462. Mucormycosis at a Tertiary Care Center In Gujarat, India
Session: Poster Abstract Session: Mucor, Fusarium, and other Filamentous Mycoses
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Mucor IDSA poster 2015.pdf (2.5 MB)
  • Background: With the alarming rise in the incidence of mucormycosis in India especially in patients with uncontrolled diabetes, we desired to evaluate mucormycosis patients at a tertiary care center in Gujrat, India.

    Methods: We retrieved the clinical details of all the patients diagnosed for proven mucormycosis at Sterling Hospital and ID clinic over the period from January 1, 2015 through April 30, 2015. The data were analyzed to describe demographic data, underlying disease, co-morbidities, site of infection, and outcome of the patients.

    Results: A total of 27 patients with the median age of 50 (16-65) years, were diagnosed with mucormycosis during the study period. Rhino-orbital-cerebral mucormycosis was the most common (51.9%) followed by pulmonary and cutaneous with equal frequency (22.2%). The majority (55.6%) of the patients had uncontrolled diabetes or diabetic ketoacidosis and 40% of those patients were ignorant of underlying diabetes while presenting with mucormycosis. 25.9% patients had no underlying disease and majority (22.2%) had cutaneous mucormycosis. Other comorbidities were observed in 6 patients; 2 each had tuberculosis & ischemic heart disease (IHD) with end stage renal failure (ESRD), 1 each had hypertension & COPD. The median (range) duration of symptoms before presentation was 28 (1 -90) days. 14 (51.9%) patients could complete 6 weeks of amphotericin B therapy; 6 patients died before completion of therapy. The mortality rate was 25.9% and an equal percentage of patients were lost to follow up. All patients who completed the antifungal therapy survived except one with ESRD/IHD.  

    Table 1: Epidemiology of patients with mucormycosis
    Risk Factors                          n= Site Involved                    n=
    Diabetes:                               15

    Steroids:                                 07

    No Risk factors:                       07

    Immunosuppressives:              05

    SOT:                                       03

    Malignancy:                             01

    PNS/Orbit/Palate:              14

    Lung:                                   06

    Skin & Soft Tissue:                06

    Kidney:                                01

                               Treatment: N=27, M: 19, F: 8 Antifungal                                                 Surgical
    ABDC*:                                   17

    L Amb**:                                09

    Posaconazole:                         01

    Radicle resection:              08

    Sinoscopic debridement:       12

    No Surgery:                         07

    * Amphotericin B Deoxycholate, ** Liposomal Amphotericin B

    Conclusion:

    Like other parts of India, uncontrolled diabetes was the predominant risk factor in our patient. Patients who complete six weeks of amphotericin B treatment are likely to survive.

    Atul Patel, MD, FIDSA1, Ketan Patel, MD1, Aniket Shah, MD2, Kamlesh Patel, MD3 and Arunaloke Chakrabarti, MD, FIDSA4, (1)Infectious Diseases, Vedanta Institute of Medical Sciences, Ahmedabad, India, (2)Infectious Diseases, Sterling Hospital, Ahmedabad, India, (3)Microbiology, Sterling Hospital, Ahmedabad, India, (4)Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India

    Disclosures:

    A. Patel, None

    K. Patel, None

    A. Shah, None

    K. Patel, None

    A. Chakrabarti, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.