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A Meta-Analysis of 556 Individual COVID-19-Associated Mucormycosis Cases: Learning from the Pandemic
29 Pages Posted: 27 Jul 2022
More...Abstract
Background: Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases since the second wave of the pandemic. The changing patient profile during the pandemic led to the need for a comprehensive insight, we aimed to reveal the characteristics of mucormycosis developing in the background of COVID-19.
Methods: We searched PubMed, Scopus, Web of Science, Cochrane, CINAHL, and Ovid MEDLINE databases for the studies reporting mucormycosis during or after COVID-19. We performed individual participant data meta-analysis by using PRISMA guideline.
Findings: We analyzed the individual data of 556 reported COVID-19-associated mucormycosis (CAM) cases from 31 countries. Most reported cases (86·5%) were from low- and middle-income countries. After diabetes (77·2%), history of corticosteroid use for COVID-19 (76·6%) was the most common underlying condition. The overall mortality rate was 44·4%. Risk factors for increased mortality were age >65 years, female sex, diabetic ketoacidosis, history of malignancy, underlying pulmonary or renal disease, obesity, neutropenia, and Aspergillus co-infection. Moreover, mortality was higher in patients with pulmonary, gastrointestinal, and disseminated mucormycosis. Rhizomucor sp., more commonly isolated from cases of pulmonary mucormycosis, were more fatal. CAM occurred on average 22 days after COVID-19 and 8 days into hospitalization. The diagnosis of patients with Aspergillus co-infection or pulmonary mucormycosis was delayed significantly. Contrary to the reports before the pandemic, cutaneous mucormycosis was rare (<1%). Amphotericin B was the most frequently used antifungal and posaconazole use was more common in the surviving group, whereas simultaneous therapy using both agents was not associated with improved outcome.
Interpretation: COVID-19 pandemic remarkably influenced the distribution of predisposing factors, mortality predictors, and clinical manifestations of mucormycosis. The rising prevalence of corticosteroid use, COVID-19-associated lung damage, and shifting microbiological profile introduced new challenges to the diagnosis and management of mucormycosis, which necessitated a further emphasis on CAM research.
Funding Information: None.
Declaration of Interests: None.
Keywords: covid-19-associated mucormycosis, CAM, antifungal therapy, individual participant data meta analysis, opportunistic infections, corticosteroids use in CAM, fatality in CAM, mucormycosis, corticosteroid use, fungal infections
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