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Indian Journal of Medical Microbiology, Vol. 28, No. 3, July-September, 2010, pp. 262 Correspondence Spectrum of zygomycoses in north India: An institutional experience S Mohapatra, M Jain, I Xess Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110 029, India Zygomycosis is a fulminant fungal infection caused by pathogens of class Zygomycetes. [1] A majority of human zygomycosis is caused by order Mucorales, which includes Rhizopus, Mucor, Rhizomucor, Absidia, and Apophysomyces. [2] Rhino-cerebral, pulmonary, cutaneous, gastrointestinal, and disseminated forms are common manifestations of this infection. [1] Ten years (June′1999-May′2009) data on patients with clinically suspected zygomycosis was collected retrospectively. Medical records of positive cases of Zygomycosis were reviewed. Out of 78 clinically suspected cases of zygomycosis, 29 were confirmed microscopically and/or by culture. Rhizopus arrhizus was the predominant isolate 86.2%. Two cases (6.8%) of Apophysomyces elegans and one case (3.4%) of Rhizomucor pusillus were identified in the basis of morphology. One rare case of Cokeromyces recurvatus was identified from a patient with rhino-orbito-cerebral mucormycosis. The patient presented with proptosis, loss of vision, nasal obstruction, and altered sensorium. Rhino-cerebral zygomycosis was the commonest presentation (45%) followed by disseminated Zygomycosis (24%). The underlying risk factors for zygomycosis are mentioned in [Table - 1]. Eleven out of 13 patients of rhino-cerebral zygomycosis presented with hyperglycaemia and ketoacidosis. Most of the patients with disseminated zygomycosis were immunocompromised. Haematological malignancy with associated neutropenia was the predominant risk factor. All patients received amphotericin B; 10 of them required surgical debridement of lesion. Treatment was successful in 23 patients (79%) whereas 6 (21%) died of cerebral involvement or disseminated diseases. Failure of treatment was common in cancer patients with Rhizopus infection. Zygomycetes are known to affect immunocompromised hosts. An underlying disease is often associated with a specific type of zygomycosis. Like-wise, rhino-orbito-cerebral involvement is seen in patients with diabetic ketoacidosis; pulmonary infection in patients with blood cancer; disseminated manifestation in drug abusers; gastrointestinal type in patients with malnutrition; and cutaneous lesions in patients with history of trauma or burns. [1] In our series, similar associations were observed in patients with rhino-orbito-cerebral and disseminated types who had associated diabetes and neutropenia, respectively. The incidence of disseminated mycosis was very high (24.1%). Most of these patients had either malignancy or had undergone organ transplantation. This indicates that with increase incidence of immunosuppressive conditions, a change in presentation of zygomycosis from rhino-cerebral to disseminated variety may be expected. [4] Zygomyecetes are rapidly progressive fungi causing angio-invasion, thrombosis, and tissue necrosis. Surgical debridement of the lesion along with aggressive antifungal therapy remains the primary modality of treatment. [5] Despite the recent advances in diagnosis and management of opportunistic fungal infections, zygomycosis continues to pose formidable diagnostic and therapeutic challenges. References
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