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399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India

BACKGROUND: Though the rise in number of mucormycosis cases has been reported globally, the rise in India is alarming especially in uncontrolled diabetics. However, multiple gaps exist in the understanding of the disease in this country. METHODS: To describe the epidemiology, diagnosis, treatment pr...

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Autores principales: Patel, Atul, Kaur, Harsimran, Xess, Immaculata, Michael, Joy S, Savio, Jayanthi, Rudramurthy, Shivaprakash, Singh, Rakesh, Shastri, Prakash, Umabala, Pamidimukkala, Sardana, Raman, Kindo, Anupama Jyoti, Capoor, Malini, Mohan, Sangeetha, Chakrabarti, Arunaloke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253864/
http://dx.doi.org/10.1093/ofid/ofy210.410
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author Patel, Atul
Kaur, Harsimran
Xess, Immaculata
Michael, Joy S
Savio, Jayanthi
Rudramurthy, Shivaprakash
Singh, Rakesh
Shastri, Prakash
Umabala, Pamidimukkala
Sardana, Raman
Kindo, Anupama Jyoti
Capoor, Malini
Mohan, Sangeetha
Chakrabarti, Arunaloke
author_facet Patel, Atul
Kaur, Harsimran
Xess, Immaculata
Michael, Joy S
Savio, Jayanthi
Rudramurthy, Shivaprakash
Singh, Rakesh
Shastri, Prakash
Umabala, Pamidimukkala
Sardana, Raman
Kindo, Anupama Jyoti
Capoor, Malini
Mohan, Sangeetha
Chakrabarti, Arunaloke
author_sort Patel, Atul
collection PubMed
description BACKGROUND: Though the rise in number of mucormycosis cases has been reported globally, the rise in India is alarming especially in uncontrolled diabetics. However, multiple gaps exist in the understanding of the disease in this country. METHODS: To describe the epidemiology, diagnosis, treatment practices, and outcome of mucormycosis in India. A single-arm prospective observational study was conducted in the network of 17 tertiary care centres across India during April 2016 through September 2017. All consecutive proven mucormycosis patients were enrolled in this study. Clinical data including risk factors, investigations, and treatment were collected. All isolates and histopathological specimens were sent to Mycology Reference Laboratory at Chandigarh for final identification (phenotypic and sequencing) and drug susceptibility testing. RESULTS: A total of 474 cases were enrolled between the study period. Rhino-orbito-cerebral mucormycosis was common (42.7%) presentation with 22.8% patients had brain involvement, followed by pulmonary (14.6%), cutaneous (11.8%), isolated renal (3.9%), and intra-abdominal (2.8%) mucormycosis. The underlying disease or predisposing factors were noted in 79.7% cases (84.9% diabetes mellitus, 12.9% steroids, 10.3% trauma or history of surgery, 9.7% malignancy, and 9.2% transplant). The most common agents isolated were Rhizopus species (75.9%, R. arrhizus [74.3%] and R. homothallicus [6.7%]) followed by Apophysomyces variabilis (7.4%), Mucor species (6%), and Lichtheimia corymbifera (4%). The patients were managed by medical therapy in 82.8%, surgery in 56.8% while 51.7% received combined medical and surgical management. Amphotericin B (96.8%) either lipid formulations (65.7%) or conventional form (39.1%) was the common antifungal used. The mortality of patients was 30.4%; of which, 80.3% patients died within 6 weeks of their diagnosis. 24.3% patients left hospital against medical advice while 50.1% survived. CONCLUSION: Rhino-orbital-cerebral mucormysosis in uncontrolled diabetics is common presentation in India. R. arrhizus followed by A. variabilis are common species isolated from those patients. Survival was noted only in half of the patients despite increased awareness and diagnosis. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62538642018-11-28 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India Patel, Atul Kaur, Harsimran Xess, Immaculata Michael, Joy S Savio, Jayanthi Rudramurthy, Shivaprakash Singh, Rakesh Shastri, Prakash Umabala, Pamidimukkala Sardana, Raman Kindo, Anupama Jyoti Capoor, Malini Mohan, Sangeetha Chakrabarti, Arunaloke Open Forum Infect Dis Abstracts BACKGROUND: Though the rise in number of mucormycosis cases has been reported globally, the rise in India is alarming especially in uncontrolled diabetics. However, multiple gaps exist in the understanding of the disease in this country. METHODS: To describe the epidemiology, diagnosis, treatment practices, and outcome of mucormycosis in India. A single-arm prospective observational study was conducted in the network of 17 tertiary care centres across India during April 2016 through September 2017. All consecutive proven mucormycosis patients were enrolled in this study. Clinical data including risk factors, investigations, and treatment were collected. All isolates and histopathological specimens were sent to Mycology Reference Laboratory at Chandigarh for final identification (phenotypic and sequencing) and drug susceptibility testing. RESULTS: A total of 474 cases were enrolled between the study period. Rhino-orbito-cerebral mucormycosis was common (42.7%) presentation with 22.8% patients had brain involvement, followed by pulmonary (14.6%), cutaneous (11.8%), isolated renal (3.9%), and intra-abdominal (2.8%) mucormycosis. The underlying disease or predisposing factors were noted in 79.7% cases (84.9% diabetes mellitus, 12.9% steroids, 10.3% trauma or history of surgery, 9.7% malignancy, and 9.2% transplant). The most common agents isolated were Rhizopus species (75.9%, R. arrhizus [74.3%] and R. homothallicus [6.7%]) followed by Apophysomyces variabilis (7.4%), Mucor species (6%), and Lichtheimia corymbifera (4%). The patients were managed by medical therapy in 82.8%, surgery in 56.8% while 51.7% received combined medical and surgical management. Amphotericin B (96.8%) either lipid formulations (65.7%) or conventional form (39.1%) was the common antifungal used. The mortality of patients was 30.4%; of which, 80.3% patients died within 6 weeks of their diagnosis. 24.3% patients left hospital against medical advice while 50.1% survived. CONCLUSION: Rhino-orbital-cerebral mucormysosis in uncontrolled diabetics is common presentation in India. R. arrhizus followed by A. variabilis are common species isolated from those patients. Survival was noted only in half of the patients despite increased awareness and diagnosis. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253864/ http://dx.doi.org/10.1093/ofid/ofy210.410 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Patel, Atul
Kaur, Harsimran
Xess, Immaculata
Michael, Joy S
Savio, Jayanthi
Rudramurthy, Shivaprakash
Singh, Rakesh
Shastri, Prakash
Umabala, Pamidimukkala
Sardana, Raman
Kindo, Anupama Jyoti
Capoor, Malini
Mohan, Sangeetha
Chakrabarti, Arunaloke
399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title_full 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title_fullStr 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title_full_unstemmed 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title_short 399. Multi-centre Observational Study on Epidemiology, Treatment, and Outcome of Mucormycosis in India
title_sort 399. multi-centre observational study on epidemiology, treatment, and outcome of mucormycosis in india
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253864/
http://dx.doi.org/10.1093/ofid/ofy210.410
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