COVID-19-associated mucormycosis of head-and-neck region: A systematic review
Background and Aim: With the second wave of COVID-19, there has been a substantial rise in opportunistic infections like mucormycosis. Mucormycosis is a fatal fungal infection and understanding the associated risk factors and their management plays a key role to reduce mortality and morbidity caused due to such infections. This systematic review was conducted to assess the risk factors, clinical characteristics and to understand the pathogenesis of COVID-19-associated mucormycosis (CAM)
affecting the head-and-neck region.
Methods: The PubMed database was searched with the keywords; ((Mucormycosis) OR (invasive fungal sinusitis)) AND (COVID-19) and the PRISMA chart was prepared for the selection of the reports based on the inclusion and exclusion criteria.
Results: A total of 261 cases of CAM affecting the head-and-neck region were analyzed in this systematic review. Most of the patients presented with rhino-orbital/rhino-orbito-cerebral form of mucormycosis (rhino-orbital mucormycosis/rhino-orbital-cerebral mucormycosis). Pulmonary mucormycosis along with rhino-orbital form, involvement of hard palate, and maxillary sinus was seen in one case each. A total of 224 (85.8%) patients were diabetic, 68 (30.3%) of them had poor glycemic control. Steroids were administered in 210 (80.4%) patients. Except for two, antifungal treatment was given to all patients. Follow-up data revealed 67 (25.6%) deaths and 193 (73.9%) were alive with one patient lost during follow-up.
Conclusion: The findings of this systematic review suggested that the occurrence of mucormycosis in COVID-19 patients is related to the inherent effects of COVID-19 infection on the immune system, comorbidities especially diabetes, and treatment aspects. Hence, a detailed understanding of these factors may aid in the personalized management of CAM and improve the disease outcome.
Relevance for Patients: The risk factors in patients affected by CAM should be recognized and closely monitored in post-COVID-19 patients. A multidisciplinary team must be in place to reduce the mortality and morbidity in such patients.
1. Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J
Ophthalmol 2021;69:244-52.
2. Petrikkos G, Tsioutis C. Recent Advances in the Pathogenesis of Mucormycoses. Clin Ther 2018;40:894-902.
3. Ibrahim AS, Kontoyiannis DP. Update on Mucormycosis Pathogenesis. Curr Opin Infect Dis 2013;26:508-15.
4. Spellberg B, Edwards J Jr., Ibrahim A. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management. Clin Microbiol Rev 2005;8:556-69.
5. Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post Coronavirus Disease Mucormycosis: A Deadly
Addition to the Pandemic Spectrum. J Laryngol Otol 2021;135:442-7.
6. Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in People with
Diabetes: Understanding the Reasons for Worse Outcomes. Lancet Diabetes Endocrinol 2020;8:782-92.
7. Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated with COVID-19. Cureus 2020;12:e10726.
8. Mekonnen ZK, Ashraf DC, Jankowski T, Grob SR, Vagefi MR, Kersten RC, et al. Acute Invasive Rhino-Orbital
Mucormycosis in a Patient with COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast
Reconstr Surg 2021;37:e40-80.
9. Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and Orbital Mucormycosis. Indian J Ophthalmol
2021;69:1002-4.
10. Pasero D, Sanna S, Liperi C, Piredda D, Branca GP, Casadio L, et al. A Challenging Complication Following
SARS-CoV-2 Infection: A Case of Pulmonary Mucormycosis. Infection 2020;17:1-6.
11. Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital Mucormycosis in a COVID-19
Patient: A Case Report. Int J Surg Case Rep 2021;82:105957.
12. Karimi-Galougahi M, Arastou S, Haseli S. Fulminant Mucormycosis Complicating Coronavirus Disease 2019
(COVID-19). Int Forum Allergy Rhinol 2021;11:1029-30.
13. Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Kanavi MR, Farjad R. Rhino-orbital Mucormycosis during
Steroid Therapy in COVID-19 Patients: A Case Report. Eur J Ophthalmol 2021;10:11206721211009450.
14. Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, CallejaAlarcon S, Romero-Gutierrez L. A Case of Fatal RhinoOrbital Mucormycosis Associated with New Onset Diabetic Ketoacidosis and COVID-19. Cureus 2021;13:e13163.
15. Revannavar SM, Supriya PS, Samaga L, Vineeth VK. COVID-19 Triggering Mucormycosis in a Susceptible
Patient: A New Phenomenon in the Developing World? BMJ Case Rep 2021;14:e241663.
16. Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg 2021;6:1-8.
17. Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral Mucormycosis and COVID-19 Pneumonia. J Med Cases
2021;12:85-9.
18. Pauli MA, Pereira LM, Monteiro ML, de Camargo AR, Rabelo GD. Painful Palatal Lesion in a Patient with
COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:620-25.
19. Arora R, Goel R, Khanam S, Kumar S, Shah S, Singh S, et al. Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 a Preliminary Report from a Single Hospital. Clin Ophthalmol 2021;15:3505-14.
20. Roushdy T, Hamid E. A Case Series of Post COVID-19 Mucormycosis-a Neurological Prospective. Egypt J Neurol Psychiatr Neurosurg 2021;57:100.
21. Roopa R, Thanthoni M, Warrier AS. COVID-19 Coinfection with Mucormycosis in a Diabetic Patient.
Cureus 2021;13:e15820.
22. Bonates P, João GA, Cruz KS, Ferreira MS, Baía-daSilva DC, Farias ME, et al. Fatal Rhino-orbito-cerebral
mucormycosis Infection Associated with Diabetic Ketoacidosis Post-COVID-19. Rev Soc Bras Med Trop
2021;54:e03582021.
23. Arjun R, Felix V, Niyas VK, Kumar MA, Krishnan RB, Mohan V, et al. COVID-19 Associated Rhino-orbital
Mucormycosis: A Single Centre Experience of Ten Cases. QJM. 2022;114(11):831-34.
24. Baskar HC, Chandran A, Reddy CS, Singh S. Rhinoorbital Mucormycosis in a COVID-19 Patient. BMJ Case
Rep 2021;14:e244232.
25. Joshi AR, Muthe MM, Patankar SH, Athawale A, Achhapalia Y. CT and MRI Findings of Invasive Mucormycosis in the Setting of COVID-19: Experience from a Single Center in India. AJR Am J Roentgenol
2021;217:1431-32.
26. Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, et al. Mucormycosis and COVID-19: An Epidemic within a Pandemic in India. Mycoses 2021;64:1253-60.
27. Fouad YA, Abdelaziz TT, Askoura A, Saleh MI, Mahmoud MS, Ashour DM, et al. Spike in Rhino-OrbitalCerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic. Front Med (Lausanne) 2021;8:645270.
28. Buil JB, van Zanten AR, Bentvelsen RG, Rijpstra TA, Goorhuis B, van der Voort S, et al. Case Series of Four
Secondary Mucormycosis Infections in COVID-19 Patients, the Netherlands, December 2020 to May 2021.
Euro Surveill 2021;26:2100510.
29. Pakdel F, Ahmadikia K, Salehi M, Tabari A, Jafari R, Mehrparvar G, et al. Mucormycosis in Patients with
COVID-19: A Cross-sectional Descriptive Multicentre Study from Iran. Mycoses 2021;64:1238-52.
30. Meshram HS, Kute VB, Chauhan S, Desai S. Mucormycosis in Post-COVID-19 Renal Transplant Patients: A
Lethal Complication in Follow-up. Transpl Infect Dis 2021;23:e13663.
31. Bayram N, Ozsaygılı C, Sav H, Tekin Y, Gundogan M, Pangal E, et al. Susceptibility of Severe COVID-19
Patients to Rhino-orbital Mucormycosis Fungal Infection in Different Clinical Manifestations. Jpn J Ophthalmol
2021;65:515-25.
32. Arana C, Ramírez RE, Xipell M, Casals J, Moreno A, Herrera S, et al. Mucormycosis Associated with COVID-19 in Two Kidney Transplant Patients. Transpl Infect Dis 2021;23:e13652.
