Epidemiology of Mucormycosis in India

Abstract

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.

Case series of four secondary mucormycosis infections in COVID-19 patients, the Netherlands, December 2020 to May 2021

“…Cases of mucormycosis are now being reported in patients with severe COVID-19, associated with uncontrolled diabetes mellitus and systemic corticosteroid therapy [9]. Numerous cases of COVID-19 associated mucormycosis (CAM) are reported from India, which is known to have a high burden of (poorly regulated) diabetes mellitus [9,12]. However, a recent cohort of 38 CAM cases was reported from outside India, including cases from Europe, the Middle East, North and South America, with an estimated prevalence of 0.3% to 0.8% [10].…”

Key Factors Fuelling India's Second COVID Surge

“…The estimated prevalence of mucormycosis is around 70 times higher in India than that in global data. [5,6] As well as having a detrimental impact on the sinuses, it has the capacity to invade the brain and the lungs, and is potentially life-threatening for individuals with underlying health conditions. The disease is being reported at an alarming frequency over the past decades from India with predominant features of rhino-orbito-cerebral presentation associated with uncontrolled diabetes.…”

“…Isolated renal mucormycosis in an immunocompetent host is a unique entity in India. [6] Although most cases are sporadic, outbreaks of mucormycosis are known to have occurred. [7] In healthcare settings, it can be difficult to determine whether mucormycosis is healthcare-associated or whether the infections were acquired somewhere else.…”

Mucormycosis or black fungus: An emerging threat in COVID-19

“…5 It is saprophytic nonseptate or sparsely septate fungi of the order Mucorales. 6 It causes angio-invasion and associated with high morbidity and mortality. 7,8 Mucormycosis is previously known as 'zygomycosis'.…”

“…If India is included, the number will be 910,000 cases globally. 6,14 The exact incidence of mucormycosis in India is unknown due to the lack of population-based study. 6 Bangladesh has no data regarding the prevalence or incidence of mucormycosis at present.…”