Table 1.

Predisposing conditions for mucormycosis.

Underlying Disease	Organ/region infected with fungus	Fungus/Disease 3. Disease entities in mucormycosis	Objective	No. Of patients	Country	Methodology	Results & Conclusion	Reference
ROCM and Stroke	Paranasal region and Brain	Mucormycosis	Administration of amphotericin B and its complications to stroke and vasculopathy	6 cases	Taiwan	Questionnaire survey	•Fatal infarctions, thrombotic occlusion, haemorrhage anmycotic aneurysm. •Combination of ocular exenteration, radical debridement parenteral and local administration of amphotericin B should be considered.	Thajeb et al. (2004)
Gerstmann syndrome	Brain	Rhizomucor	Clinical examination and discussion of a case with aggressive mucormycosis	A 60-year-old women	USA	•MRI •CTA •Immunostaining	•Hemorrahage with mucormycosis observed •Early detection and management of the infection is needed	Stretz et al. (2017)
Cerebral mucormycosis	Brain – basal ganglia	Rhizopus	Analysis of a case with mucormycosis along with multiple risk factors	A 28-year-old man	USA	•CT scan •MRI •CSF and serum testing •Histopathological examination	•CSF and serum testing were negative. Fungal outgrowths were observed. Neurological status declined. •Hemorraghic abscess was noticed in autopsy. •Early detection and therapy treats the disease.	Malik et al. (2014)
Cerebral Lymphoma, vision loss, cirrhosis, diabetes	Brain	Mucormycosis	Analysis of fungal infection in orbital and CNS inflammation	A 61-year-old man	USA	•MRI •Biopsy •CT	•CSF analysis showed fungal infection •This fungal infection should be investigated in vision loss and orbital cellulitis patients	Beketova et al. (2018)
Rhinocerebral mucormycosis	Paranasal sinus, orbital and intra-cranial	Mucormycosis	To analyse the infection in CT scan to determine paranasal sinus, orbital and intra-cranial involvement	17 cases	India	•CT scan •Cadaveric dissections	•Ethmoidal sinus involved with infection then spread to orbital region and finally intra-cranial part. •If blood stained nasal discharge occurs, CT should be conducted along with amphotericin B treatment should be given.	Kulkarni et al. (2005)
Diabetes	Lungs	Pulmonary mucormycosis and tuberculosis	A diabetic case with fungal co-infection	A 56-year old female	Netherlands	•X-ray, CT scan •Biopsy •RT-PCR •lobectomy	•Treatment with TB and mycosis medications showed few adverse effects •Diabetic patients should undergo the examination of these co-infections	Jiménez-Zarazúa et al. (2019)
Chronic lymphocytic leukemia	Blood and bone marrow	Aspergillosis and Mucormycosis	Assessment of fungal infection in leukemia patient	A 79-year-old man	USA	•MRI •Immunoassay •NGS •CT •Autopsy	•No risk factors were associated other than corticosteroids. •More studies based on risk factors should be assessed	Tsikala-Vafea et al. (2020)
Septic shock	Intestine	Mucormycosis	Examination of fungal infection in immunocompetent individual	A 40-year-old male	Ethiopia	•CT scan •Colonoscopy	•Hepatomegaly, icterus sclera, intestinal infection •Investigation on mucormycosis should be carried out without traditional risk factors in immunocompetent patients	Wotiye et al. (2020)
Hypothyroidism	Throat	Aspergillosis and Mucormycosis	A case study treated with corticosteroids developed fungal infections	A 55-year-old female	Italy	•Electromyography •CT and MRI •CSF examination	•Hemiparesis and hypoesthesia observed. Low glucose level. Respiratory failure. Pulmonary empyema was observed. •Though corticosteroids taken for a short period led to low immune function	Mantero et al. (2019)
Diabetes mellitus	Pansinusitis	Mucormycosis	Analysis of infection in a diabetic patient	A 56-year-old male	India	•MRI •MRA •Biopsy •GMS and PAS staining	•The fungal growth invaded sphenoid bone and to clivus and to basilar artery. •Early recognition and treatment is needed	Kumar, 2021