33. Krishna DS, Raj H, Kurup P, Juneja M. Maxillofacial Infections in Covid-19 Era-Actuality or the Unforeseen:
2 Case Reports. Indian J Otolaryngol Head Neck Surg 2021:1-4. DOI: 10.1007/s12070-021-02618-5.
34. Rao R, Shetty AP, Nagesh CP. Orbital Infarction Syndrome Secondary to Rhino-orbital Mucormycosis in a Case of COVID-19: Clinico-radiological Features. Indian J Ophthalmol 2021;69:1627-30.
35. Sebastian SK, Kumar VB, Gupta M, Sharma Y. Covid Assossiated Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg 2021:1-4. DOI: 10.1007/s12070-021- 02471-6
36. Nehara HR, Puri I, Singhal V, Ih S, Bishnoi BR, Sirohi P. Rhinocerebral Mucormycosis in COVID-19 Patient with Diabetes a Deadly Trio: Case Series from the North-Western Part of India. Indian J Med Microbiol 2021;39:380-3.
37. Dallalzadeh LO, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Secondary Infection with Rhino-orbital Cerebral
Mucormycosis Associated with COVID-19. Orbit 2021:1- 4. DOI: 10.1080/01676830.2021.1903044
38. Staats CC, Kmetzsch L, Schrank A, Vainstein MH. Fungal Zinc Metabolism and its Connections to Virulence. Front Cell Infect Microbiol 2013;3:65.
39. Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, et al. Multicenter Epidemiologic Study
of Coronavirus Disease-Associated Mucormycosis, India. Emerg Infect Dis 2021;27:2349-59.
40. Patel A, Kaur H, Xess I, Michael JS, Savio J, Rudramurthy S, et al. A Multicentre Observational Study
on the Epidemiology, Risk Factors, Management and Outcomes of Mucormycosis in India. Clin Microbiol Infect
2020;26:944.e9-15.
41. Sivagnanam S, Sengupta DJ, Hoogestraat D, Jain R, Stednick Z, Fredricks DN, et al. Seasonal Clustering of
Sinopulmonary Mucormycosis in Patients with Hematologic Malignancies at a Large Comprehensive Cancer Center. Antimicrob Resist Infect Control 2017;6:123.
42. Bhogireddy R, Krishnamurthy V, Jabaris SS, Pullaiah CP, Manohar S. Is Mucormycosis an Inevitable Complication of Covid-19 in India? Braz J Infect Dis 2021;25:101597.
43. Mahalaxmi I, Jayaramayya K, Venkatesan D, Subramaniam MD, Renu K, Vijayakumar P, et al. Mucormycosis: An Opportunistic Pathogen during COVID-19. Environ Res 2021;201:111643.
44. Moser D, Biere K, Han B, Hoerl M, Schelling G, Choukér A, et al. COVID-19 Impairs Immune Response to
Candida albicans. Front Immunol 2021;12:640644.
45. Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A Systematic Review of Cases Reported
Worldwide and in India. Diabetes Metab Syndr 2021;15:102146.
46. Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, et al. Hyperferritinemia in Critically
Ill COVID-19 Patients is Ferritin the Product of Inflammation or a Pathogenic Mediator? Clin Chim Acta
2020;509:249-51.
47. Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the Phoenix: Mucormycosis in COVID-19 Times. Indian J Ophthalmol 2021;69:1563-8.
48. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, Regional, and National Burden and Trend of Diabetes in
195 Countries and Territories: An Analysis from 1990 to 2025. Sci Rep 2020;10:14790.
49. Montefusco L, Ben Nasr M, D’Addio F, Loretelli C, Rossi A, Pastore I, et al. Acute and Long-term Disruption
of Glycometabolic Control after SARS-CoV-2 Infection. Nat Metab 2021;3:774-85.
50. Kumar M, Sarma DK, Shubham S, Kumawat M, Verma V, Singh B, et al. Mucormycosis in COVID-19 Pandemic: Risk Factors and Linkages. Curr Res Microb Sci 2021;2:100057.
