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Meta-Analysis
. 2022 Jun;187(2-3):271-289.
doi: 10.1007/s11046-022-00627-8. Epub 2022 Mar 21.

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Atsuyuki Watanabe #  1 , Matsuo So #  2 , Hayato Mitaka  2 , Yoshiko Ishisaka  2 , Hisato Takagi  3 , Ryota Inokuchi  4 , Masao Iwagami  4 , Toshiki Kuno  5
Affiliations
Meta-Analysis

Clinical Features and Mortality of COVID-19-Associated Mucormycosis: A Systematic Review and Meta-Analysis

Atsuyuki Watanabe et al. Mycopathologia. 2022 Jun.

Abstract

The recent increase of COVID-19-associated mucormycosis (CAM) has been commanding global attention. However, basic epidemiologic characteristics have not firmly been established. In this systematic review and meta-analysis, we sought to determine the clinical manifestations, potential risk factors, and outcomes of CAM. Observational studies reporting CAM were searched with PubMed and EMBASE databases in January 2022. We collected data on comorbidities and treatment for COVID-19, and performed a one-group meta-analysis on the frequency of orbital exenteration procedure and mortality of CAM using a random-effect model. Fifty-one observational studies, including a total of 2,312 patients with proven CAM, were identified. Among the 51 studies, 37 were conducted in India, 8 in Egypt, and 6 in other countries. The most common comorbidity was diabetes mellitus (82%). While 57% required oxygenation, 77% received systemic corticosteroids. Among CAM, 97% were rhino-orbital-cerebral (ROCM), and 2.7% were pulmonary mucormycosis. Usual presentations were headache (54%), periorbital swelling/pain (53%), facial swelling/pain (43%), ophthalmoplegia (42%), proptosis (41%), and nasal discharge/congestion (36%). Regarding the outcomes, orbital exenteration was performed in 17% (95% CI: 12-21%, I2 = 83%) of the COVID-19-associated ROCM patients. The mortality of CAM was 29% (95% CI; 22-36%, I2 = 92%). In conclusion, this systematic review and meta-analysis indicated that the most prevalent type of CAM was ROCM, and most CAM patients had diabetes mellitus and received systemic glucocorticoids. Clinicians in the endemic areas should have a high index of suspicion for this invasive fungal complication of COVID-19 when a diabetic patient who received high-dose systemic glucocorticoids developed rhino-orbital symptoms.

Keywords: COVID-19; Diabetes mellitus; Glucocorticoids; Meta-analysis; Mucormycosis.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Forrest plots for management and outcomes (random-effect model). a Frequency of endoscopic or surgical procedure performed in patients with CAM. b Frequency of orbital exenteration performed in patients with COVID-19-associated ROCM. c Overall mortality of CAM
Fig. 2
Fig. 2
Forrest plots for management and outcomes (random-effect model). a Frequency of endoscopic or surgical procedure performed in patients with CAM. b Frequency of orbital exenteration performed in patients with COVID-19-associated ROCM. c Overall mortality of CAM
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