• Aspergillosis
• COVID-19
• Invasive fungal sinusitis
• Mucormycosis
• Rhino- orbito-cerebral mucormycosis
• Scoring system

• COVID-19
• Mucorales
• black fungus
• mucormycosis
• zygomycosis

• Orbit
• amphotericin B
• injection
• mucormycosis
• retrobulbar

• Humans
• Amphotericin B/therapeutic use
• Antifungal Agents/therapeutic use
• Mucormycosis/diagnostic imaging
• Mucormycosis/drug therapy
• Retrospective Studies
• Case-Control Studies
• Orbital Diseases/diagnostic imaging
• Orbital Diseases/drug therapy
• Eye Diseases/drug therapy

• COVID-19
• Mucormycosis
• SARS-CoV-2
• fungal infection

• Male
• Humans
• Female
• Adult
• Middle Aged
• Aged
• Mucormycosis/epidemiology
• Mucormycosis/therapy
• Iran/epidemiology
• COVID-19/therapy
• Risk Factors
• Cost of Illness

• Humans
• Mucormycosis/epidemiology
• Pandemics
• COVID-19
• SARS-CoV-2
• Disease Outbreaks

• Black turbinate
• COVID-19
• MRI
• corticosteroids
• diabetes mellitus
• guitar pick sign
• mucormycosis
• orbital compartment syndrome
• orbital exenteration

• clinical presentation
• covid-19
• diabetes
• diagnosis
• investigations
• mucormycosis
• pathogenesis
• rhino-orbital cerebral mucormycosis
• sars-cov-2
• treatment

• Maxillofacial area
• Mucormycosis
• Systematic review
• Therapeutic regimen

• Corticosteroids
• Covid-19
• Diabetes-mellitus
• Giemsa
• KOH
• Mucormycosis

The objective is to describe the radiological imaging findings of post-COVID-19 acute invasive fungal rhinosinusitis (AIFRS), being familiar with the wide variety of imaging spectrum, thus raising the suspicion for early diagnosis. Methods: In this retrospective study, we reviewed the imaging findings in 54 patients with proven post-COVID-19 AIFRS who underwent endoscopic/surgical debridement from April 2020 to September 2021. Most of these patients presented with facial or orbital swelling or facial pain. Medical records with a special emphasis on radiological imaging (50 NCCT of the paranasal sinuses and 17 MRIs of the orbit) were reviewed regarding the degree of mucosal disease of sinuses, nasal cavity, and nasopharynx, extra sinus soft tissue infiltration, especially orbital and cerebral extension (parenchymal, cavernous sinus, vascular or neuro-invasion).

We reported findings in 54 patients with post-COVID-19 AIFRS, of whom 30 were men and 24 were women with a mean age of 48.06. Unexpectedly, infiltration of pterygopalatine fossa was found to precede mucosal opacification of sinuses nasal cavity and affection of nasopharynx. Out of 54 patients, 49 showed inflammatory changes involving pterygopalatine fossa, 29.6% of patients showed infiltration of orbital tissues, 22 patients suffered from a fungal invasion of the cavernous sinus and 3 patients had carotid artery involvement.

Imaging findings of AIFRS significantly vary from subtle mucosal thickening of paranasal sinuses, up to orbital and intracranial extension with vascular thrombosis and neuroinvasion. The hallmark inflammatory tissue infiltration into the pterygopalatine fossa and facial soft tissue may precede mucosal disease.

Objective: To highlight fungi other than mucormycetes as causative agents of rhinosinusitis with periocular swelling in coronavirus (COVID-19) infection caused by Delta variant of SARS-CoV-2 virus and identify the presenting features, risk factors, intervention, and outcomes.

Methods and analysis: A retrospective interventional study of 96 patients with fungal rhinosinusitis and periocular swelling was done in patients with concurrent or recovered COVID-19 infection with the Delta variant (B.1.617.2) of SARS-CoV-2 virus in India. All patients with mucormycetes infection were excluded. Clinical presentation, medical history, blood reports, and imaging were analyzed. Management was by intravenous (IV) liposomal amphotericin B and functional endoscopic sinus surgery (FESS) with paranasal sinus debridement. Limited orbital debridement with or without transcutaneous retrobulbar liposomal amphotericin B (TRAMB) was done in patients with orbital involvement. Postoperative antifungal therapy was decided on the basis of the causative fungi.

