Samaddar Arghadip, Shrimali Twishi, Sharma Anuradha
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India.
Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India.
Mycoses. 2023 Mar;66(3):181-195. doi: 10.1111/myc.13538. Epub 2022 Oct 20.
Apophysomyces species are an emerging cause of mucormycosis in several regions of the world, primarily affecting immunocompetent individuals. The present study addresses the global epidemiology, clinical presentation, management and outcome of mucormycosis caused by Apophysomyces spp. The study included patients diagnosed with Apophysomyces infection at our hospital between March 2019 and August 2020. In addition, cases published in PubMed and Google Scholar from inception to July 2022 were systematically searched and analysed. Only proven and probable cases that meet the eligibility criteria were included. The Indian cases were compared with those from other countries, and the results were analysed by descriptive statistics. In total, six cases of mucormycosis due to Apophysomyces spp. were diagnosed at our hospital, with additional 250 cases identified through literature search. The main underlying diseases were diabetes mellitus (24%), malignancy (3.2%) and chronic kidney disease (2.8%). The major predisposing factor was trauma (55.6%). Necrotizing fasciitis was the most common (63.2%) clinical presentation. Healthcare-associated mucormycosis accounted for 10.4% of the cases. Globally, A. elegans was the most common species (48.8%), whereas A. variabilis was predominant (86.2%) in India. Surgery was performed in 83.5% of patients. Among those treated with antifungal agents, 98% received amphotericin B and 8.1% received posaconazole. Inappropriate antifungal usage was observed in 12.7%. The overall mortality was 42.3%. A combined medical and surgical management was associated with higher survival. Our study highlights the knowledge gap among physicians regarding this infection. A timely diagnosis and aggressive management can improve the outcomes in such cases.
在世界多个地区，阿波菲孢霉菌种是毛霉病的一个新兴病因，主要影响免疫功能正常的个体。本研究探讨了由阿波菲孢霉菌种引起的毛霉病的全球流行病学、临床表现、治疗及预后。该研究纳入了2019年3月至2020年8月期间在我院被诊断为阿波菲孢霉菌感染的患者。此外，还对自开始至2022年7月在PubMed和谷歌学术上发表的病例进行了系统检索和分析。仅纳入符合入选标准的确诊和疑似病例。将印度的病例与其他国家的病例进行比较，并通过描述性统计分析结果。我院共诊断出6例由阿波菲孢霉菌种引起的毛霉病病例，通过文献检索又确定了250例。主要基础疾病为糖尿病（24%）、恶性肿瘤（3.2%）和慢性肾脏病（2.8%）。主要诱发因素是创伤（55.6%）。坏死性筋膜炎是最常见的临床表现（63.2%）。医疗相关毛霉病占病例的10.4%。在全球范围内，线虫状阿波菲孢霉是最常见的菌种（48.8%），而在印度，多变阿波菲孢霉占主导（86.2%）。83.5%的患者接受了手术治疗。在接受抗真菌药物治疗的患者中，98%接受了两性霉素B，8.1%接受了泊沙康唑。观察到12.7%的患者存在抗真菌药物使用不当的情况。总体死亡率为42.3%。综合药物和手术治疗与更高的生存率相关。我们的研究凸显了医生对这种感染认识上的差距。及时诊断和积极治疗可改善此类病例的预后。
