Emerging Rhizopus microsporus Infections in India

Pandey, M. B.; Singh, Gagandeep; Agarwal, Reshu; Dabas, Y. P. S.; Jyotsna, Viveka P; Kumar, Rakesh; Xess, Immaculata

doi:10.1128/jcm.00433-18

Cited by 24 publications

(15 citation statements)

References 12 publications

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“…In contrast to our study, their third most common species was Apophysomyces variabilis [31]. R. microsporus had previously been reported as the second most common cause of IM from our centre [37]. In the present study, R. arrhizus was identified among eight 'possible' cases using molecular methods.…”

Section: Discussioncontrasting

confidence: 91%

Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

Pandey

Xess

Singh

et al. 2021

Journal of Medical Microbiology

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Introduction. Invasive mucormycosis (IM) is a life-threatening infection caused by fungi belonging to the order Mucorales. Histopathology, culture and radiology are the mainstay of diagnosis but lack sensitivity, leading to a delay in timely diagnosis and intervention. Recently, PCR-based approaches have been shown to be a promising method in diagnosing IM. Hypothesis/Gap Statement. Molecular-based approaches may be a valuable adjunct to standard conventional methods for diagnosing IM, especially among culture negatives and patients on antifungal therapy. Aim. In the present study we aimed to evaluate the clinical utility of panfungal and Mucorales-specific PCR for diagnosing IM from various clinical specimens. Methodology. This was a prospective study in which 239 clinically suspected cases of IM attending our tertiary care hospital from August 2015 to March 2018 were enrolled. All the cases were defined as ‘proven’, ‘probable’ or ‘possible’ based on EORTC/MSGERC guidelines. In addition to conventional diagnostics (KOH-calcofluor stain and culture), panfungal and Mucorales-specific PCR assays were also performed. The amplified products were sequenced for species identification. In vitro antifungal susceptibility was performed on all the culture-positive isolates. Results. Among 239 clinically suspected cases of IM, only 140 cases were diagnosed by the demonstration of aseptate ribbon-like hyphae on direct microscopy. Culture was positive in 35.7 % (54/140) of direct microscopy-positive samples. Among the proven cases (n=11), the sensitivity for both Mucorales-specific nested PCR and panfungal PCR was 100 %, but specificity was 91.9 and 73.7% respectively. In probable cases (n=129), the sensitivity of both the PCRs was 98.5 % and specificity for panfungal PCR was 73.7 and 91.9 % for Mucorales-specific PCR. Conclusion. Pan fungal PCR in combination with Mucorales-specific PCR, followed by sequencing, may play a significant role in IM diagnosis especially among those negative for both direct microscopy and culture.

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Section: Discussioncontrasting

confidence: 91%

Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

Pandey

Xess

Singh

et al. 2021

Journal of Medical Microbiology

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“…India accounts for approximately 60% of the documented mucormycosis cases due to Apophysomyces species [5,140,141]. Beyond Apophysomyces variabilis , infections due to R. microsporus and R. homothallicus are on the rise in India [5,142]. R. homothallicus was isolated from patients with ROCM type, pulmonary and cutaneous form of disease [5,143,144].…”

Section: Causative Agents Of Mucormycosismentioning

confidence: 99%

Global Epidemiology of Mucormycosis

Prakash

Chakrabarti

2019

JoF

700

753

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Mucormycosis is an angio-invasive fungal infection, associated with high morbidity and mortality. A change in the epidemiology of mucormycosis has been observed in recent years with the rise in incidence, new causative agents and susceptible population. The rise has been perceived globally, but it is very high in the Asian continent. Though diabetes mellitus overshadow all other risk factors in Asia, post-tuberculosis and chronic renal failure have emerged as new risk groups. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis in patients with haematological malignancy and transplant recipients. In immunocompetent hosts, cutaneous mucormycosis is commonly seen following trauma. The intriguing clinical entity, isolated renal mucormycosis in immunocompetent patients is only reported from China and India. A new clinical entity, indolent mucormycosis in nasal sinuses, is recently recognized. The causative agents of mucormycosis vary across different geographic locations. Though Rhizopus arrhizus is the most common agent isolated worldwide, Apophysomyces variabilis is predominant in Asia and Lichtheimia species in Europe. The new causative agents, Rhizopus homothallicus, Mucor irregularis, and Thamnostylum lucknowense are reported from Asia. In conclusion, with the change in epidemiology of mucormycosis country-wise studies are warranted to estimate disease burden in different risk groups, analyse the clinical disease pattern and identify the new etiological agents.

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“…However, the spectrum of agents causing this disease in India is considerably large. Recent studies reported a rise in mucormycosis cases due to Rhizopus microsporus and Rhizopus homothallicus [ 5 , 6 , 13 , 69 ]. Rhizopus species are associated with ROCM mucormycosis [ 3 , 5 , 6 ], and this finding correlates well with the abundant presence of Rhizopus species in soil and air samples [ 66 , 67 ].…”

Section: Causative Agents Of Mucormycosismentioning

confidence: 99%

“…The Apophysomyces species ranks second in India compared to the Lichtheimia species in developed countries [ 12 ]. Infections due to Rhizopus microsporus and Rhizopus homothallicus are rising in India [ 5 , 6 , 13 ]. In the present review, we discuss the epidemiology, risk factors and underlying diseases, causative agents, and clinical outcomes associated with mucormycosis in the Indian population.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Mucormycosis in India

2021

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Mucormycosis is an angioinvasive disease caused by saprophytic fungi of the order Mucorales. The exact incidence of mucormycosis in India is unknown due to the lack of population-based studies. The estimated prevalence of mucormycosis is around 70 times higher in India than that in global data. Diabetes mellitus is the most common risk factor, followed by haematological malignancy and solid-organ transplant. Patients with postpulmonary tuberculosis and chronic kidney disease are at additional risk of developing mucormycosis in this country. Trauma is a risk factor for cutaneous mucormycosis. Isolated renal mucormycosis in an immunocompetent host is a unique entity in India. Though Rhizopus arrhizus is the most common etiological agent of mucormycosis in this country, infections due to Rhizopus microsporus, Rhizopus homothallicus, and Apophysomyces variabilis are rising. Occasionally, Saksenaea erythrospora, Mucor irregularis, and Thamnostylum lucknowense are isolated. Though awareness of the disease has increased among treating physicians, disease-associated morbidity and mortality are still high, as patients seek medical attention late in the disease process and given the low affordability for therapy. In conclusion, the rise in the number of cases, the emergence of new risk factors and causative agents, and the challenges in managing the disease are important concerns with mucormycosis in India.

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Emerging Rhizopus microsporus Infections in India

Cited by 24 publications

References 12 publications

Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

Global Epidemiology of Mucormycosis

Epidemiology of Mucormycosis in India

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