment plan could be a challenge for physicians. Patients with underlying co‐morbidities, immunocompromised patients, and those receiving corticosteroids are at higher risk of developing mucormycosis co‐infection and it is crucial to have an eye examination for early signs and symptoms suggesting a fungal infection in these patients.

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A multicentre observational study on the epidemiology, risk factors, management and outcomes of mucormycosis in India

Cited by 312 publications

References 28 publications

Epidemiology and Diagnosis of Mucormycosis: An Update

Epidemiology and Diagnosis of Mucormycosis: An Update

Father–Son COVID‐19‐associated mucormycosis: Important role of genetic susceptibility in combination with environmental factors

Retracted: Mucormycosis infection in patients with COVID‐19: A systematic review

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