Clinical Spectrum, Microbiological Characteristics, and Outcomes of Apophysomyces Infections in Immunocompetent Patients: A Case Series From North India.

BACKGROUND

Apophysomyces species are emerging etiological agents of mucormycosis, particularly in tropical and subtropical regions. Unlike classical mucormycosis, which predominantly affects immunocompromised individuals, Apophysomyces infections frequently occur in immunocompetent hosts following traumatic implantation of fungal spores.

OBJECTIVES

To describe the clinical manifestations, microbiological characteristics, management strategies, and outcomes of Apophysomyces infections diagnosed at a tertiary care center in North India.

METHODS

A retrospective observational study was conducted on patients with culture-confirmed and molecularly confirmed Apophysomyces infections diagnosed between January 2019 and December 2024. Demographic details, predisposing factors, clinical presentation, laboratory findings, treatment modalities, and outcomes were reviewed.

RESULTS

We reported 10 (25%) cases of primary cutaneous, rhino-orbital, pulmonary mucormycosis due to Apophysomyces sppamong 40 cases of mucormycosis diagnosed during the study period. On direct microscopy and culture, the isolates were identified as Apophysomyces variabilis (A. variabilis) in nine cases (90%) and Apophysomyces elegans (A. elegans) in one case (10%). The mean age of patients was 39.5 years (range: 1 month-60 years), and males were predominant, that is, seven cases (70%). Trauma-associated inoculation was the predominant predisposing factor, accounting for the majority of infections. Clinical manifestations included osteomyelitis, necrotizing fasciitis, cutaneous and subcutaneous infections, chest wall involvement, postoperative wound infection, and rhino-orbital disease. Extensive surgical debridement and medical management led to the recovery of six cases (60%), whereas four (40%) succumbed due to a delay in approaching our centre. Species identification was confirmed by internal transcribed spacer (ITS) and 28S recombinant DNA (rDNA) sequencing. Combined surgical debridement and liposomal amphotericin B therapy was associated with improved outcomes.

CONCLUSIONS

Apophysomyces species represent an emerging cause of invasive mucormycosis among immunocompetent individuals in North India. Trauma remains the principal predisposing factor. Early microbiological diagnosis, prompt surgical intervention, and timely antifungal therapy are critical determinants of favourable clinical outcomes.