Cutaneous Zygomycosis: Major Concerns (Commentary) (Disease/Disorder Overview‪)‬

Till two decades back zygomycosis due to fungi belonging to the class Zygomycetes and the order Mucorales was considered rare fatal opportunistic fungal infection. In the recent past, zygomycosis is emerging throughout the world in part due to continued rise of diabetics and the increased use of immunosuppressive agents, but the rise in India is phenomenal (1-3). The rise in incidence had been reported systematically from one tertiary care center in India (13 cases/year during 1990-1999, to 35 cases/ year during 2000-2004, and to 50 cases/year during 2006-2007) (2, 3). However, the awareness about the rise in cases of zygomycosis is restricted only to a few centers in India (1), and the rise is largely associated with uncontrolled diabetes mellitus (1-3). Based on clinical presentation and involvement of particular anatomical site, the disease is categorized into six clinical types: rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and miscellaneous. With increased awareness about the disease in recent years, the clinicians to certain extent recognize zygomycosis in differential diagnosis of opportunistic infections in particular group of patients like uncontrolled diabetes, haematological malignancy undergoing chemotherapy, haematological stem cell transplant recipients. However, the diagnosis of cutaneous zygomycosis, though easy as the infection occurs in exposed part of the body, is frequently either missed or delayed due to lack of awareness and absence of any underlying illness in nearly 50 per cent of patients. Cutaneous zygomycosis may be gradual and slowly progressive or may be aggressive and fulminant leading to necrotizing lesions and haematogenous dissemination. Slowly progressive cutaneous zygomycosis may be misdiagnosed as multiple autoimmune disease, drug reactions, infections, infiltrative diseases, neoplastic disorder; and aggressive fulminant disease as pyoderma gangrenosum, bacterial synergistic gangrene. In this context the article published in this issue by Chander et al (4) is very much relevant and highlights the need of early diagnosis of this disease. Delay in diagnosis leads to increased mortality. In this study, 55 per cent patients died and in authors own admission "Five patients expired probably either because of delay in diagnosis and treatment ..." (4).