Diabetes mellitus	Eye	Mucormycosis	Optic nerve infarction due to mucormycosis in a diabetes case	A 51-year-old male	Texas	•MRI •Exenteration and sinus debridement	•Extensive infarction on the left optic nerve with ipsilateral cavernous sinus thrombosis and periorbital adnexal inflammation. •Mucormycosis confirmed on histopathology	Chaulk et al. (2021)
Optic neuropathy	Eye	Mucormycosis	A case with retrobulbar optic neuropathy linked with mucormycosis.	A 94-year-old women	Japan	•MRI •Histopathology	•Right eye with sphenoid sinus with mucormycosis •Clinicians should recommend invasive fungal sinusitis present as retrobulbar optic neuropathy	Sano et al. (2018)
Renal failure and diabetes mellitus	Eye	Mucormycosis	ROCM observed in a case with ophthalmic nerve infection.	A 34-year-old man	Taiwan	•Ophthalmic and neurological examination •CSF examination •MRI •Grams stain	•Black eschars observed in bilateral canthi extending to vascular region. It spreads to bilateral ophthalmic nerves and intracranial nerves. •Patients with neuro-ophthalmological signs should consider ROCM in immunocompromised patients	Lau et al. (2011)
Seizure	Brain	Rhizopus	Examination of the fungal infection in a case	A 49-year-old male	USA	•MRI and CT scan •CSF examination •Autopsy	•Cerebral mucormycosis with prominent vascular pathology and hemorrhagic necrosis was observed •Tissue diagnosis with surgical excision and antifungal therapy might rescue life from this condition	Verma et al. (2006)
Diabetic ketoacidosis with ophthalmoplegia	Nostril region	mucormycosis	Recovery from mucormycosis infection in a case	A 22-year-old women	USA	•CT scan •Nasoendoscopy •Biopsy	•Surgical removal of the right eye, paranasal sinuses maxilla and palate, suboccipitalcraniectomy and shunting for hydrocephalus. •Antifungal treatment for 18 months •Delivers the risk of infection with multiple surgeries	Zafar and Prabhu (2017)
Diabetes mellitus	Orbital region	Rhizopusorzae	Two cases treated with posaconazole and amphotericin B with sinus surgical debridement.	2 cases	China	•funduscopic examination •MRI •CT scan	•Orbital mucormycosis treated with antifungal medications. •This study highlights the unusual manifestations on orbital mucormycosis as well as antifungal treatment	Zhang et al. (2013)
Diplopia, otalgia and right side numbness. Autoimmune hepatitis	Cerebral region	Mucormycosis	Assessment of fungal infection in a 12 year old girl	A 12-year-old girl	USA	•MRI •Biopsy	•Infection observed with acute sinusitis and then developed to thrombosis and carotid artery. •Immediate surgical and antifungal therapy might control the infection.	Ibrahim et al. (2009)
Diabetes, kidney failure, myelodysplastic syndrome, acute leukemia,	Cerebral region	Mucormycosis	Retrospective study of 36 cases with mucormycosis.	36 cases	Mexico	•surgical debridement •CT scan •MRI	•Rhinocerebral and systemic mucormycosis. •The study recommended medical and surgical therapy	Rangel-Guerra et al. (1996)
HIV infection and diabetes	Cerebral region	Mucormycosis	Mucormycosis with vasculitis in a diabetic case	A 54-year-old woman	Brazil	•CSF analysis •CT scan •Histopathologic analysis and angiography with HR-VWI •Surgical debridements	•Vasculitis with inflammation •More studies required to examine the accuracy for mucormycosis.	de Moura Feitoza et al. (2019)
Diabetes mellitus	Cerebral region	Mucormycosis	Progressive ophthalmoplegia and blindness in infection	18-year-old woman	USA	•MRI •Lumbar puncture •Funduscopic examination •surgical debridement	•Fungal hyphae observed in ophthalmic artery and in the optic nerve perineurals heath without significant optic nerve inflammation. •The infection should be suspected in ophthalmoplegia and blindness in patients with diabetes	Hu et al. (2006)