Results: Four cases of Aspergillus and one each of Fusarium, Curvularia, and Penicillium-associated fungal rhinosinusitis with periocular swelling were seen. Signs of orbital involvement on MRI were present in all four of them. Two of these showed partial third-nerve palsy while one case with aspergillosis suffered cavernous sinus thrombosis. Proptosis was not witnessed in any case. History of diabetes and use of steroids was seen in all patients. All patients had mild to moderate COVID-19 with oxygen supplementation needed in one. No mortality, acute vision loss, or exenteration took place.

Conclusion: Aspergillus, Fusarium, Curvularia, and Penicillium were non-mucormycetes causes of fungal rhinosinusitis with periocular swelling in COVID-19 infection with the Delta variant (B.1.617.2) of SARS COV-2 virus. Few cases showed orbital and intracranial involvement.

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a serious public health concern, particularly in developing countries. This meta-analysis aims to identify the risk factors that affect the mortality rate of patients with CAM.

We systematically searched PubMed, Google Scholar, Scopus, Cochrane library, and preprint databases using pertinent keywords and the reference lists of the included relevant articles from inception till October 27, 2021. In order to reduce the effects of small-scale studies, we only selected cross-sectional, case–control, and cohort studies and case series with at least four patients. We identified 26 articles that included 821 patients with CAM. The effect size (ES) of mortality rate was 28% (95% confidence interval (CI) 20%–38%; I² =82.28%; p for Cochran Q<0.001). The CAM patients with a history of comorbidities other than diabetes (malignancies, transplant, or renal failure), mechanical ventilation due to COVID-19, pulmonary and cerebral mucormycosis, and those who only received medical treatment for mucormycosis had the highest mortality rate.

Coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a major public health problem, particularly in developing countries. Severe COVID-19 infection, history of mechanical ventilation, early CAM, comorbidities other than diabetes (malignancies, transplant, or renal failure), pulmonary and rhino-orbito-cerebral mucormycosis, and delivering only medical treatment for mucormycosis were the worst prognostic factors in CAM patients. Identifying the mortality-related risk factors in CAM patients may help reduce the mortality rate by implementing optimized treatment approaches.

The online version contains supplementary material available at 10.1007/s12281-022-00440-2.

• COVID-19
• corticosteroids
• diabetes: diabetes ketoacidosis
• immunocompromise
• mucormycosis
• pulmonary
• rhino-orbito-cerebral

Mucormycosis is an invasive fungal infection caused by fungi belonging to order Mucorales. Recently, with the increase in COVID-19 infections, mucormycosis infections have become a matter of concern globally, because of the high morbidity and mortality rates associated with them. Due to the association of mucormycosis with COVID-19 disease, it has been termed COVID-19-associated mucormycosis (CAM). In the present review, we focus on mucormycosis incidence, pathophysiology, risk factors, immune dysfunction, interactions of Mucorales with endothelial cells, and the possible role of iron in Mucorales growth. We review the limitations associated with current diagnostic procedures and the requirement for more specific, cost-effective, convenient, and sensitive assays, such as PCR-based assays and monoclonal antibody-based assays for the effective diagnosis of mucormycosis. We discuss the current treatment options involving antifungal drug therapies, adjunctive therapy, surgical treatment, and their limitations. We also review the importance of nutraceuticals-based therapy for the prevention as well as treatment of mucormycosis. Our review also highlights the need to explore the potential of novel immunotherapeutics, which include antibody-based therapy, cytokine-based therapy, and combination/synergistic antifungal therapy, as treatment options for mucormycosis. In summary, this review provides a complete overview of COVID-19-associated mucormycosis, addressing the current research gaps and future developments required in the field.

