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.
Highlights
Mucormycosis, as an angio-invasive infection, is caused by ubiquitous environmental fungal species of the Mucorales order, e.g., Rhizopus arrhizus, Rhizomucor pusillus, Lichtheimia corymbifera and Apophysomyces variabili [1]
COVID-19 was confirmed based on reverse transcription polymerase chain reactions (RT–PCR) in all the included studies except the study by Ramaswami et al 2021, and mucormycosis was confirmed based on histopathology, culture or staining [53]
The majority of the studies reporting COVID-19-associated mucormycosis (CAM) prevalence were from India (n = 4) [53,54,55,56], whereas a single study was from Turkey [63] and Pakistan [64]
Summary
Mucormycosis, as an angio-invasive infection, is caused by ubiquitous environmental fungal species of the Mucorales order, e.g., Rhizopus arrhizus, Rhizomucor pusillus, Lichtheimia corymbifera and Apophysomyces variabili [1]. The clinical presentation of mucormycosis varies according to the anatomical site of involvement including rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal and disseminated forms [2]. It is widely depicted as a disease of the immunocompromised cohorts because its risk factors include uncontrolled diabetes mellitus, end-stage renal disease, hematologic malignancies, and solid organ transplantation [2]. Roden et al 2005 conducted the first ever systematic review for mucormycosis cases that included 929 patients documented by 459 case reports/series, which were published between 1940 and 2003 [5] Since this inaugural analysis, all the succeeding systematic reviews published in the last five years confirmed two main epidemiologic characteristics of mucormycosis: its rapidly growing incidence and its strong affinity to diabetes mellitus [6,7,8,9,10,11]
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