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.
Ferguson BJ. Mucormycosis of the nose and paranasal sinuses. Otolaryngol Clin North Am 2000;3(2):349–365. DOI: 10.1016/S0030-6665(00)80010-9.
Epstein VA, Kern RC. Invasive fungal sinusitis and complications of rhinosinusitis. Otolaryngol Clin North Am 2008;41(3):497–524. DOI: 10.1016/j.otc.2008.01.001.
Auluck A. Maxillary necrosis by mucormycosis. A case report and literature review. Med Oral Patol Oral Cir Bucal 2007;12(5):E360–E364.
Jagdish C, Reetika S, Pallavi S, et al. Mucormycosis of the paranasal sinus with gas forming maxillary osteomyelitis — a case report. Internet J Microbiol 2012;10(1). Available from: https://ispub.vom/IJMB/10/1/13760.
Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of Zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005;41(5):634–653. DOI: 10.1086/432579.
Parfrey NA. Improved diagnosis and prognosis of mucormycosis. A clinicopathologic study of 33 cases. Medicine 1986;65(2):113–123. DOI: 10.1097/00005792-198603000-00004.
Ferry AP, Abedi S. Diagnosis and management of rhinoorbito-cerebral mucormycosis (phycomycosis). A report of 16 personally observed cases. Ophthalmology 1983;90(9):1096–1104. DOI: 10.1016/S0161-6420(83)80052-9.
Talmi YP, Goldschmied-Reouven A, Bakon M, et al. Rhino - orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002;127(1):22–31. DOI: 10.1067/mhn.2002.126587.
Strasser MD, Kennedy RJ, Adam RD. Rhinocerebralmucormycosis: therapy with amphotericin B lipid complex. Arch Intern Med 1996;156(3):337–339. DOI: 10.1001/archinte.1996.00440030 145018.
Singh I, Gupta V, Gupta SK, et al. Our experience in endoscopic management of mucormycosis: a case series and review of literature. Int J Otorhinolaryngol Head Neck Surg 2017;3(2):465–471. DOI: 10.18203/issn.2454-5929.ijohns20171217.
Gillespie MB, O'Malley BW. An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin North Am 2000;33(2):323–334. DOI: 10.1016/S0030-6665(00)80008-0.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B–based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008;47(4):503–509. DOI: 10.1086/590004.
Spellberg B, Ibrahim AS. Recent advances in the treatment of mucormycosis. Curr Infect Dis Rep 2010;12(6):423–429. DOI: 10.1007/s11908-010-0129-9.
Gleissner B, Schilling A, Anagnostopolous I, et al. Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma 2004;45(7):1351–1360. DOI: 10.1080/10428190310001653691.