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2021;69:1670-92.
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1. Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J
Ophthalmol 2021;69:244-52.
2. Petrikkos G, Tsioutis C. Recent Advances in the Pathogenesis of Mucormycoses. Clin Ther 2018;40:894-902.
3. Ibrahim AS, Kontoyiannis DP. Update on Mucormycosis Pathogenesis. Curr Opin Infect Dis 2013;26:508-15.
4. Spellberg B, Edwards J Jr., Ibrahim A. Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management. Clin Microbiol Rev 2005;8:556-69.
5. Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post Coronavirus Disease Mucormycosis: A Deadly
Addition to the Pandemic Spectrum. J Laryngol Otol 2021;135:442-7.
6. Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in People with
Diabetes: Understanding the Reasons for Worse Outcomes. Lancet Diabetes Endocrinol 2020;8:782-92.
7. Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated with COVID-19. Cureus 2020;12:e10726.
8. Mekonnen ZK, Ashraf DC, Jankowski T, Grob SR, Vagefi MR, Kersten RC, et al. Acute Invasive Rhino-Orbital
Mucormycosis in a Patient with COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthalmic Plast
Reconstr Surg 2021;37:e40-80.
9. Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and Orbital Mucormycosis. Indian J Ophthalmol
2021;69:1002-4.
10. Pasero D, Sanna S, Liperi C, Piredda D, Branca GP, Casadio L, et al. A Challenging Complication Following
SARS-CoV-2 Infection: A Case of Pulmonary Mucormycosis. Infection 2020;17:1-6.
11. Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital Mucormycosis in a COVID-19
Patient: A Case Report. Int J Surg Case Rep 2021;82:105957.
12. Karimi-Galougahi M, Arastou S, Haseli S. Fulminant Mucormycosis Complicating Coronavirus Disease 2019
(COVID-19). Int Forum Allergy Rhinol 2021;11:1029-30.
13. Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Kanavi MR, Farjad R. Rhino-orbital Mucormycosis during
Steroid Therapy in COVID-19 Patients: A Case Report. Eur J Ophthalmol 2021;10:11206721211009450.
14. Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, CallejaAlarcon S, Romero-Gutierrez L. A Case of Fatal RhinoOrbital Mucormycosis Associated with New Onset Diabetic Ketoacidosis and COVID-19. Cureus 2021;13:e13163.
15. Revannavar SM, Supriya PS, Samaga L, Vineeth VK. COVID-19 Triggering Mucormycosis in a Susceptible
Patient: A New Phenomenon in the Developing World? BMJ Case Rep 2021;14:e241663.
16. Moorthy A, Gaikwad R, Krishna S, Hegde R, Tripathi KK, Kale PG, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg 2021;6:1-8.
17. Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral Mucormycosis and COVID-19 Pneumonia. J Med Cases
2021;12:85-9.
18. Pauli MA, Pereira LM, Monteiro ML, de Camargo AR, Rabelo GD. Painful Palatal Lesion in a Patient with
COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol 2021;131:620-25.
19. Arora R, Goel R, Khanam S, Kumar S, Shah S, Singh S, et al. Rhino-Orbito-Cerebral-Mucormycosis During the COVID-19 Second Wave in 2021 a Preliminary Report from a Single Hospital. Clin Ophthalmol 2021;15:3505-14.
20. Roushdy T, Hamid E. A Case Series of Post COVID-19 Mucormycosis-a Neurological Prospective. Egypt J Neurol Psychiatr Neurosurg 2021;57:100.
21. Roopa R, Thanthoni M, Warrier AS. COVID-19 Coinfection with Mucormycosis in a Diabetic Patient.
Cureus 2021;13:e15820.
22. Bonates P, João GA, Cruz KS, Ferreira MS, Baía-daSilva DC, Farias ME, et al. Fatal Rhino-orbito-cerebral
mucormycosis Infection Associated with Diabetic Ketoacidosis Post-COVID-19. Rev Soc Bras Med Trop
2021;54:e03582021.
