Mucormycosis Case Series Due To Covid-19 Delta Variant

<p><strong>Abstract</strong></p>\n<p>The COVID-19 pandemic, particularly the Delta variant, has been associated with an increase in opportunistic infections, such as mucormycosis, especially in immunocompromised individuals. This case series presents three patients with type-2 diabetes mellitus who developed mucormycosis after receiving high-dose steroid treatment during their COVID-19 treatment. Despite the best medical and surgical efforts, all three patients faced severe outcomes, highlighting the challenges in managing mucormycosis, particularly in the context of COVID-19.</p>\n<p>Each patient exhibited extensive tissue necrosis, primarily affecting the nasal and paranasal regions, with rapid progression to orbital and cerebral involvement in some cases. Radiological evaluations, including CT and MR imaging, revealed extensive sinus involvement and necrotic changes, necessitating aggressive surgical debridement. The management included sinus surgery, maxillectomy, orbital exenteration, and the use of systemic antifungals like amphotericin-B. However, despite these interventions, all patients succumbed to the disease due to the angioinvasive nature of the infection and the complications of their underlying conditions.</p>\n<p>The pathophysiology of COVID-19-related mucormycosis is multifaceted. Hyperglycemia, often exacerbated by steroid use, along with the immunosuppressive effects of COVID-19, creates an environment conducive to fungal proliferation. Moreover, endothelial damage and reduced phagocytic function contribute to the angioinvasive behavior of Mucorales. Early diagnosis, close monitoring, and prompt surgical intervention are critical for improving survival rates. This case series underscores the importance of vigilance in at-risk patients and the need for a multidisciplinary approach to manage such infections effectively.</p>\n<p><strong>Keywords</strong>: Mucormycosis, COVID-19 Delta variant, Type-2 diabetes mellitus, Steroid therapy, Orbital exenteration, Sinus surgery, Amphotericin-B, Angioinvasive infection.</p>