Objectives: To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality. Methods: We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic profile, microbiology, predisposing factors, management and 90-day mortality were recorded; risk factors for mortality were analysed. Results: We included 465 patients. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/ 465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and posaconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappropriate in 7.6% (30/394) of the individuals. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival. Conclusions: Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation. A.

The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.

Dirofilariasis is a parasitic infection of the carvivores that may present as a zoonotic infestation in humans. Systemic involvement in man is subcutaneous, pulmonary, or ocular. We report a rare occurrence of ocular dirofilariasis in a 25-year-old male patient who presented with pain and redness in the eye. A live, white, coiled, and highly motile worm was present in the anterior chamber. The worm, however, could not be detected in the anterior chamber, posterior segment, or the angle of the anterior chamber when the patient was taken to the operating room for surgical removal of the worm. The patient was made to lie prone till the worm reappeared in the anterior chamber and was removed by paracentesis. The worm was identified as Dirofilaria repens on the basis of microscopic and histopathological examination.

Cryptococcosis is a common opportunistic infection among immunocompromised individuals. Some of the commonly affected sites are respiratory and central nervous system. Lymph node is an unusual site of involvement which could mimic tuberculosis, as seen in our case. We report a 32-year-old male immunocompromised patient presenting with generalized lymphadenopathy who was clinically suspected to have tuberculous lymphadenitis. He was diagnosed to have disseminated cryptococcosis on fine needle aspiration cytology and fungal isolation on culture.

BackgroundThough 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.MethodsTo 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.ResultsA 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.ConclusionRhino-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.