Adjunctive use of posaconazole, hyperbaric oxygen therapy, and methylene blue for COVID-19-associated mucormycosis

The study aimed to assess the cumulative role of oral posaconazole, post-debridement Hyperbaric Oxygen (HBO) therapy, along with local application and steam inhalation with methylene blue as an adjunct to surgery to prevent further progression of COVID-19 associated sino-maxillary or mandibular mucormycosis.

A retrospective observational study was conducted on patients diagnosed with sino-maxillary or mandibular mucormycosis associated with COVID-19. A total of 38 patients underwent surgical debridement and received adjunctive treatment with posaconazole, hyperbaric oxygen therapy, and local application and steam inhalation of methylene blue. Medical records were analyzed for COVID-19-related hyperglycemia, prolonged hospitalization, immunosuppressive/steroid therapy, and the use of iron or zinc supplements, which may be linked to increased mucormycosis incidence. Outcomes were evaluated for association with any concurrent infection, complications, need for sequential debridement, and further progression of disease.

A total of 38 patients (range: 23-68) were included, comprising 24 males and 14 females. Isolated sino-maxillary involvement was observed in 32 cases (84.21%), and mandibular involvement in 5 cases (13.15%). No further disease progression was noted during the 2-year follow-up, based on clinical evaluation and postoperative computed tomography (CT) scans. Actinomycosis co-infection was identified in 21.05% of cases. Complications included wound dehiscence (39.47%), pus discharge (5.26%), reversible hearing impairment during HBO therapy (5.26%), and flap necrosis (2.63%). Four patients (10.52%) required sequential surgical debridement for sequestrum removal.

It was concluded that concurrent use of oral posaconazole, adjunct HBO therapy and methylene blue prevents further progression of COVID-19 associated sino-maxillary and mandibular mucormycosis.