Chronic lymphocytic leukemia	Cerebral region	Rhizomucorpusillus	A case study with mucormycosis in an immunocompromised host	61-year-old man	USA	•CT scan •GMS stain •Sequencing	•Histopathology revealed with mucormycosis. Amplification and sequencing of 28 S ribosomal RNA gene showed the fungal species •Early diagnosis and antifungal therapy along with surgery is recommended.	Farid et al. (2017)
Eye movement syndrome	Sphenoid sinus	Mucormycosis	Patient with the infection suffered simultaneous carotid artery occlusion with infarction and a contralateral horizontal gaze palsy.	54-year-old man	San Antonio	•CT scan	•Lesion observed in the cavernous sinus producing occlusion of the internal carotid artery. •Sensory symptoms were normal with the involvement of trigeminal nerve.	Carter and Rauch (1994)
Diabetes mellitus (three patients) and Chronic leukemia (one patient)	Cerebral region	Mucormycosis	Examination of fungal infection in 4 cases with underlying diseases	4 cases	Turkey (Abstract)	•CT scan •Otorhinolaryngologic examination	•Neurological abnormalities were observed. Two patients were dead. •Mucormycosis should be investigated in ophthalmoplegia and rapid diagnosis should be ensured.	Karakurum et al. (2005)
Diabetes mellitus with Cushing's syndrome	Cerebral region	Mucormycosis	Infection is associated with Cushing's syndrome and solid tumors	42-year-old women	Mexico	•CT scan •Autopsy	•Left temporal lobe infarction. Patient died and autopsy found out to be plurihormonal pituitary adenoma with extension to the sphenoid bone and sellar erosion. ACTH found in left lung. •The study correlated ACTH-producing ectopic pulmonary tumor, pituitary apoplexy and mucormycosis	Salinas-Lara et al. (2008)
Acute lymphoblastic leukemia	Cerebral region	Mucormycosis	A case of fatal invasive ROCM with thrombotic occlusion of the internal carotid arteries following hematopoietic stem cell transplantation for acute lymphoblastic leukemia.	A 5-year-old boy	Switzerland	•MRI and angiography •Blood stem cell transplantation	•ROCM with bilateral thrombotic occlusion of the internal carotid arteries •Treatment should be initiated quickly for this type of case	Abela et al. (2013)
Stroke	Cerebral region	Mucormycosis	Outcome of stroke occurring in pregnancy and puerperium	36 patients	USA	•Questionnaire survey	•Stroke types revealed in varied pregnancy and the puerperium cases •Strokes are likely to occur in the third trimester and postpartum period and cluster in the first postpartum week	Skidmore et al. (2001)
Hodgkin's lymphoma	Cerebral region	Mucormycosis	Assessment of mucormycosis in lymphoma patient which ended in multiple stroke	A 56-year-old man	Spain	•MRI	•Multiple subcortical strokes with mucormycosis •Prognosis is poor and it is yet to be developed	Jiménez Caballero et al. (2012)
Diabetes mellitus and immunosuppression conditions	Cerebral region	Mucormycosis	Regional differences in the infection and its causes	–	Middle East and North Africa	•Data collection	•310 cases with infection. Majority cases reported with diabetes and immunosuppressed conditions. •Effective treatment and preventive strategies should be implemented	Stemler et al. (2020)
Chronic lymphocytic leukemia	Cerebral region	Mucormycosis	A case of mucormycosis with cerebral involvement which ended in ischemic stroke	A 68-year-old man	Pennsylvania	•CT and MRI scans •Autopsy	•A left temporoparietal lesion with restricted diffusion and vasogenicedema. •CT scan suggested with ischemic stroke. •Autopsy showed greyish blue discoloration, and histological study revealed mucormycosis with vascular invasion and thrombosis •Consideration of angioinvasive organisms as the etiology of stroke might be necessary	Ermak et al. (2014)
Diabetes	Cerebral region	Mucormycosis	A case with diabetes infected with mucormycosis	Elder man	Victoria	•CT scan •Autopsy	•Thrombosis with infection in cerebral region •Early diagnosis is the key to effective therapy	Macdonell et al. (1987)
