Sinonasal Mucormycosis Amidst the Second Wave of COVID-19 Pandemic; Clinical Spectrum and Outcome in a Tertiary Care Center in Nepal.

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.