COVID-19 associated pulmonary mucormycosis: A systematic review of published cases with review of literature.

Abstract

There is sharp rise in cases of Coronavirus disease 2019 (COVID-19)-associated mucormycosis worldwide and specially during second wave of COVID-19 pandemic. This systemic review was conducted to characterize pulmonary mucormycosis associated with COVID-19 infection. A systematic literature search was conducted in the electronic database of PubMed and Google Scholar from 1^st January 2020 to June 5, 2021 using keywords. Details of all the cases that reported pulmonary mucormycosis in people with COVID-19 so far, were retrieved and analyzed. Total 9 articles of pulmonary mucormycosis with COVID-19 infection were reported in the database of PubMed and Google Scholar. Only one case till date was reported from India, others are from USA (n-3), Italy (n-2), France (n-1), UK (n-1), and Arizona (n-1). Pooled data from this study showed mucormycosis was predominantly seen in males (8 male, 1 female). The most common comorbidities associated were diabetes (n-3), hematological malignancy, (n-2) and end-stage renal disease (n-2), while 2 cases did not show any associated comorbidity. All the cases were having severe COVID-19 infection and 7 out of 9 patients were in ICU and on mechanical ventilation at the time of diagnosis. None of the cases associated with rhino-orbital-cerebral mucormycosis (ROCM) except 1 patient with sinus involvement. Mortality was found in 7 out of 9 patients. There is a need to keep a high index of suspicion in patients with severe COVID-19 infections, diabetic, and received treatment in ICU with ventilator support for early diagnosis and treatment. Although Mucor is less common than Aspergillus infection, it is associated with higher mortality.