Prognostication of Sino-Nasal Mucormycosis

Document Type : Original


Department of Otolaryngology & Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.


For the purpose of prognostication of sinonasal mucormycosis, a detailed analysis of the clinical, diagnostic, therapeutic and outcome parameters has been contemplated.
Materials and Methods:
Retrospectively data was collected for all patients of sinonasal mucormycosis managed in a tertiary care hospital in last 5years.
Diabetes was the commonest comorbidity among total of 52 cases. Disease extent-wise, 16, 23 and 13 patients had sino-nasal (SN), rhino-orbital (RO) and rhino-orbito-cerebral (ROC) mucormycosis respectively.  Median cumulative Amphotericin-B administered was 3.5gms and 94.2% of cases underwent surgical debridement depending on the disease extent. With a median follow-up of 18months, 67% of the patients are alive and disease free, 2% are under treatment and 29% of patients have expired. The mortality rate was 12.5% in SN, 30.5% in RO and 38.5% in ROC mucormycosis. Palatal and orbital involvement is associated with statistically significant mortality risk at one month.
Mortality rate in sino-nasal mucormycosis can be significantly curtailed with prompt control of underlying comorbidity, aggressive medical and adequate surgical management.


  1. 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
  2. Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years? Clin Otolaryngol. 2018;43(6):1454-1464. doi:10.1111/coa.13175
  3. Raizada N, Jyotsna VP, Kandasamy D, Xess I, Thakar A, Tandon N. Invasive fungal rhinosinusitis in patients with diabetes. J Infect Dev Ctries. 2018; 12(09 SE-Original Articles). doi: 10. 3855/ jidc.9699
  4. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Heal. 2018;6(12):e1352-e1362. doi:10.1016/S2214-109X (18) 30387-5
  5. Chakrabarti A, Singh R. Mucormycosis in India: unique features. Mycoses. 2014;57 Suppl 3:85-90. doi:10.1111/myc.12243
  6. Bala K, Chander J, Handa U, Punia RS, Attri AK. A prospective study of mucormycosis in north India: experience from a tertiary care Med Mycol. 2015;53(3):248-257. doi:10. 1093/ mmy/ myu086
  7. Dhiwakar M, Thakar A, Bahadur S. Improving outcomes in rhinocerebral mucormycosis - early diagnostic pointers and prognostic factors. J Laryngol Otol. 2003;117(11):861-865. doi:DOI: 10.1258/ 002221503322542854
  8. Chakrabarti A, Denning DW, Ferguson BJ, et al. Fungal rhinosinusitis. Laryngoscope. 2009; 119(9): 1809-1818. doi:10.1002/lary.20520
  9. Ibrahim AS, Spellberg B, Walsh TJ, Kontoyiannis DP. Pathogenesis of mucormycosis. Clin Infect Dis an Off Publ Infect Dis  Soc Am. 2012;54 Suppl 1(Suppl 1):S16-22. doi:10.1093/ cid/ cir865
  10. Binder U, Maurer E, Lass-Florl C. Mucormycosis--from the pathogens to the disease. Clin Microbiol Infect. 2014;20 Suppl 6:60-66. doi: 10.1111/1469-0691.12566
  11. Mignogna MD, Fortuna G, Leuci S, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis  IJID  Off Publ  Int Soc Infect Dis. 2011;15(8):e533-40. doi:10.1016/j.ijid.2011.02.005
  12. Sivagnanam S, Sengupta DJ, Hoogestraat D, et al. Seasonal clustering of sinopulmonary mucormycosis in patients with hematologic malignancies at a large comprehensive cancer center. Antimicrob Resist Infect Control. 2017;6: 123. doi:10.1186/s13756-017-0282-0
  13. Al-Ajam MR, Bizri AR, Mokhbat J, Weedon J, Lutwick L. Mucormycosis in the Eastern Mediterra- nean: a seasonal disease. Epidemiol Infect. 2006; 134(2):341-346.doi:10.1017/S095026880500 4930
  14. Shpitzer T, Keller N, Wolf M, et al. Seasonal variations in rhino-cerebral Mucor infection. Ann Otol Rhinol Laryngol. 2005;114(9):695-698. doi: 10. 1177/000348940511400907
  15. Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Med Mycol. 2019;57(4):395-402. doi:10. 1093/ mmy/ myy 060
  16. Lanternier F, Dannaoui E, Morizot G, et al. A global analysis of mucormycosis in France: the RetroZygo Study (2005-2007). Clin Infect Dis an Off Publ Infect Dis  Soc Am. 2012;54 Suppl 1:S35-43. doi:10.1093/cid/cir880
  17. Spellberg B, Edwards JJ, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18(3):556-569. doi:10.1128/CMR.18.3.556-569.2005
  18. Sravani T, Uppin SG, Uppin MS, Sundaram C. Rhinocerebral mucormycosis: Pathology revisited with emphasis on perineural spread. Neurol India. 2014;62(4):383-386.doi:10.4103/0028-886.141252
  19. Lone P, Wani N, Jehangir M. Rhino-orbito-cerebral mucormycosis: Magnetic resonance imaging. Indian J Otol. 2015;21(3):215-218. doi: 10. 4103/0971-7749.159700
  20. Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base. 2009;19(2):117-125. doi:10.1055/s-0028-1096209
  21. Hong H-L, Lee Y-M, Kim T, et al. Risk factors for mortality in patients with invasive mucormycosis. Infect Chemother. 2013;45(3):292-298. doi:10. 3947/ ic.2013.45.3.292
  22. Tissot F, Agrawal S, Pagano L, et al. ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients. Haematologica. 2017;102(3):433 LP - 444. doi:10. 3324/ haematol.2016.152900
  23. Cornely OA, Arikan-Akdagli S, Dannaoui E, et al. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect  Off Publ Eur  Soc Clin Microbiol Infect Dis. 2014;20 Suppl 3:5-26. doi: 10.1111/1469-0691.12371
  24. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol. 1994; 39(1):3-22. doi:10.1016/s0039-6257(05) 80041-4
  25. Almyroudis NG, Sutton DA, Linden P, Rinaldi MG, Fung J, Kusne S. Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature. Am J Transplant  Off J Am Soc  Transplant Am Soc Transpl Surg. 2006; 6(10): 2365-2374. doi:10.1111/j.1600-6143. 2006. 01496.x
  26. Bozorgi V, Talebitaher M, Shalbaf N, Radmanesh N, Nasri F, Ansari-Ramandi MM. Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran. Pan Afr Med J. 2016;24:232. doi:10.11604/pamj.2016.24.232.9688
  27. Strasser MD, Kennedy RJ, Adam RD. Rhinocerebral mucormycosis. Therapy with amphotericin B lipid complex. Arch Intern Med. 1996;156(3):337-339. doi: 10.1001/ archinte.156.
  28. Shah PD, Peters KR, Reuman PD. Recovery from rhinocerebral mucormycosis with carotid artery occlusion: a pediatric case and review of the literature. Pediatr Infect Dis J. 1997;16(1):68-71. doi:10.1097/00006454-199701000-00015