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VOLUME 12 , ISSUE 2-3 ( May-December, 2019 ) > List of Articles

Original Article

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

Nikhil M John, R Anil Kumar, Bandadka Ramya, Hosaagrahara Subbegowda Satish

Keywords : Endoscopic debridement, Liposomal amphotericin B, Mucormycosis, Sinonasal mucormycosis

Citation Information : John NM, Kumar RA, Ramya B, Satish HS. Management of Sinonasal Mucormycosis at a Tertiary Care Center: Our Experience. Clin Rhinol An Int J 2019; 12 (2-3):52-56.

DOI: 10.5005/jp-journals-10013-1364

License: CC BY-NC 4.0

Published Online: 24-02-2021

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: 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 of 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.


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