Global Epidemiology of Mucormycosis

Abstract

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.

Early Diverging Fungus Mucor circinelloides Lacks Centromeric Histone CENP-A and Displays a Mosaic of Point and Regional Centromeres

“…Mucor circinelloides, a fungus of the subphylum Mucoromycotina, is an exception and molecular tools are available to modify its genome [14]. M. circinelloides, as with other Mucorales, causes an infectious disease known as mucormycosis, which have been associated with high mortality rates due to rhino-orbitalcerebral, pulmonary, or cutaneous infections [15]. Despite its medical significance and research efforts to identify new antifungal targets, the genome biology and cell cycle of this fungus remain poorly understood.…”

Early diverging fungus Mucor circinelloides lacks centromeric histone CENP-A and displays a mosaic of point and regional centromeres

“…Mucor circinelloides , a fungus of the subphylum Mucoromycotina, is an exception and molecular tools are available to modify its genome 14 . M. circinelloides , as with other Mucorales, causes an infectious disease known as mucormycosis, which have been associated with high mortality rates due to rhino-orbital-cerebral, pulmonary, or cutaneous infections 15 . Despite its medical significance and research efforts to identify new antifungal targets, the genome biology and cell cycle of this fungus remain poorly understood.…”

Drug-resistant epimutants exhibit organ-specific stability and induction during murine infections caused by the human fungal pathogenMucor circinelloides

“…One possibility is that there is simply more fungal replication in the brain, enabling more opportunities for stochastic toggling of epigenetic states. Clinically speaking, rhino-orbito-cerebral mucormycosis is the most common manifestation of disease, and this could reflect an aspect of the cerebral environment that makes the brain especially favorable for Mucor growth (2, 3). Histopathologic analysis of the systemic Mucor infections carried out in this study correlates with clinical evidence, as qualitatively more hyphal elements were visualized in the brain than in the other organs studied (Fig 1C).…”