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Background: Fungal coinfections have been part of the complications in coronavirus disease (COVID-19) patients. While systematic reviews on individual fungus was available, comprehensive data on the occurrence of various fungal infections was limited. Methodology: A systematic search in the databases ‘PubMed’ and ‘Global Research Database on COVID-19 by the World Health Organization (WHO) was made using relevant search terms. Only fungal coinfections/superinfections in confirmed COVID-19 cases were considered. All observational studies, case series, and case reports in English were included. Overall, the occurrence of the fungal infections and the associated factors was noted. Chi-square and Fisher’s exact tests compared epidemiological factors between survived and dead. Results: Data from 126 eligible studies reporting 870 cases showed that mucormycosis was the most common infection (42.5%), followed by aspergillosis (32.41%) and candidiasis (22.87%). The majority of the infections were seen in severe COVID-19 (94.01%), in ICU (67.25%), and with mechanical ventilation (73.61%). Prior steroid therapy was seen in 81.3% in mucormycosis. In aspergillosis, mechanical ventilation, infection due to Aspergillus fumigatus and administration of steroids at more than the recommended dose were significantly associated with those who died (p<0.05). Conclusion: Mucormycosis, followed by invasive pulmonary aspergillosis and invasive candidiasis, has been the most common coinfections/superinfections in COVID-19 patients. Early diagnosis led to better survival in Covid associated mucormycosis (CAM); however, in COVID-19-associated pulmonary aspergillosis (CAPA), mechanical ventilation, larger doses of corticosteroids than recommended and infection with A. fumigatus were significant associations among those who succumbed to the condition.
Sharma et al. (Sun,) studied this question.