• COVID-19
• antibodies
• antifungal drugs
• black fungus
• combination therapy
• cytokine therapy
• immunotherapies
• mucormycosis

Fungal co-infections are frequent in patients with coronavirus disease 2019 (COVID-19) and can affect patient outcomes and hamper therapeutic efforts. Nonetheless, few studies have investigated fungal co-infections in this population. This study was performed to assess the rate of fungal co-infection in patients with COVID-19 as a systematic review. EMBASE, MEDLINE, and Web of Science were searched considering broad-based search criteria associated with COVID-19 and fungal co-infection. We included case reports and case series studies, published in the English language from January 1, 2020 to November 30, 2021, that reported clinical features, diagnosis, and outcomes of fungal co-infection in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Totally, 54 case reports and 17 case series were identified, and 181 patients (132 men, 47 women, and 2 not mentioned) co-infected with COVID-19 and fungal infection enrolled. The frequency of fungal co-infection among patients with COVID-19 was 49.7, 23.2, 19.8, 6.6, and 0.5% in Asia, America, Europe, Africa, and Australia, respectively. Diabetes (59.6%) and hypertension (35.9%) were found as the most considered comorbidities in COVID-19 patients with fungal infections. These patients mainly suffered from fever (40.8%), cough (30.3%), and dyspnea (23.7%). The most frequent findings in the laboratory results of patients and increase in C-reactive protein (CRP) (33.1%) and ferritin (18.2%), and lymphopenia (16%) were reported. The most common etiological agents of fungal infections were Aspergillus spp., Mucor spp., Rhizopus spp., and Candida spp. reported in study patients. The mortality rate was 54.6%, and the rate of discharged patients was 45.3%. Remdesivir and voriconazole were the most commonly used antiviral and antifungal agents for the treatment of patients. The global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 54.6% of COVID-19 patients with fungal co-infections died. Thus, this study indicated that fungal co-infection and COVID-19 could increase mortality. Targeted policies should be considered to address this raised risk in the current pandemic. In addition, fungal infections are sometimes diagnosed late in patients with COVID-19, and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with fungal infections should be screened regularly during the COVID-19 pandemic to prevent the spread of the COVID-19 patients with fungal co-infection.

• Aspergillus
• COVID-19
• co-infection
• fungal infection
• systematic review

Mucormycosis has become increasingly associated with COVID-19, leading to the use of the term “COVID-19 associated mucormycosis (CAM)”. Treatment of CAM is challenging due to factors such as resistance to many antifungals and underlying co-morbidities. India is particularly at risk for this disease due to the large number of patients with COVID-19 carrying comorbidities that predispose them to the development of mucormycosis. Additionally, mucormycosis treatment is complicated due to the atypical symptoms and delayed presentation after the resolution of COVID-19. Since this disease is associated with increased morbidity and mortality, early identification and diagnosis are desirable to initiate a suitable combination of therapies and control the disease. At present, the first-line treatment involves Amphotericin B and surgical debridement. To overcome limitations associated with surgery (invasive, multiple procedures required) and amphotericin B (toxicity, extended duration and limited clinical success), additional therapies can be utilized as adjuncts or alternatives to reduce treatment duration and improve prognosis. This review discusses the challenges associated with treating CAM and the critical aspects for controlling this invasive fungal infection—early diagnosis and initiation of therapy, reversal of risk factors, and adoption of a multipronged treatment strategy. It also details the various therapeutic options (in vitro, in vivo and human case reports) that have been used for the treatment of CAM.

Invasive fungal sinusitis (IFS) in patients with active or recent COVID‐19 have been reported throughout the world. The primary purpose of the systematic review is to describe factors associated with IFS in patients with COVID‐19. The goal of the case series was to also characterize these factors in addition to evaluating the incidence of IFS at our institution after the onset of the pandemic.

A systematic review using the preferred reporting in systematic reviews and meta‐analyses (PRISMA) framework identified publications of IFS cases associated with COVID‐19 (IFSAC). Search terms were “COVID‐19,” “invasive,” “fungal,” and “sinusitis.” IFS cases were evaluated for COVID‐19 status, fungal etiology, comorbidities, treatment, and outcome. A case series of patients at our center with IFS between December 1, 2018 to March 31, 2020 (“pre‐covid”) and April 1, 2020 to August 1, 2021 (“post‐covid”) was also performed with the above parameters.