23. Arjun R, Felix V, Niyas VK, Kumar MA, Krishnan RB, Mohan V, et al. COVID-19 Associated Rhino-orbital
Mucormycosis: A Single Centre Experience of Ten Cases. QJM. 2022;114(11):831-34.
24. Baskar HC, Chandran A, Reddy CS, Singh S. Rhinoorbital Mucormycosis in a COVID-19 Patient. BMJ Case
Rep 2021;14:e244232.
25. Joshi AR, Muthe MM, Patankar SH, Athawale A, Achhapalia Y. CT and MRI Findings of Invasive Mucormycosis in the Setting of COVID-19: Experience from a Single Center in India. AJR Am J Roentgenol
2021;217:1431-32.
26. Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, et al. Mucormycosis and COVID-19: An Epidemic within a Pandemic in India. Mycoses 2021;64:1253-60.
27. Fouad YA, Abdelaziz TT, Askoura A, Saleh MI, Mahmoud MS, Ashour DM, et al. Spike in Rhino-OrbitalCerebral Mucormycosis Cases Presenting to a Tertiary Care Center During the COVID-19 Pandemic. Front Med (Lausanne) 2021;8:645270.
28. Buil JB, van Zanten AR, Bentvelsen RG, Rijpstra TA, Goorhuis B, van der Voort S, et al. Case Series of Four
Secondary Mucormycosis Infections in COVID-19 Patients, the Netherlands, December 2020 to May 2021.
Euro Surveill 2021;26:2100510.
29. Pakdel F, Ahmadikia K, Salehi M, Tabari A, Jafari R, Mehrparvar G, et al. Mucormycosis in Patients with
COVID-19: A Cross-sectional Descriptive Multicentre Study from Iran. Mycoses 2021;64:1238-52.
30. Meshram HS, Kute VB, Chauhan S, Desai S. Mucormycosis in Post-COVID-19 Renal Transplant Patients: A
Lethal Complication in Follow-up. Transpl Infect Dis 2021;23:e13663.
31. Bayram N, Ozsaygılı C, Sav H, Tekin Y, Gundogan M, Pangal E, et al. Susceptibility of Severe COVID-19
Patients to Rhino-orbital Mucormycosis Fungal Infection in Different Clinical Manifestations. Jpn J Ophthalmol
2021;65:515-25.
32. Arana C, Ramírez RE, Xipell M, Casals J, Moreno A, Herrera S, et al. Mucormycosis Associated with COVID-19 in Two Kidney Transplant Patients. Transpl Infect Dis 2021;23:e13652.
33. Krishna DS, Raj H, Kurup P, Juneja M. Maxillofacial Infections in Covid-19 Era-Actuality or the Unforeseen:
2 Case Reports. Indian J Otolaryngol Head Neck Surg 2021:1-4. DOI: 10.1007/s12070-021-02618-5.
34. Rao R, Shetty AP, Nagesh CP. Orbital Infarction Syndrome Secondary to Rhino-orbital Mucormycosis in a Case of COVID-19: Clinico-radiological Features. Indian J Ophthalmol 2021;69:1627-30.
35. Sebastian SK, Kumar VB, Gupta M, Sharma Y. Covid Assossiated Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg 2021:1-4. DOI: 10.1007/s12070-021- 02471-6
36. Nehara HR, Puri I, Singhal V, Ih S, Bishnoi BR, Sirohi P. Rhinocerebral Mucormycosis in COVID-19 Patient with Diabetes a Deadly Trio: Case Series from the North-Western Part of India. Indian J Med Microbiol 2021;39:380-3.
37. Dallalzadeh LO, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Secondary Infection with Rhino-orbital Cerebral
Mucormycosis Associated with COVID-19. Orbit 2021:1- 4. DOI: 10.1080/01676830.2021.1903044
38. Staats CC, Kmetzsch L, Schrank A, Vainstein MH. Fungal Zinc Metabolism and its Connections to Virulence. Front Cell Infect Microbiol 2013;3:65.
39. Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, et al. Multicenter Epidemiologic Study
of Coronavirus Disease-Associated Mucormycosis, India. Emerg Infect Dis 2021;27:2349-59.
40. Patel A, Kaur H, Xess I, Michael JS, Savio J, Rudramurthy S, et al. A Multicentre Observational Study
on the Epidemiology, Risk Factors, Management and Outcomes of Mucormycosis in India. Clin Microbiol Infect
2020;26:944.e9-15.
41. Sivagnanam S, Sengupta DJ, Hoogestraat D, Jain R, Stednick Z, Fredricks DN, et al. Seasonal Clustering of
Sinopulmonary Mucormycosis in Patients with Hematologic Malignancies at a Large Comprehensive Cancer Center. Antimicrob Resist Infect Control 2017;6:123.
42. Bhogireddy R, Krishnamurthy V, Jabaris SS, Pullaiah CP, Manohar S. Is Mucormycosis an Inevitable Complication of Covid-19 in India? Braz J Infect Dis 2021;25:101597.
43. Mahalaxmi I, Jayaramayya K, Venkatesan D, Subramaniam MD, Renu K, Vijayakumar P, et al. Mucormycosis: An Opportunistic Pathogen during COVID-19. Environ Res 2021;201:111643.
44. Moser D, Biere K, Han B, Hoerl M, Schelling G, Choukér A, et al. COVID-19 Impairs Immune Response to
Candida albicans. Front Immunol 2021;12:640644.
45. Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: A Systematic Review of Cases Reported
Worldwide and in India. Diabetes Metab Syndr 2021;15:102146.
46. Gómez-Pastora J, Weigand M, Kim J, Wu X, Strayer J, Palmer AF, et al. Hyperferritinemia in Critically
Ill COVID-19 Patients is Ferritin the Product of Inflammation or a Pathogenic Mediator? Clin Chim Acta
2020;509:249-51.
47. Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the Phoenix: Mucormycosis in COVID-19 Times. Indian J Ophthalmol 2021;69:1563-8.
48. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, Regional, and National Burden and Trend of Diabetes in
195 Countries and Territories: An Analysis from 1990 to 2025. Sci Rep 2020;10:14790.
49. Montefusco L, Ben Nasr M, D’Addio F, Loretelli C, Rossi A, Pastore I, et al. Acute and Long-term Disruption
of Glycometabolic Control after SARS-CoV-2 Infection. Nat Metab 2021;3:774-85.
50. Kumar M, Sarma DK, Shubham S, Kumawat M, Verma V, Singh B, et al. Mucormycosis in COVID-19 Pandemic: Risk Factors and Linkages. Curr Res Microb Sci 2021;2:100057.
51. Tandon A, Tandon S. COVID-19 and Mucormycosis: Time we Answer Questions? J Assoc Physicians India
2021;69:11-2.
52. Leonardelli F, Macedo D, Dudiuk C, Theill L, Cabeza MS, Gamarra S, et al. In vitro Activity of Combinations of Zinc Chelators with Amphotericin B and Posaconazole against Six Mucorales Species. Antimicrob Agents Chemother 2019;63:e00266-19.
53. Sen M, Honavar SG, Bansal R, Sengupta S, Rao R, Kim U, et al. Epidemiology, Clinical Profile, Management,
and Outcome of COVID-19-associated Rhino-orbitalcerebral Mucormycosis in 2826 Patients in India Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol
2021;69:1670-92.
54. Ochi JW, Harris JP, Feldman JI, Press GA. Rhinocerebral Mucormycosis: Results of Aggressive Surgical
Debridement and Amphotericin B. Laryngoscope 1988;98:1339-42.
55. Bhattacharyya A, Sarma P, Sharma DJ, Das KK, Kaur H, Prajapat M, et al. Rhino-orbital-cerebral-mucormycosis in COVID-19: A Systematic Review. Indian J Pharmacol 2021;53:317-27.
56. Maurya RP. Indications for Orbital Exenteration in COVID-19 Associated Rhino-orbito-cerebral Mucormycosis. IP Int J Ocul Oncol Oculoplast 2021;7:105-8.
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