Diabetes mellitus with Garcin syndrome	Cerebral region	Mucormycosis	Analysis of infection and tuberculosis meningitis in a case with underlying disease.	–	China	•CT scan with X-ray	•Tuberculous meningitis developed to mucormycosis. •Diagnosis should be first in identifying the infection.	Yang and Wang (2016)
Diabetes mellitus	Cerebral region	Mucormycosis	To identify the prevalence and predisposing factors of mucormycosis in diabetes mellitus patients	162 patients	Iran	•Detailed history, and otorhinolaryngologic, ophthalmic •and neurologic examinations	•30 people had diabetes (19 were women and 11 were men) •Diabetes may be predisposing factor for fungal infection	Sarvestani et al. (2013)
Acute lymphoblastic leukemia	Cerebral region	Mucormycosis	Treatment for leukemia resulted with infection and neuropathy	17-year-old-female	USA	•MRI •Thyroid hormone assessment	•Neuropathic pain developed with mucormycosis infection •Neuropathic pain is difficult to assess and can be a great source of pain suffering	Dworsky et al. (2017)
Leukemia	Cerebral region	Mucormycosis	Isavuconazole treatment risk assessment in leukemia patients	100 patients	Houston	•Questionnaire analysis	•13 patients had the risk of isavuconazole in which had 4 cases with mucormycosis. •There is a lack of risk assessment in isavuconazole induced patients.	Rausch et al. (2018)
Acute leukemias	Cerebral region	Rizopusspp	Assess the risk factors of infection in children with leukemia	1136 subjects	Israel	•CT and MRI scan •GMS stain	•39 children with mucormycosis. Fungal infection was highly associated with acute leukemia.	Elitzur et al. (2020)
Diabetes mellitus	Cerebral region	Mucormycosis	Identification of infection in diabetic patient with complications to acute infarction.	57-year-old man	Iran	•CT scan •Biopsy	•Subarachnoid haemorrhage with stroke. Biopsy showed mucormycosis infection. •Early interventions are necessary to avoid serious complications	Sasannejad et al. (2015)
Diabetes mellitus	Sinus region	Rhizopusarrhizus	To estimate the distribution of infection and its associated factors	208 cases	Iran	•Sequencing and data collection	•Increase in infection was observed from 2008 to 2014. •Monitoring and diagnosis of this infection is essential	Dolatabadi et al. (2018)
Multiple diseases	Cerebral region	Rhizopusoryzae and Apophysomyceselegans	Clinical course of mucormycosis	75 cases	India	•Data collection from hospital	•Diabetes with infection was common. Risk factors such as renal failure and chronic liver disease require attention •Surgical debridement needed for treatment	Chakrabarti et al. (2009)
CSS	Cerebral region	Mucormycosis	To assess the clinical and etiological profile of patients with CSS	73 patients	India	•hematological, biochemical and radiological examination	•Paranasal, bone erosion and internal carotid artery with infection •The patients can be diagnosed accurately	Bhatkar et al. (2017)
Diabetes mellitus and Hypothyroidism	Cerebral region	Rhizopussps	A progressive bilateral visual loss from mucormycosis due to bilateral optic nerve and retinal infarction in a patient with diabetes	62-year-old woman	New York	•MRI •Rhinosopic examination •Fundoscopic examination	•Progressive sinusitis, periorbitaledema and cellulitis, ophthalmoplegia, and unilateral visual loss •Pseudoephedrine use enhanced the Rhizopus growth	Merkler et al. (2016)
Parkinsonism	Cerebral region	Mucormycosis	Parkinsonism disease with mucormycosis infection	A 24-year-old man	USA	•CT and MRI scans	•Septate hypha was observed. Gradual improvement was observed followed by amphotericin B therapy •Infectious parkinsonism can result from fungal infections of the striatum.	Adler et al. (1989)