Fourteen studies totaling 206 cases of IFSAC were identified. Most cases came from India (140/206, 68.0%), followed by Egypt (62/206, 30.1%), and North America (4/206, 1.9%). Diabetes was the most common comorbidity (151/206, 73.3%). Recent or prolonged steroid use was noted in 65.0% of cases (134/206). In our series, five pre‐covid and four post‐covid cases were identified. One had recent COVID‐19 infection. Acute myeloid leukemia was the most common pre‐covid comorbidity (3/5, 60.0%). Diabetes was the most frequent post‐covid comorbidity (2/4, 50.0%). Chronic steroid usage was noted in two pre‐covid and one post‐covid cases.

Diabetes and steroid use are common factors in reported cases of IFSAC. IFS incidence in our case series did not change appreciably after the onset of the pandemic.

Level of Evidence: 4.

• Aspergillus
• Associated pulmonary aspergillosis (CAPA)
• Candida
• Mucormycosis
• Non-Candida yeasts
• Pneumonia

• COVID-19/epidemiology
• Coinfection/epidemiology
• Humans
• Mycoses/epidemiology
• Pandemics
• SARS-CoV-2

• ACE2
• CAM
• COVID-19
• GRP-78
• SARS-CoV-2
• corticosteroids
• cytokine storm
• hyperglycemia
• immunosuppression
• iron overload
• mucormycosis

• FC 2015-02-834 Consejo Nacional de Ciencia y Tecnología
• Ciencia de Frontera 2019-6380 Consejo Nacional de Ciencia y Tecnología
• CONACYT-México Red Temática Glicociencia en Salud

• Anesthesia, Local
• Antifungal Agents/therapeutic use
• Eye Infections, Fungal/drug therapy
• Humans
• Mucormycosis/drug therapy
• Mucormycosis/surgery
• Orbital Diseases/drug therapy
• Orbital Diseases/surgery

Severe-acute respiratory coronavirus 2 (SARS-CoV-2) causing corona virus disease 2019 (COVID-19) has been the single most important pathogen driving health care delivery system for the last one and half years. Now, as the time is passing, many issues related to co-infections/secondary infections/superinfections in COVID-19 patients are emerging. The literature is getting enriched everyday by addition of reports from all over the world for the same. The purpose of this review is to decipher the plethora of fungal infections in COVID-19.

COVID-19 infection along with it brought many risk factors namely lung injury, immunosuppression, need for oxygen therapy, monoclonal antibodies, steroid therapy, etc. which are known predisposing factors for fungal infections. Rather the extent and severity of fungal pathogens has been so much that it has led to new terminologies like CAC (COVID-19-associated Candida), CAPA (COVID-19-associated pulmonary aspergillosis) and CAM (COVID-19-associated mucormycosis). There is increase in invasiveness of Candida, prevalence of aspergillosis in COVID-19 damaged lung and outbreak of mucormycosis in COVID-19 patients resulting in “double trouble,” keeping laboratory personnel, clinicians, and intensivists on their toes in managing these patients.

Awareness and understanding regarding these possible complications is necessary to decrease the morbidity and mortality among patients. The COVID-19 and fungal coinfections may bring more insight into ways of pathogenesis of fungal infections, need for better antifungal agents, quick diagnostic modalities, and better management policies in the near future.

• COVID-19
• Co-infections
• Fungal diagnostics
• Mucormycosis
• SARS-CoV-2

• COVID-19
• Coinfection/epidemiology
• Humans
• Mucormycosis/diagnosis
• Mucormycosis/drug therapy
• Mucormycosis/epidemiology
• Opportunistic Infections/complications
• Opportunistic Infections/epidemiology
• Pandemics
• SARS-CoV-2

The COVID-19 pandemic has led to a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis (ROCM) in India. The purpose of our report is to describe the prevalence of ROCM in the context of SARS-CoV-2 infection during the second Indian COVID-19 wave, as well as its diagnostics proceeding, and to discuss the challenges met in the time frame from the suspected diagnosis to the therapeutic decision in such patients. We conducted a retrospective multicentre case series study at six centres of Sudhalkar and Raghudeep group of hospitals in India. ROCM was confirmed in 38 (2.5%) of the 1546 patients admitted with SARS-CoV-2 infection. The average time to establish a diagnosis was 16 days. In total, 19 (50%) patients suffered from type 2 diabetes and were mostly treated with hypoglycaemic agents (in 90% of cases). The standard of care for SARS-CoV-2 management included systemic steroids therapy, intravenous remdesivir for 5 days, and concomitant prophylactic antibiotic therapy following admission. The median (IQR) blood glucose levels in all patients during the course of hospitalisation was 320 (250.5–375) mg/dl. A total of 16% of patients had an irreparable functional loss, and the mortality was 5%. We may hypothesise that excessive administration of antibiotics that profoundly affects human microbiota, coupled with poorly controlled glycaemia and unprotocolised haphazard steroid administration, contribute to a favourable setting for mucormycosis infections.

Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we review the major oral and maxillofacial mycoses of COVID-19, the associated comorbidities, and the probable precipitating factors.

English-language manuscripts published between March 2020 and October 2021 were searched using PubMed, OVID, SCOPUS, and Web of Science databases, using appropriate keywords.

We identified 30 articles across 14 countries, which met the inclusion criteria of PRISMA guidelines. These yielded a total of 292 patients with laboratory-confirmed COVID-19, 51.4% (n = 150) of whom presented with oral and maxillofacial fungal infections, mainly comprising candidosis, mucormycosis, and aspergillosis. Candida infections were the most prevalent, present in 64% (n = 96), followed by mucormycosis, and only a single case of aspergillosis was noted. Oral and maxillofacial mycoses were predominantly seen in those with comorbidities, especially in those with diabetes (52.4%). Oral mucormycosis was noted in 8.6% (n = 13) and mainly manifested on the hard palate. An overall event rate of oral/maxillofacial mucormycosis manifestation in patients with COVID-19 with diabetes mellitus type 1/2 was about 94% (49/52; 95% confidence interval, 0.73%-0.89%), implying a very high association between diabetes mellitus and the latter condition. All fungal infections appeared either concurrently with COVID-19 symptoms or during the immediate recovery period.

SARS-CoV-2 infection–related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.

Background: The coronavirus disease 2019 (COVID-19) pandemic has taken the world to different dimensions. With the surge of the second wave in India, the number of cases with mucormycosis has increased. Mucormycosis is a potentially life-threatening, opportunistic, invasive, fungal infection that can occur in immunocompromised states. The aim of the study is to analyze the clinicopathological parameters of patients with mucormycosis in the surge of the second wave of COVID-19.

Materials and Methods: All cases of mucormycosis reported in the Department of Pathology in a tertiary care centre in South India from March 2021 to June 2021 were included in the study. The patient details were retrieved from the Medical Records section. The patient characteristics, location, associated comorbidities, management and treatment outcomes were analyzed and compared to similar studies reported worldwide.

Results: Of 58 cases, 38 (65%) were males and 20 (35%) were females. The ages ranged from 34 to 77 years. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in 46 patients in reverse transcription polymerase chain reaction (RT-PCR) with high-resolution computed tomography (HRCT) Chest changes noted in 54 patients. Associated comorbidities were noted in 52 patients, with uncontrolled diabetes mellitus (46 patients; 88%) being the most common. Location was commonly in nasal and paranasal sinuses (43%), followed by orbital (2%), cerebral (10%) and pulmonary (8%) areas. Among the paranasal sinuses, the maxillary sinus was commonly involved. Mixed fungal infections (Aspergillus sp. and Candida sp.) were noted in eight (14%) cases. Oxygen therapy was given in 85% of cases; 30% of cases needed ventilator support; corticosteroid therapy was initiated in 49 patients, tocilizumab in six patients as treatment for mucormycosis. Amphotericin B was administered in 59% of patients based on clinical findings alone. After histopathological confirmation, 90% of them received amphotericin. Functional endoscopic sinus surgery (FESS) was done in 96% of cases, among them 45% underwent extensive surgical debridement and 15% underwent orbital decompression. Orbital exenteration (2%) was the other modality of management.

Conclusion: Detailed analysis of clinicopathological features suggests the possibilities of immunosuppression (due to diabetes and use of corticosteroids in treatment of COVID-19) and COVID-19 (endothelial damage, cytokine storm) being the pathogenesis associated with the sudden surge of mucormycosis.

