Changing trends: an overview of increasing burden of fungal infections from a tertiary care hospital in Punjab (north India)


  • Shivani Tyagi Post Graduate Resident, Department of Microbiology, Christian Medical College & Hospital, Ludhiana, Punjab, India
  • Aroma Oberoi Professor and Head, Department of Microbiology, Christian Medical College & Hospital, Ludhiana, Punjab, India
  • Vipin Sam Alexander Senior Resident, Department of Microbiology, Christian Medical College & Hospital, Ludhiana, Punjab, India
  • Sangeetha Mohan Associate Professor, Department of Microbiology, Christian Medical College & Hospital, Ludhiana, Punjab, India





Background: Fungal infections are an emerging group of infections particularly affecting immunocompromised individuals and those with indwelling medical devices. Spectrum of fungal pathogens is wide which include yeasts like Candida and Cryptococcus and filamentous fungi like Aspergillus and Zygomycetes.

Materials and methods: A retrospective study was conducted over a period of five years in the department of Microbiology in a tertiary care hospital in North India. Various clinical samples were collected from the patients presenting with clinically suspected fungal infections. Direct microscopy with potassium hydroxide (KOH) was done to visualize the presence of fungal elements and Gram staining was done for any suspected yeast infection. Fungal cultures of all samples were inoculated on Sabourauds dextrose agar (SDA).

Results: A total of 5724 clinical samples with suspected fungal etiology were received in the Microbiology laboratory during the study period. From a total of 689 isolates which came positive, Candida sp. was the most common isolate accounting for 520 (75.4 %), followed by Aspergillus species 110 (15.9 %), Mucor species 34 (4.9 %), Cryptococcus species 9 (1.3 %), Penicillium species 8 (1.2 %), Dermatophytes 4 (0.6 %), Fusarium sp. 3 (0.4%) and Acremonium sp. 1 (0.1%).

Conclusions: Fungal infections share a good amount in the burden of increased morbidity and mortality in the diseased. Regular surveillance studies are important to determine the prevalence of different fungal infections in various centers.


Keywords: Fungus, candida, aspergillus, zygomycetes, India.


Clark TA, Hajjeh RA. Recent trends in the epidemiology of invasive mycoses. Curr Opin Infect Dis. 2002 Dec; 15(6):569-74.

Richardson MD, Warnock DW. Fungal Infection: Diagnosis and Management, 3rd edn. Oxford: Blackwell publishing, 2003.

Richardson M. Changing patterns and trends in systemic fungal infections. J Antimicrob Chemother. 2005 Sep; 56 Suppl 1:i5-i11.

Winn WC et al. Mycology. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th edition. USA: Lippincott Williams and Wilkins; 2006: p. 1156-232.

Pappas PG, Alexander BD, Andes DR, Hadley S, Kauffman CA, Freifeld A, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010 Apr 15; 50(8):1101-11. doi: 10.1086/651262.

Colombo AL, Nucci M, Park BJ, Nouer SA, Arthington-Skaggs B, da Matta DA, et al. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol. 2006 Aug; 44(8):2816-23.

Hajjeh RA, Sofair AN, Harrison LH, Lyon GM, Arthington-Skaggs BA, Mirza SA, et al. Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program. J Clin Microbiol. 2004 Apr; 42(4):1519-27.

Almirante B, Rodriguez D, Park BJ, Cuenca-Estrella M, Planes AM, Almela M, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005 Apr; 43(4):1829-35.

Takakura S, Fujihara N, Saito T, Kudo T, Iinuma Y, Ichiyama S. National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungal agents including voriconazole and micafungin. J Antimicrob Chemother. 2004 Feb; 53(2):283-9. Epub 2003 Dec 19.

Kauffman CA. Zygomycosis: reemergence of an old pathogen. Clin Infect Dis. 2004 Aug 15; 39(4):588-90. Epub 2004 Jul 30.

Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005 Sep 1; 41(5):634-53. Epub 2005 Jul 29.

Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C, et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005 Apr 15; 191(8):1350-60. Epub 2005 Mar 16.

Maschmeyer G. The changing epidemiology of invasive fungal infections: new threats. Int J Antimicrob Agents. 2006 Jun;27 Suppl 1:3-6. Epub 2006 May 16.

Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006 Aug;91(8):1068-75.

Richardson M, Lass-Florl C. Changing epidemiology of systemic fungal infections. Clin Microbiol Infect. 2008 May;14 Suppl 4:5-24. doi: 10.1111/j.1469-0691.2008.01978.x.

View Full Article: