Management of Sinonasal Mucormycosis at a Tertiary Care Center: Our Experience

R Anil Kumar, Nikhil M John, Bandadka Ramya, Hosaagrahara Subbegowda Satish
2019 Clinical Rhinology An International Journal  
Mucormycosis is a group of invasive infections caused by filamentous fungi of the Mucoraceae family. Most commonly seen in immunocompromised individuals. Sinonasal mucormycosis is a rare infection, difficult to treat, and can also be fatal. Aims and objectives: To highlight the importance of early detection of disease, early initiation of antifungal therapy, surgical debridement, and adequate management of immunosuppressive conditions. Materials and methods: In this prospective study, 46 cases
more » ... f sinonasal mucormycosis with different courses of illness and comorbidities who presented to the ENT OPD at Bengaluru Medical College and Research Institute from July 2015 to June 2018 were included. They were subjected to a common standardized treatment protocol and outcomes were assessed and discussed. Results: Most of the patients in our study were in the 4th decade of life. Diabetes mellitus was seen in 94% of our patients. Imaging studies were non-specific with features suggestive of sinusitis. Nasal endoscopy helps in arriving at a provisional diagnosis and knowing the extent of the lesion. Biopsy of tissue showing fungal hyphae with invasion is confirmatory. In our study, 22 (47.8%) patients expired during the time period. Among the expired patients, only 7 had got combined modality treatment and 20 patients presented after 6 months of the onset of symptoms. In patients with strict glycemic control, no recurrences were seen. Conclusion: The key to manage mucormycosis is early detection and initiation of antifungal treatment. In any immunocompromised patient presenting with features of sinusitis, mucormycosis has to be ruled out. Liposomal amphotericin B therapy has better compliance. Endoscopic debridement is of vital importance for excellent local control. Control of glycemic status boosts the body's immune process and reduces the chance of recurrence.
doi:10.5005/jp-journals-10013-1364 fatcat:ylofb4sqizevnmtirnxgtemfka