International Journal of Anatomy Radiology and Surgery (Jul 2022)
Clinical Presentation and Outcome of Sinonasal Mucormycosis in Pre COVID-19 Era from a Tertiary Care Centre in Uttarakhand: A Cross-sectional Study
Introduction: Sinonasal mucormycosis is an invasive fungal rhinosinusitis which rapidly involves orbits and brain either by direct extension or angioinvasion. Uncontrolled diabetics and immunocompromised patients are prone for this invasive fungal infection. The rapidity of severity of symptoms and morbidity of this invasive fungal infection warrant earliest diagnosis and appropriate management. This research work will be helpful in comparing sinonasal mucormycosis in Coronavirus Disease- 2019 (COVID-19) patients as all cases in present study were not associated with COVID-19 infection. Aim: To observe presenting features and estimate morbidity of mucormycosis patients in tertiary care hospital. Materials and Methods: This cross-sectional retroprospective study was conducted in Department of Otorhinolaryngology of a tertiary teaching hospital from July 2018 to March 2020. Total 25 sinonasal mucormycosis patients who underwent endoscopic debridement along with amphotericin B were included in this study. Patient was analysed regarding age, gender, chief complains, accompanying co-morbidity, extension of disease, medical treatment, surgical intervention and final outcome. Statistical analysis was done in the form of mean, mode, median and percentage wherever required. Results: Total 14 (56%) patients were male and 11 (44%) patients were female with median age of 48 years. Total 13 (52 %) patients had facial pain or headache while 13 (52%) had facial or orbital swelling followed by nasal symptoms in 5 (20%), vision loss in 4 (16%) and ptosis in 3 (12%) cases. Twenty four (96%) of cases were having uncontrolled diabetes mellitus. Only 3 (12%) had limited sinonasal disease while 22 (88%) had fungal invasion in orbit. Total 7 (28%) patients had intracranial extension. Out of 25 patients, 4 (16%) expired, 7 (28%) had permanent vision loss and 12 (48%) recovered completely and 2 (8%) left hospital against medical advice. Conclusion: Present study concluded that mucormycosis is strongly associated with uncontrolled diabetes mellitus. Most common presenting features were facial pain, headache and facial orbital swelling. Only half of the patients recovered with minimal morbidity. Mortality is associated with intracranial extension of mucormycosis. Early diagnosis, extensive and timely endoscopic debridement and appropriate use of amphotericin B is key for treatment of black fungus.