Comparative risk assessment of COVID‐19 associated mucormycosis and aspergillosis: A systematic review

Abstract

COVID‐19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID‐19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA‐associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South‐European and West‐European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre‐existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one‐fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.

Clinical Profile and Factors Associated with Adverse Outcomes in Coronavirus Disease 2019-associated Mucormycosis: A Single-centre Study

“…Patients in our cohort may have been predisposed to developing CAM by preexisting diabetes mellitus or prediabetic state, steroid therapy, and compromised immune functions due to COVID-19, as observed in other studies. 7,9,15 Corticosteroid use is particularly implicated in the aetiopathogenesis of CAM, as a systemic immune response to invasive fungal infections, such as mucormycosis and aspergillosis, are found in a very high proportion of patients. 14 Steroid therapy may exacerbate gross alterations in lymphocyte and macrophage functions in COVID-19, and make patients particularly vulnerable to these kinds of invasive fungal diseases.…”

COVID-19-Associated Rhino-Orbital Mucormycosis: Histological and Electron Microscopy Characteristics

“…Mucormycosis, also known as zygomycosis, is a fungal infection caused by ubiquitous organisms from the class of Zygomycetes, the order of Mucorales, most commonly by the genus Rhizopus [1]. The epidemiology, pathogenesis, clinical presentation, diagnosis, and management of mucormycosis have all been reviewed extensively, both independently [1,2] and in the context of COVID-19 [3][4][5][6][7]. These fungi are typical environmental organisms but can cause a devastating opportunistic infection, especially for immunosuppressed patients.…”

COVID-19-associated mucormycosis in India: Why such an outbreak?

“…Moreover, very few CAM cases were reported outside India [9] . In Europe, fungal infections associated with COVID-19 were mainly COVID-19-associated pulmonary aspergillosis (CAPA), whereas CAM was rarer [10] . A multicentric prospective study in France [11] reported 76 proven/probable CAPA cases and 6 proven/probable CAM cases among 509 COVID-19 patients on mechanical ventilation.…”

“…A multicentric prospective study in France [11] reported 76 proven/probable CAPA cases and 6 proven/probable CAM cases among 509 COVID-19 patients on mechanical ventilation. Conversely, in India, few CAPA cases were reported compared with the CAM cases [10] .…”