KUMJ | VOL. 22 | NO. 4 | ISSUE 88 | OCTOBER. - DECEMBER. 2024
Sinonasal Mucormycosis Amidst the Second Wave of COVID-19 Pandemic; Clinical Spectrum and Outcome in a Tertiary Care Center in Nepal
Gurung U, Dongol K, Paudel S, Thapa NM, Pradhananga RB, Gyawali BR, Shrestha GS
Abstract: Background
Mucormycosis is an angioinvasive opportunistic fungal infection which surged during
the second wave of COVID-19 pandemic.
Objective
This study assessed patient demographics, risk factors, clinical characteristics, and
outcomes of sinonasal mucormycosis during the second wave of COVID-19 pandemic.
Method
The clinical records of patients with histologically proven sinonasal mucormycosis,
admitted between May 2021 to October 2021, in a tertiary center were reviewed.
Result
There were 25 patients (18 males, 7 females). The age ranged from 16 to 70 years
(mean 51 ± 9.5 years). Uncontrolled diabetes mellitus detected in 23 patients was the
most common co-morbidity. COVID-19 infection was documented in 20 patients. The
mean time of diagnosis was 12 days after the onset of COVID-19 infection. Based on
the disease extent, six patients had sino-nasal, seven had rhino-orbital, and 12 had
rhino-orbital-cerebral involvement. The most common first presenting symptom was
orbital (17/25) followed by facial (5/25) and orodental (3/25). All patients received
intravenous amphotericin B for 2 to 8 weeks. Maintenance with posaconazole ranged
from 3 to 9 months. Sixteen patients underwent surgical debridement. Out of the
25 patients, 14 (56%) had good recovery. Poor outcome was observed mostly with
intracranial involvement.
Conclusion
Uncontrolled diabetes mellitus was a common risk factor. Advanced disease at
presentation was frequently encountered due to rapid extrasinus spread. Nearly
50% of patients had good recovery whilst poor outcome was observed, mostly with
intracranial involvement. Adequate blood sugar control, early administration of
antifungals, and aggressive surgical debridement are the mainstay of treatment.
Keyword : COVID-19, Hyperglycemia, Mucor, Mucormycosis, Pandemic
