A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment
A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment
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DOI：
10.1093/mmy/myy060
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Chakrabarti, Arunaloke
中科院分区：
文献类型：
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作者：
Prakash, Hariprasath;Ghosh, Anup Kumar;Chakrabarti, Arunaloke
据报道，在印度，大量未受控制的糖尿病患者中存在由毛霉目菌引起的毛霉菌病，但尚未发表系统的多中心流行病学研究。本前瞻性研究于2013年至2015年在印度的四个主要三级保健中心（两个在印度北部，两个在印度南部）进行，以比较两个地区之间毛霉菌病的流行病学，治疗策略和结局。采用分子技术来确认分离株的身份或鉴定活检样本中的病原体。研究期间共报告了388例确诊/可能的毛霉菌病病例，总死亡率为46.7%。糖尿病（n = 172，56.8%）和创伤（n = 31，10.2%）是常见的危险因素。总的来说，少根根霉（n = 124，51.9%）是鉴定出的主要病原体，其次是小孢根霉（n = 30，12.6%），变异附囊酵母（n = 22，9.2%）和同宗根霉（n = 6，2.5%）。多变量分析显示，死亡率与胃肠道（OR：18.70，P = .005）和肺部感染（OR：3.03，P = .015）显著相关。在比较这两个地区时，大多数（82.7%）病例来自印度北部;未控制的糖尿病（n = 157，P = .0001）和结核后毛霉菌病（n = 21，P = .006）与印度北部病例显著相关。两个地区的毛霉目菌种和治疗策略无显著差异。印度北部患者的死亡率（50.5%）显著高于印度南部的32.1%（P = 0.016）。这项研究强调了印度北部未受控制的糖尿病患者中毛霉菌病病例的数量较高，以及R。microsporus和R.引起这种疾病。
Mucormycosis due to Mucorales is reported at large numbers in uncontrolled diabetics across India, but systematic multicenter epidemiological study has not been published yet. The present prospective study was conducted at four major tertiary care centers of India (two in north and two in south India) during 2013-2015 to compare the epidemiology, treatment strategies and outcome of mucormycosis between the two regions. Molecular techniques were employed to confirm the identity of the isolates or to identify the agent in biopsy samples. A total of 388 proven/probable mucormycosis cases were reported during the study period with overall mortality at 46.7%. Uncontrolled diabetes (n = 172, 56.8%) and trauma (n = 31, 10.2%) were the common risk factors. Overall, Rhizopus arrhizus (n = 124, 51.9%) was the predominant agent identified, followed by Rhizopus microsporus (n = 30, 12.6%), Apophysomyces variabilis (n = 22, 9.2%) and Rhizopus homothallicus (n = 6, 2.5%). On multivariate analysis, the mortality was significantly associated with gastrointestinal (OR: 18.70, P = .005) and pulmonary infections (OR: 3.03, P = .015). While comparing the two regions, majority (82.7%) cases were recorded from north India; uncontrolled diabetes (n = 157, P = .0001) and post-tubercular mucormycosis (n = 21, P = .006) were significantly associated with north Indian cases. No significant difference was noted among the species of Mucorales identified and treatment strategies between the two regions. The mortality rate was significantly higher in north Indian patients (50.5%) compared to 32.1% in south India (P = .016). The study highlights higher number of mucormycosis cases in uncontrolled diabetics of north India and emergence of R. microsporus and R. homothallicus across India causing the disease.