Hematologic malignancies or HCT recipients	–	Mucorales	Effect of isavuconazole in hematologic malignancies or HCT recipients	145 patients	Portland	•PCR •Radiograph assessment •Antifungal testing	•12 patients showed fungal infections in which 2 had mucorales infection. •Increased rate of invasive fungal infection showed the need of primary prophylaxis.	Fontana et al. (2020)
Hematologic malignancies or HCT recipients	rhino-orbital-cerebral, pulmonary, disseminated, gastrointestinal and cutaneous	Mucormycosis	Antifungal treatment for hematologic malignancies or HCT recipients who were affected with mucormycosis.	64 patients	USA	•Data collection •Antifungal treatment	•Combinational treatment resulted with poor results. •More evidences need to be performed to confirm this observation.	Miller et al. (2021)
Lymphoid cancers	Cerebral region	Mucorales	Assessment of children with lymphoid cancers who developed fungal abscesses.	8 children	India	•Fungal abscess examination •Data collection. •Antifungal therapy	•Prolong antifungal therapy can achieve treating the infections	Ramanathan et al. (2020)
Hematological diseases	Cerebral region	Mucorales	Patients with hematological diseases assessed for fungal infections	689 patients	South Korea	•Biochemical analysis •Sequencing •Fungal infection assessment	•27 patients had mucorales infection. •More diagnostic efforts are needed	Lee et al. (2020)
Diabetes and non-diabetic patients	rhino-orbito-cerebral	Mucorales	Compare the fungal infection in diabetic and non-diabetic patients	63 patients	Iran	•Ophthalmic investigation •Imaging studies •Biopsy	•Patients' survival was observed in 51% of diabetics and 70% of non-diabetics •Vision survival were not different in both the groups	Abdolalizadeh et al. (2020)
Diabetes mellitus, Malignancy, transplant	rhino-orbital	Rhizopus	Prospective observational study with mucormycosis across 12 centres in India	465 patients	India	•Questionnaire analysis	•Shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B were independent risk factors of mortality. •Diabetes was the major predisposing factor	Patel et al. (2020)
Lymphoid cancers	Lungs, CNS, sinus, liver and orbital regions	Mucorales	Evaluation of mycotic infection in hematological malignancies	37 patients	Italy	•CT scan •Antifungal treatment	•28 patients died due to infection and 9 patients were cured by antifungal therapy.	Pagano et al. (1997)
Renal transplant	Rhino-cerebral and pulmonary regions	Mucorales	Investigation of infection in renal transplant patients	25 patients	Iran	•Biopsy	•Pulmonary infection was seen more than rhino-cerebral infection. •Mucormycosis has poor prognosis after renal transplantation	Einollahi et al. (2011)
Acute lymphocytic leukemia	cerebral	Mucormycosis	A case with leukemia reported with mucormycosis	3-year-old girl	France	•MRI and CT scan •Microscopic examination •qPCR	•Isavuconazole therapy showed promising effects •Combinational administration of amphotericin B was also given •Isavuconazolecan be an alternative or adjunct to amphotericin B	Cornu et al. (2018)
Congenital neutropenia	–	Mucormycosis	Neutropenia patient with recurrent infections.	–	Iran	•Molecular study	•HAX1 mutation observed. •Mucormycosis observed in immunodeficient patients. •Early diagnosis and treatment is essential.	Fahimzad et al. (2008)

ROCM: rhino-orbito-cerebral mucormycosis; MRI: Magnetic resonance imaging; CT: computed tomography; CTA: computed tomography angiography; GMS: Grocott–Gomorimethenamine silver stain; PAS: periodic acid–Schiff; HR-VWI: high-resolution vessel wall imaging; ACTH: adrenal corticotropic hormone; CSS: cavernous sinus syndrome; HIV: human immunodeficiency virus; CSF: cerebrospinal fluid; RT-PCR: reverse transcription polymerase chain reaction; NGS: next-generation sequencing; HCT: hematopoietic cell transplant; PCR: polymerase chain reaction; qPCR: quantitative polymerase chain reaction; HAX1: HCLS1 Associated Protein X-1.