An Update on COVID-19 Associated Mucormycosis Characteristics, Risk Factors, and Outcomes: a Systematic Review and Meta-Analysis

Purpose of ReviewThis meta-analysis aimed to identify the CAM manifestations, clinical presentations, relevant risk factors, mortality risk factors, treatments, outcomes, and survival.Recent FindingsCOVID-19-associated mucormycosis (CAM) increased dramatically, with mucormycosis development estimated to be 50 times higher than before the COVID-19 pandemic. CAM is a high-mortality disease with significant morbidities in survivors. A significant association between uncontrolled diabetes and CAM has been indicated. In addition, high-dose corticosteroid therapy and ICU admission were present in many rhino-orbito-cerebral mucormycosis (ROCM) patients and non-ROCM, respectively. In the present study, we systematically searched PubMed, Scopus, WoS, and PMC, preprint databases, and the reference lists of the included relevant studies until Oct 2021. Studies that report mucormycosis cases (proven/probable) with individual patient details with confirmed COVID-19 infection were included according to the PRISMA statement. Pooling data of 210 CAM patients (proven, 87.6%; probable, 12.4%) was retrieved from 60 case reports/series studies from 17 countries.SummaryPrimary or corticosteroid-induced diabetes was the leading independent risk factor for rhino-maxillo-orbito-cerebral mucormycosis (RMOCM) development (OR:18.29). In contrast, ICU admission was the main independent risk factor for non-RMOCM development (OR:11.64). In the absence of the mentioned risk factors, the risk of CAM is low (3.33%). CAM mortality was high (43.5%), with significantly higher fatality in non-RMOCM (77.3%). Severe/critically ill COVID-19 (OR: 3.66), ICU admission (OR: 6.78), and mechanical ventilation (OR: 6.27) were associated with a higher risk of CAM mortality. Cerebral and orbital involvement increased mortality (OR: 3.253 and OR: 3.205) in RMOCM patients; conversely, the surgical intervention improved outcomes (OR: 18.922). Control of hyperglycemia and COVID-19 infection and evidence-based corticosteroid therapy is essential to prevent CAM development. Identifying and controlling the preexisting/predisposing and mortality risk factors of CAM combined with the implementation of aggressive evidence-based management with a multidisciplinary approach can reduce CAM-related morbidity and mortality. An update to the traditional mucormycosis classification was also introduced to refer to maxillary involvement.