Table 2.

Recent studies on COVID-19 cases with Mucormycosis.

Age of COVID-19 case	Symptoms	Clinical History	Clinical examination	Treatment	Study Findings and Conclusion	Reference
60-year-old male	severe breathlessness, pyrexia, tachypnea, and generalized malaise	diabetic (>10 years) pulse rate was 80/minute, blood pressure was 150/90 mmHg, Patient was afebrile on admission, respiratory rate was 26/minute, with a specific oxygen saturation of 86% on oxygen supplementation (10 L/min) bilateral crepts at the lung non-healing ulcer with the diabetic peripheral vascular disease was observed on right foot	•RT-PCR •CT scan •MRI	oral anti hypoglycemic tablets intravenous meropenem, oral oseltamivir with intravenous methylprednisolone and dexamethasone subcutaneous enoxaparin (40mg/0.4 ml) twice daily	•Acute respiratory distress syndrome deteriorated. •Ophthalmic examination observed with conjunctival edema and signs of exposure keratitis. MRI observed with mucormycosis. •COVID-19 associated with secondary infections due to immune dysregulation	Mehta and Pandey, (2020)
33-year-old Somali female	hypertension and asthma with altered mental status	patient began with symptoms of vomiting, cough, and shortness of breath 2 days prior to presentation. Signs of mild tachycardia, hypertension, and tachypnea. Afebrile and normal oxygen saturation. Left eye ptosis with 1 cm proptosis	•Chest X-ray •CT scan •MRI scan	Vancomycin and piperacillin-tazobactam, Amphotericin B	•Multifocal signal abnormality with edema, and evidence of ischemia and infarction. Cerebral edema had evolved into multiple encapsulated complex fluid. Mucormycosis was observed on sinusitis region •The patient's severe immunocompromised state from untreated diabetes, and ultimately diabetic ketoacidosis is what made her vulnerable to contract both mucormycosis and COVID-19.	Werthman-Ehrenreich (2021)
60-year-old man	diabetes, asthma, hypertension, hyperlipidemia and recent travel with dyspnea and hypoxia	Reported COVID-19 negative, and was discharged and later noticed with elevated level of glucose with oxygen demand. Was tested COVID-19 with ARDS	•CTA •Sinus histopathology •MRI •Fundus examination	Intravenous vancomycin and cefepime, antifungal coverage with liposomal amphotericin B, and strict glucose management. Dexamethasone 6 mg daily and a single dose of convalescent plasma as a treatment for COVID-19	•Partial opacification of the right sphenoid sinus and erosions of the lamina papyracea was observed. •Clinical and radiographic findings noticed with fungal rhinosinusitis. The right eye had mild proptosis with erythema and edema of the eyelids and conjunctival chemosis •Co-infection COVID-19 and Rhizopus. These diseases share risk factors, have high mortality rates, but presently have contradictory management principles.	Mekonnen et al, (2021)
9 patients	COVID-19 infection	Post-mortem examination conducted.	•Histochemical analysis •Immunohistochemical analysis •Histopathological analysis •RT-PCR	–	•Thrombotic features were observed. Lymphocyte depletion. Acute tubular injury was observed in all patients. Acute pancreatitis, adrenal micro-infarction, pericarditis, disseminated mucormycosis, aortic dissection and marantic endocarditis were the major findings. Viral genomes were detected outside of the respiratory tract in four of five patients. •Additional examination of secondary infection should be considered to understand the role of COVID-19	Hanley et al. (2020)
86-year-old male	arterial hypertension with acute diarrhea, cough, dyspnea, and fever	Throat swab confirmed COVID-19	•CT scan •EGD •GMS	ceftriaxone, azithromycin, oseltamivir, and hydrocortisone was provided.	•Pathologucal examination confirmed mucormycosis. Two giant gastric ulcers with dirty debris and a deep hemorrhagic base without active bleeding located in the greater and lesser curvature •Mucormycosis should be considered if atypical gastric ulcer in observed in COVID-19 patients	do Monte Junior et al. (2020)
44-year-old women	Diabetes mellitus observed. Fever, malaise, myalgia, dry cough and partial dyspnoea was noticed.	Positive for influenze and negative for COVID-19	•RT-PCR •CT scan •H&E stain •MRI	amphotericin B and posaconazole was administered.	•Abundant aseptate hyphae was observed in sinusitis region •COVID-19 associated mucormycosis is highly risky than influenza causing infection. More studies required to explore prognostic factors	Ahmadikia et al. (2021)
