[1, 2] However, it has also been described in patients with no underlying disease.[1, 2] The emergence of mucormycosis is being reported globally, with an alarming rise in the number of cases from developing countries including India.[1, 2, 4, 7-9] The precise epidemiology of this disease in developing world is not well known due to limited data as a result of sub-optimal awareness, inadequate reporting and diagnostic facilities at many of the healthcare centers.[1] However, the available literature suggests a considerable variation between the developing and developed nations, with differences in the prevalence, risk factors and causative agents involved.[1,

4-7] Certain peculiarities have been observed in cases of mucormycosis in India compared with the western world, including a high incidence of this disease; uncontrolled diabetes and diabetic ketoacidosis as the principal risk factor; rhino-orbito-cerebral

(ROC) form as the most buy Panobinostat common clinical presentation; isolated renal mucormycosis as a new entity; and a wide and varied spectrum of pathogens involved in such infections.[1] Seasonal variations in incidence of mucormycosis with respect to temperature, rainfall and humidity have also been noted.[10] In this review, we highlight these distinct features of mucormycosis with reference to India. An upsurge of mucormycosis is being reported throughout the world over the past two decades, however, the rise in developing countries including India has been phenomenal.[1, 2, 4, 7-9] Three consecutive PLX4032 manufacturer case series on mucormycosis have been reported from a single tertiary-care centre in India: 129 cases over 10 years (1990–1999), 178 cases during the subsequent 5 years (2000–2004) and then 75 cases in an 18 month period during 2006–2007.[4-6] Many other Indian centres have also subsequently published multiple series of this disease in different risk groups.[10-13] This increasingly high incidence of mucormycosis in India has been attributed primarily to a Thalidomide continued increase in the patient population with uncontrolled diabetes, which is a one of the major risk factors for this disease in developing countries.[1] In fact, India has the second largest

diabetic population globally (65.1 million),[14] with nearly 70% of these cases being those of uncontrolled diabetes.[15] Environmental factors, such as tropical and sub-tropical humid climate and high environmental temperature in most parts of India, further provide an optimum set-up for survival of these fungi, and perhaps contribute to the disease prevalence.[1] Better awareness, expertise and diagnostic facilities in many of the healthcare centres have also significantly contributed to an increased recognition of this disease over the past years.[3] Majority of the reported cases from India have been those of proven mucormycosis, diagnosed based on culture and histopathology.[3] Very few authors have included probable mucormycosis in their series.