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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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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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. |
format | Online Article Text |
id | pubmed-6253864 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
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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