41-year-old man	Diabetes mellitus with loss of taste and cough.	Deep pain in the nose which radiated to throat. Oral cavity noted with black eschar	•Chest X-ray •CT scan •RT-PCR •MRI	Cefepime and IV abelcet, which is amphotericin B complexed with two phospholipids	•Bilateral lung infiltrates and chronic sinusitis was observed. RT-PCR reported to be positive for COVID-19. Sinuses and intracranial abscess in the infratemporal fossa with cavernous sinus enhancement •The severity of infection is due to uncontrollable diabetes with COVID-19	Alekseyev et al. (2021)
31 patients	Diabetes, COVID-19	Vision diminution and ophthalmoplegia	•Ophthalmic examination •Imaging studies	amphotericin B	•Orbital cellulitis and pansinusitis was observed with mucormycosis. 28 patients recovered. •Rhino-orbital mucormycosis significant during COVID-19	Ravani et al. (2021)
6 patients	COVID-19	ptosis and ophthalmoplegia, edema, ptosis and proptosis, conjunctival congestion, and severe chemosis	•Histopathologic examination •Cytopathologic examination •Microscopic evalaution	Corticosteroids, posaconazole was initiated	•Infection with mucor was observed •High index of suspicion, early diagnosis, and suitable management is recommended	Sen et al. (2021)
55-year-old man	diabetes mellitus, hypertension, and ischemic cardiomyopathy presented with fever, dry cough, and progressive breathlessness	Respiratory rate was 26 breaths/minute, blood pressure 110/80 mmHg, and heart rate of 90 beats/minute. The oxygen saturation was 84%	•Chest X-ray •RT-PCR •CT scan •LCB mount	examethasone and remdesivir	•Bilateral diffuse infiltrates and cardiomegaly. Aseptate hyphae with nodal rhizoids and short sporangiophores with terminal spherical sporangia filled with brownish sporangiospores was observed on mounting. •Rhizopus microsporus observed to be a serious infection in COVID-19 patients. Early diagnosis and treatment is essential in pulmonary mucormycosis.	Garg et al. (2021)
66-year-old male	COVID-19 positive	Deterioration of oxygen.	•CT scan •LCB mount	hydroxychloroquine and lopinavir-ritonavir	•Buried cavitary lesions in the left lung and cranial CT showed corpuscular material in the left maxillary sinus. Mounting showed aseptate broad hyphae, sporangia and sporangiospores •COVID-19 impairs immune response and expose patients to opportunistic infections.	Pasero et al. (2020)
38-year-old male	COVID-19 positive.	high grade fever, body ache, cough and shortness of breath	•RT-PCR •MRI •Lactofuchsin staining	Methylprednisolone, Dexamethasone. Intravenous Fluconazole and Amphotericin B	•Malaise, proptosis, chemosis, periorbital cellulitis and restricted medial gaze was observed. Partial opthalmoplegia and no nasal discharge were seen. Aseptate, branching broad based fungal hyphae, areas of necrosis with granulomas were seen. •Rhizopus oryzae was noticed in COVID-19 patients hence better prevention and management is required	Maini et al. (2021)
32 year old women	Diabetes with ptosis and left facial pain		•CT scan •Nasal endoscopy •MRI	–	•Opacification of the left ethmoid, maxillary and frontal sinus indicative of fungal sinusitis. Subperiosteal lesion in the superomedial extraconal of the left orbit •Orbital apex syndrome with mucormycosis in COVID-19 patients requires emergency diagnosis and treatment strategies.	Saldanha et al. (2021)
Middle aged women	Diabetes mellitus with ptosis	Sinuses on the left side	•MRI •CT scan •Chest X-ray	Amphotericin B and aspirin. Antifungal treatment	•Opacification of the left ethmoid, maxillary and frontal sinuses. Inflammation of internal carotid artery and acute infarct of the parieto-occipital lobe. Ethmoid sinusitis impinging on the lamina papyracea. •Imaging studies are recommended in COVID-19 patients with fungal co-infection.	Revannavar et al. (2021)
40-year old woman and a 54-year old man	COVID-19	–	•Histopathology •Nasal endoscopic examination •Radiologic findings	corticosteroid therapy and amphotericin B	•Bilateral visual loss, ophthalmoplegia proptosis and orbital inflammation. Mucormycosis in both the patients •Steroidal treatment might have caused fungal infection in COVID-19 patients	Veisi et al. (2021)
