Table 1.
Studies and clinical characteristics, treatment and outcomes in patients with COVID-19-associated mucormycosis.
| Author(s) | References | Year | Country | Publication type | Case numbers | Age (years) | Gender | Systemic diseases | Pulmonary involvement of COVID-19 | Type of Mucormycosis | Diagnosis | Probable or Proven | Post COVID | Steroid use | Antibiotic use | Tocilizumab use | Medical Treatment |
Surgical treatment | Outcome | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Hanley B et al. | [10] | 2020 | UK | Case | 1 | 22 | M | No | Yes ARDS |
Disseminated | Post mortem | Proven | No | NA | NA | NA | NA | NA | Death |
| 2 | Mehta S et al. | [11] | 2020 | India | Case | 1 | 60 | M | DM | Yes ARDS |
Rhino-orbital | Nasal biopsy and culture | Proven | No | Yes | Meropenem, oseltamivir | Yes (400 mg) | Amphotericin B | No | Death |
| 3 | Mekonnen ZK et al. | [12] | 2020 | USA | Case | 1 | 60 | M | DM, asthma, HT, hyperlipidemia | Yes ARDS |
Rhino-orbital | Biopsy and culture: Rhizopus spp. |
Proven | No | Yes | Vancomycin, cefepime | NA | Amphotericin B, caspofungin added, then switched from amphotericin B to posaconazole | Surgical debridement | Death |
| 4 | Monte Junior ESD et al. | [13] | 2020 | Brasil | Case | 1 | 86 | M | HT | Yes | Gastrointestinal | Pathological | Proven | No | Yes | Ceftriaxone, azithromycin, oseltamivir | NA | No | No | Death |
| 5 | Pasero D et al. | [14] | 2020 | Italy | Case | 1 | 66 | M | HT | Yes | Pulmonary | Bronchial aspirate, BAL: Rhizopus spp. |
Proven | No | No | Piperacillin/tazobactam, levofloxacin | No | Amphotericin B, then isavuconazole | No | Death |
| 6 | Placik DA et al. | [15] | 2020 | USA | Case | 1 | 49 | M | No | Yes | Pulmonary | Microbiological analysis: Rhizopus spp. |
Proven | No | Yes | Ceftriaxone, azithromycin | Yes | Amphotericin B | Thoracotomy: the affected area was repaired and resected | Death |
| 7 | Werthman-Ehrenreich A | [16] | 2020 | USA | Case | 1 | 33 | F | HT, asthma | Yes | Rhino-orbito-cerebral | Sinus cultures | Proven | No | No | Piperacillin/tazobactam, vancomycin | No | Amphotericin B | Sinus debridement | Death |
| 8 | Alekseyev K et al. | [17] | 2021 | USA | Case | 1 | 41 | M | DM | Yes | Rhino-cerebral | Radiological | Probable | No | Yes | NA | No | Amphotericin B | Surgical debridement | Alive |
| 9 | Arana C et al. | [18] | 2021 | Spain | Two cases | 2 | 48, 62 |
2 M | DM (n = 1), HT (n = 2), kidney transplantation (n = 1), CRF (n = 1) | Yes | Rhino-sinusal (n = 1) Musculoskeletal (n = 1) |
Culture from the necrotic tissue | Proven (n = 2) | Yes (n = 1) No (n = 1) |
Yes (n = 2) | Ceftriaxone, azithromycin (n = 1) Azithromycin (n = 1) |
Yes (n = 1) 400 mg No (n = 1) |
Amphotericin B (n = 2) and initially isavuconazole and subsequently posaconazole (n = 1) | Surgical debridement (n = 2) | Alive (n = 2) |
| 10 | Bayram N et al. | [19] | 2021 | Turkey | Case series | 11 | 73.1 (61–88) | M (n = 9) F (n = 2) |
DM (n = 8), HT (n = 7), renal failure (n = 5) | Yes ARDS (n = 11) |
Rhino-orbital (n = 8) Rhino-orbito-cerebral (n = 3) |
Culture (n = 11) | Proven (n = 11) | No (n = 11) | Yes (n = 11) | NA | Yes (n = 2) | Amphotericin B (n = 11) | Radical debridement (n = 11) | Death (n = 7) Alive (n = 4) |
