Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Abstract

Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2–45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.

Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, India

“… 36 Although glucocorticoids are a risk factor for both CAPA and CAPM, 83 poorly controlled diabetes is more often associated with CAPM than with CAPA. 4 , 5 , 26 …”

“… 2 During the COVID-19-associated mucormycosis (CAM) outbreak, rhino-orbital mucormycosis was the most common manifestation, followed by pulmonary mucormycosis. 3 , 4 , 5 Among the various risk factors for rhino-orbital mucormycosis and pulmonary mucormycosis, uncontrolled diabetes overshadowed all others. 3 In two large multicentre cohort studies from India, pulmonary mucormycosis accounted for 13·3% of the total patients with mucormycosis before the COVID-19 pandemic, and 8·6% of the total patients with mucormycosis during the COVID-19 pandemic.…”

COVID-19-associated fungal infections in Iran: A systematic review

“…A pre-pandemic study showed an increased incidence (about 2.5 times) of mucormycosis during the years 2008–2014 in Iran [ 81 ]. Besides, this infection has become 50 times more prevalent in the COVID-19 era globally [ 82 ]. CAM has been primarily seen in India, while cases from other countries, including Iran, have also been reported [ 83 ].…”

Recent Advances and Future Directions in the Understanding of Mucormycosis

“…Traditionally, this infection has received scarce attention because of the low number of cases in comparison with other more frequent fungal infections, but the emerge of the SARS-CoV-2 disease (COVID-19) pandemic has increased the incidence of fungal infections, rising the concern about their risks ( Ghosh et al., 2021 ). The upsurge in COVID-19-associated mucormycosis with a prevalence 50 times higher than the uppermost recorded data ( Hussain et al., 2021 ) has highlighted the unmet need to better understand mucormycosis ( Stone et al., 2021 ).…”