• covid-19
• cytokine storm
• fungal stain
• immuno suppresion
• mucormycosis
• polymerase chain reaction
• steroids
• uncontrolled diabetes

The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM).

This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM.

59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death.

CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.

• Amphotericin B
• COVID-19 associated Mucormycosis
• Diabetes Mellitus
• Functional endoscopic paranasal sinus surgery
• Posaconazole
• Rhino-orbito-cerebral mucormycosis
• Steroids

• COVID-19
• Mucormycosis
• diabetes mellitus
• sinus
• steroids

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly become a global threaten since its emergence in the end of 2019. Moreover, SARS-CoV-2 infection could also present with co-infection or secondary infection by other virus, bacteria, or fungi. Among them, mucormycosis is a rare but aggressive fungal disease and it mainly affects patients particularly with poorly controlled diabetes mellitus with diabetic ketoacidosis (DKA). We here did a comprehensive review of literature reporting COVID-19 associated with mucormycosis (CAM) cases, which have been reported worldwide. The prevalence is higher in India, Iran, and Egypt than other countries, particularly highest in the states of Gujarat and Maharashtra in India. Poor diabetic control and the administration of systemic corticosteroids are the common precipitating factors causing mucormycosis in the severe and critical COVID-19 patients. In addition, COVID-19 itself may affect the immune system resulting in vulnerability of the patients to mucormycosis. Appropriate treatments of CAM include strict glycemic control, extensive surgical debridement, and antifungal therapy with amphotericin B formulations.

• COVID-19
• Corticosteroid
• Diabetes mellitus
• Fungus
• Mucormycosis

• COVID-19
• Corticosteroid
• Diabetics
• Mucormycosis
• Rhizopus

• COVID-19
• Mucormycosis
• emerging disease
• glucocorticoid
• risk factor

• Healthcare
• Hospital
• Mucorales
• Outbreak
• Rhizopus
• SARS-CoV-2

• COVID-19
• Diabetes Mellitus
• Humans
• India/epidemiology
• Mucormycosis/diagnosis
• Mucormycosis/drug therapy
• Mucormycosis/epidemiology
• Risk Factors
• SARS-CoV-2

• complications from treatment
• covid-19
• ocular involvement
• vaccine-related eye problems

• COVID-19
• Humans
• Ophthalmologists
• Pandemics
• SARS-CoV-2
• Vaccination/adverse effects

• COVID-19
• Coronavirus
• Fungal infections
• Mucor
• Mucormycosis

• Humans
• Male
• Middle Aged
• COVID-19
• Incidence
• Mucormycosis/diagnosis
• Mucormycosis/drug therapy
• Risk Factors
• SARS-CoV-2

• CAM
• CAPA
• COVID-19
• PCP
• aspergillosis
• candidemia
• cryptococcosis
• histoplasmosis
• invasive fungal infections
• mucormycosis

• COVID-19
• Mucorales
• Rhizopus
• co-infection
• cross-infection
• mucormycosis
• mycoses
• review
• risk factors
• steroids

• MUNI/IGA/1543/2020 Masarykova Univerzita
• MUNI/A/1608/2020 Masarykova Univerzita
• PPI/STE/2020/1/00014/DEC/02 Narodowa Agencja Wymiany Akademickiej
• LTC20031 Ministerstvo Školství, Mládeže a Tělovýchovy

• COVID-19
• Fungal infections
• Maxillofacial region

• COVID-19
• Orbital mucormycosis
• SARS-CoV-2 co-infection
• diabetes
• mucormycosis
• rhino-orbital infection

• Adolescent
• Adult
• Aged
• Amphotericin B/therapeutic use
• Antifungal Agents/therapeutic use
• COVID-19/complications
• COVID-19/pathology
• Caspofungin/therapeutic use
• Coinfection
• Comorbidity
• Cross-Sectional Studies
• Diabetes Complications/microbiology
• Diabetes Complications/mortality
• Diabetes Mellitus/pathology
• Drug Therapy, Combination
• Female
• Humans
• Iran
• Male
• Middle Aged
• Mucormycosis/drug therapy
• Mucormycosis/mortality
• Mucormycosis/pathology
• Respiratory Distress Syndrome/microbiology
• Respiratory Distress Syndrome/mortality
• Respiratory Distress Syndrome/pathology
• Triazoles/therapeutic use
• Young Adult
• COVID-19 Drug Treatment