| 11 | Bellanger AP et al. | [20] | 2021 | France | Case | 1 | 55 | M | Lymphoma | ARDS | Pulmonary | A. fumigatus, Rhizopus microsporus | Proven | No | NA | NA | No | Amphotericin B | No | Death |
| 12 | Dallalzadeh LO et al. | [21] | 2021 | USA | Case | 2 | 36, 48 |
M (n = 2) | DM (type 2) (n = 2) | Yes (n = 2) | Rhino-orbito-cerebral (n = 2) | 1 radiologic, 1 culture | Probable (n = 1) Proven (n = 1) |
No | Yes (n = 1) No (n = 1) |
Oral antibiotics (n = 1) NM (n = 1) |
No | Amphotericin B (n = 2), isovuconazole (n = 2), and micafungin (n = 1) | Surgical debridement was deferred | Alive (n = 2) |
| 13 | Garg D et al. | [22] | 2021 | India | Case and systematic review | 1 | 55 | M | DM, HT, ischemic cardiomyopathy, end-stage kidney disease | Yes | Pulmonary | Mycological: Rhizopus microsporus | Proven | Yes | Yes | Meropenem | No | Amphotericin B | No | Alive |
| 14 | Johnson AK et al. | [23] | 2021 | USA | Case | 1 | 79 | M | DM HT |
Yes | Pulmonary | BAL culture: Rhizopus arrhizus |
Proven | Yes | Yes | Ceftriaxone, azithromycin | No | Voriconazole, then amphotericin B | No | Alive |
| 15 | Kanwar A et al. | [24] | 2021 | USA | Case | 1 | 56 | M | End-stage kidney disease | Yes ARDS |
Pulmonary | Culture | Proven | Yes | Yes | Piperacillin/tazobactam, vancomycin | Yes (single dose) | Amphotericin B | No | Death |
| 16 | Karimi-Galougahi M et al. | [25] | 2021 | Iran | Case | 1 | 61 | F | DM | Yes | Rhino-orbital | Histopathology | Proven | Yes | Yes | NA | No | Systemic antifungal | Debridement | Alive |
| 17 | Khatri A et al. | [26] | 2021 | USA | Case and review of literature | 1 | 68 | M | Orthotopic heart transplantation, CAD |
Yes | Pulmonary | Culture: Rhizopus microsporus | Proven | Yes | Yes | Vancomycin, meropenem | No | Amphotericin B, posaconazole | Surgical debridement | Death |
| 18 | Maini A et al. | [27] | 2021 | India | Case | 1 | 38 | M | No | Yes | Rhino-orbital | Culture: Rhizopus oryzae | Proven | Yes | Yes | Piperacillin/tazobactam, metronidazole | No | Amphotericin B | Surgical debridement | Alive |
| 19 | Moorthy A et al. | [28] | 2021 | India | Cases series | 17 | 54.6 (35–73) | M (n = 15) F (n = 2) |
DM (n = 15) | Yes | Rhino-orbital (n = 6), rhino-orbito-cerebral (n = 5), rhino-cerebral (n = 3), Rhino-sinusal (n = 3) | KOH test and culture (n = 17) | Proven (n = 17) | Yes (n = 14), no (n = 3) | Yes (n = 15) No (n = 2) |
NA | No | Amphotericin B (n = 17) | Surgical (n = 17) | Alive (n = 10), death (n = 6), NA (n = 1) |
| 20 | Nehara HR et al. | [29] | 2021 | India | Case series | 5 | 62.2 (52–70) | M (n = 1) F (n = 4) |
DM (type 2) (n = 5), HT (n = 2) | Yes | Rhino-orbito-cerebral (n = 5) | LCB & KOH Mount of Nasal Culture (n = 5) |
Proven (n = 5) | No (n = 5) | Yes (n = 4), NA (n = 1) | Antibiotics (n = 5) | No | Amphotericin B (n = 5) | Debridement (n = 2), no (n = 3) | Death (n = 2), alive (n = 3) |
| 21 | Rao R et al. | [30] | 2021 | India | Case | 1 | 66 | M | DM | Yes | Rhino-orbital | Nasal swab confirmed (KOH) | Proven | No | Yes | NA | No | Amphotericin B | Orbital exenteration | Alive |
| 22 | Revannavar SM et al. | [31] | 2021 | India | Case | 1 | Middle-aged | F | DM | No | Rhino-orbito-cerebral | FESS culture: Rhizopus spp. |
Proven | No | No | NA | No | Amphotericin B | FESS | Alive |
