Overview of opportunistic fungal infections in India.

In recent years fungi have been flourishing in immunocompromised patients of tertiary care centers. The data on the burden of opportunistic mycoses in India is not clear though the climate in this country is well suited for a wide variety of fungal infections. There are very few good diagnostic mycology laboratories and clinicians are still not aware of the emerging trends. Within the limited data available, an increased incidence of invasive candidiasis, aspergillosis, and zygomycosis are reported. The emergence of fungal rhinosinusitis, penicilliosis marneffei and zygomycosis due to Apophysomyces elegans is unique in the Indian scenario. Invasive candidiasis is the most common opportunistic mycosis. The global change in spectrum of Candida species is also observed in India; however, the higher prevalence of candidemia due to Candida tropicalis instead of C. glabrata or C. parapsilosis is interesting. Invasive aspergillosis is the second contender. Though due to difficulty in antemortem diagnosis the exact prevalence of this disease is not known, high prevalence is expected in Indian hospitals where construction activities continue in the hospital vicinity without a proper impervious barrier. The other opportunistic mycosis, invasive zygomycosis is an important concern as the world's highest number of cases of this disease is reported from India. The infection is commonly observed in patients with uncontrolled diabetes mellitus. Though antiretroviral therapy in AIDS patients has been introduced in most Indian hospitals, no decline in the incidence of cryptococcosis and penicilliosis has yet been observed. Thus there is need of good diagnostic mycology laboratories, rapid diagnosis, and refinement of antifungal strategies in India.