• 99-1-252-47469 Tehran University of Medical Sciences and Health Services
• Tehran University of Medical Sciences and Health Services

• COVID-19
• diabetes
• epidemiology
• evidence
• mortality
• mucormycosis
• mycoses
• public health

• Adult
• Aged
• COVID-19
• Comorbidity
• Diabetes Mellitus
• Humans
• Male
• Middle Aged
• Mucormycosis/diagnosis
• Mucormycosis/epidemiology
• Mucormycosis/therapy
• SARS-CoV-2

• CZ.02.2.69/0.0/0.0/18_053/0016952 Masarykova Univerzita
• LTC20031 INTER-EXCELLENCE grant
• MUNI/IGA/1543/2020 and MUNI/A/1608/2020 Masarykova Univerzita

A severe pandemic of Coronavirus Disease (COVID‐19) has been sweeping the globe since 2019, and this time, it did not stop, with frequent mutations transforming into virulent strains, for instance, B.1.1.7, B.1.351, and B.1.427. In recent months, a fungal infection, mucormycosis has emerged with more fatal responses and significantly increased mortality rate. To measure the severity and potential alternative approaches against black fungus coinfection in COVID‐19 patients, PubMed, Google Scholar, World Health Organization (WHO) newsletters, and other online resources, based on the cases reported and retrospective observational analysis were searched from the years 2015–2021. The studies reporting mucormycosis with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) coinfection and/or demonstrating potential risk factors, such as a history of diabetes mellitus or suppressed immune system were included, and reports published in non‐English language were excluded. More than 20 case reports and observational studies on black fungus coinfection in COVID‐19 patients were eligible for inclusion. The results indicated that diabetes mellitus, hyperglycemic, and immunocompromised COVID‐19 patients with mucormycosis were at a higher risk. We found that it was prudent to assess the potential risk factors and severity of invasive mycosis via standardized diagnostic and clinical settings. Large‐scale studies need to be conducted to identify early biomarkers and optimization of diagnostic methods has to be established per population and geographical variation. This will not only help clinicians around the world to detect the coinfection in time but also will prepare them for future outbreaks of other potential pandemics.

Observational studies and case reports of Post‐COVID black fungus co‐infection highlighted in review.

• COVID-19
• black fungus
• diagnosis
• fungal infection
• mucormycosis

• COVID-19 associated Mucormycosis (CAM)
• black fungus
• hyperglycemia
• mucormycosis
• severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

• COVID-19
• Mucormycosis
• Rhizopus oryzae

• COVID-19
• Diabetes Mellitus
• Humans
• Invasive Fungal Infections/diagnosis
• Invasive Fungal Infections/drug therapy
• Male
• Middle Aged
• Mucormycosis/diagnosis
• Mucormycosis/drug therapy
• SARS-CoV-2

• IR.QUMS.REC.1399.357 Qazvin University of Medical Sciences

• Adult
• Aged
• Aged, 80 and over
• COVID-19/complications
• Fatal Outcome
• Female
• Humans
• Lung/diagnostic imaging
• Lung/microbiology
• Lung Diseases/complications
• Lung Diseases/diagnostic imaging
• Lung Diseases/microbiology
• Male
• Middle Aged
• Mucormycosis/complications
• Mucormycosis/diagnostic imaging
• Retrospective Studies
• SARS-CoV-2
• Tomography, X-Ray Computed/methods
• Young Adult

• Mucor
• Mucorales
• Rhizopus
• amphotericin B
• antifungal
• antifungal susceptibility
• isavuconazole
• mucoralean fungi
• mucormycosis
• posaconazole
• susceptibility

• Amphotericin B/pharmacology
• Antifungal Agents/pharmacology
• Antifungal Agents/therapeutic use
• Fungi
• Humans
• Itraconazole
• Microbial Sensitivity Tests
• Mucorales
• Mucormycosis/drug therapy
• Mucormycosis/epidemiology
• United States/epidemiology

• Astellas Pharma US (Astellas)

• COVID-19
• Mucormycosis
• SARS-CoV-2