79-year old male	diabetes mellitus and hypertension	fevers, rigors, dry cough, and worsening shortness of breath	•RT-PCR •Chest X-ray •CT scan •BAL culture	Ceftriaxone, azithromycin, remdesivir, dexamethasone, voriconazole	•COVID-19 positive with septate hyphae and characteristic conidial heads by Rhizopus arrhizus and Aspergillus fumigatus fungus. •Pulmonary aspergillosis and mucormycosis in COVID-19 patients as secondary infections	Johnson et al. (2021)
68-year old male	Hyperglycemia and acute renal failure	non-productive cough with non-bloody diarrhea, fever	•CT scan	Prednisone, mycophenolate mofetil, tacrolimus, atovaquone, nystatin, valganciclovir, hydroxychloroquine	•Purplish skin discoloration with fluctuant swelling •Evaluation for invasive fungal infections in patients with COVID-19 infection should be recommended	Khatri et al. (2021)
2 cases (Abstract)	diabetes mellitus and ketoacidosis	–	–	corticosteroids	•Fungal infection with rhino-orbital-cerebral mucormycosis •Early diagnosis is important in COVID-19 patients	Dallalzadeh et al. (2021)
24-year-old female	Obesity	COVID-19 with respiratory failure and oxygen saturation	•CT scan •RT-PCR •Fungal culture	–	•Swelling of the left inferior turbinate and thickening of the mucosa of the maxillary, ethmoid, and sphenoid sinuses on the ipsilateral side. Rhino-orbital mucormycosis •The study recommends mycotic infection in COVID-19 patients with diabetes	Waizel-Haiat et al. (2021)
49-year-old male	–	fever, cough, and shortness of breath	•Chest X-ray •RT-PCR	ceftriaxone and azithromycin, enoxaparin, remdesivir	•COVID-19 infection and necrotic empyema with mucormycosis •Immunocompromised condition developed with fungal infection	Placik et al. (2020)
53-year old male	acute myeloid leukemia, myelodysplastic syndrome, obesity and depression	sore throat, parageusia, dysosmia and fever	•RT-PCR •Chest X-ray •BAL and PAS	Corticosteroids and antibacterial therapy	•COVID-19 positive •BAL showed mixed nonpathogenic flora. Lungs observed with Rhizopus microsporus •COVID-19 ARDS with acute myeloid leukemia was observed with mucormycosis in postmortem	Zurl et al. (2021)
66-year-old male	Diabetes mellitus	–	•KOH mount	–	•COVID-19 with ophthalmoplegia. Rhino-orbital cellulitis with ischemia •This was the first study with orbital infarction syndrome in COVID-19 patient	Rao et al. (2021)
56-year-old man	Renal disease	fatigue and shortness of breath	•Chest X-ray •RT-PCR •GMS and pleural fluid culture •CT scan •MALDI-TOF	methylprednisolone and tocilizumab	•COVID-19 with mucormycosis •Higher mortality rate in COVID-19 with mucormycosis	Kanwar et al. (2021)
31 patients	Different diseases	COVID-19 symptoms	•Pathological examination	–	•Mucormycosis found in 1 patient •Reconstruction of head and neck during COVID-19 pandemic	Rashid et al. (2021)
18 patients	16 patients were diabetic	facial cellulitis, maxillary sinusitis, headache, necrosis of palatal bone/mucosa or acute loss of vision	•MRI and CT scans •KOH mount	voriconazole, posaconazole	•Maxillofacial and rhino-cerebro-orbital fungal infections •Significant increase of angioinvasive maxillofacial fungal infections in diabetic patients with COVID-19	Moorthy et al. (2021)
55-year-old man	follicular lymphoma	Inflammatory response	•RT-PCR •BAL	amphotericin B	•COVID-19 infection with fungal growth of A. fumigatus and Rhizopus microsporus •Fungal infection with immunocompromised COVID-19 patients is a rare one	Bellanger et al. (2021)
23 patients	Diabetes mellitus, renal failure and hypertension	COVID-19 positive cases	•MRI and CT scan	Steroids	•Mucormycosis in the paransal sinuses •Uncontrolled diabetes and usage of steroids aggravates the fungal infection.	Sharma et al. (2021)

ARDS: acute respiratory distress syndrome; EGD: Esophagogastroduodenoscopy; GMS: Grocott's methenamine staining; H&E: haematoxylin and eosin; LCB: Lactophenol cotton blue; BAL: bronchoalveolar lavage; PAS: periodic acid–Schiff; KOH: potassium hydroxide; MALDI-TOF: Matrix-assisted laser desorption ionization time-of-flight; MRI: magnetic resonance imaging, CT: computed tomography; COVID-19: coronavirus disease 2019; RT-PCR: reverse transcription polymerase chain reaction.