| 23 | Sai Krishna D et al. | [32] | 2021 | India | Two cases | 2 | 34, 50 |
M (n = 2) | DM (type 2) (n = 2), HT (n = 1) | Yes | Maxillo-facial (n = 2) | Maxillary biopsy + histopathological examination (n = 2) | Proven (n = 2) | Yes (n = 2) | No (n = 2) | Antibiotics (n = 2) | No | Amphotericin B (n = 2) + then itraconazole (n = 1), posaconazole (n = 1) | Surgical resection (n = 2) | Alive (n = 2) |
| 24 | Saldanha M et al. | [33] | 2021 | India | Case | 1 | 32 | F | DM | NA | Rhino-orbital | Histopathological examination | Proven | No | NA | NA | No | Conventional amphotericin B | Endoscopic sinus surgery | Alive |
| 25 | Sarkar S et al. | [34] | 2021 | India | Cases series | 10 | 45.5 (23–67) | M (n = 8) F (n = 2) |
DM (n = 10) | Yes | Rhino-orbital (n = 10) | Radiological (n = 4), tissue biopsy (n = 4), nasal swab (n = 2) | Probable (n = 4), proven (n = 6) | No | Yes (n = 10) | NA | No | Amphotericin B (n = 10) | Debridement and/or surgery (n = 7), no surgery (n = 3) | Death (n = 4), alive n = 6) |
| 26 | Sen M et al. | [35] | 2021 | India | Case Series | 5 | 58 (46–73) | M (n = 5) | DM (n = 5), HT (n = 2), CAD (n = 1) | Yes | Rhino-orbito-cerebral (n = 1) Rhino-orbital (n = 4) |
Histopathology | Proven (n = 5) | Yes (n = 4), no (n = 1) | Yes (n = 4), no (n = 1) | Cefoperazone/sulbactam (n = 1) Systemic antibiotics (n = 4) |
NA | Amphotericin B | FESS | Alive (n = 5) |
| 27 | Sharma S et al. | [36] | 2021 | India | Case series | 23 | NA | M (n = 15) F (n = 8) |
DM (n = 21), HT (n = 14), renal failure (n = 1) | No | Rhino-orbito-cerebral (n = 2) Rhino-orbital (n = 8) Rhino-sinusal (n = 13) |
Radiological | Probable (n = 23) | Yes (n = 19) No (n = 4) |
Yes (n = 23) | NA | No | Amphotericin B (n = 23) | 23 surgical debridement | Alive (n = 23) |
| 28 | Veisi A et al. | [37] | 2021 | Iran | Case | 2 | 54, 40 |
M (n = 1) F (n = 1) |
DM (n = 1) | Yes | Rhino-orbital (n = 1) Rhino-orbito-cerebral (n = 1) |
Histopathologic and radiologic (n = 2) | Proven (n = 2) | No (n = 2) | Yes (n = 2) | Meropenem, vancomycin (n = 1) Levofloxacin then piperacillin/tazobactam, vancomycin (n = 1) |
No | Amphotericin B | Endoscopic debridement | Death (n = 1), alive (n = 1) |
| 29 | Waizel-Haiat S et al. | [38] | 2021 | Mexico | Case | 1 | 24 | F | Obesity | Yes | Rhino-orbital | Culture: Lichtheimia (Absidia) spp |
Proven | No | NA | Amoxicillin-clavulanate (n = 1) | NA | Amphotericin B | No | Death |
| 30 | Zurl C et al. | [39] | 2021 | Austria | Case | 1 | 53 | M | MDS, obesity and depression | Yes ARDS |
Pulmonary | Autopsy: Rhizopus microsporus | Proven | No | Yes | Piperacillin/tazobactam, linezolid (n = 1) | Yes | Intravenous voriconazole | No | Death |
| 31 | Current report | 2021 | Turkey | Case | 1 | 54 | M | No | Yes | Maxillo-fascial | Histopathologic and radiologic | Proven | Yes | Yes | Ampicillin/sulbactam, clindamycin (n = 1) | No | No | No | Death |
HT: hypertension, UK: United Kingdom, ARDS: acute respiratory distress syndrome, NA: not available, DM: diabetes mellitus, USA: United States of America, BAL: bronchoalveolar lavage, CAD: coronary artery disease, FESS: functional endoscopic sinus surgery, CRF: chronic renal failure, KOH: potassium hydroxide, LCB: lactophenol cotton blue, MSD: myelodysplastic syndrome.