The
coronavirus disease 2019 (COVID-19) pandemic has led to a concerning resurgence of
mucormycosis. More than 47,000 cases of
mucormycosis were reported in three months from India. We update our systematic review on COVID-19-associated
mucormycosis (CAM) till June 21st, 2021, comparing cases reported from India and elsewhere. We included individual patient details of 275 cases of CAM, of which 233 were reported from India and 42 from the rest of the world.
Diabetes mellitus was the most common underlying risk factor for CAM in India than in other countries. The fatality rate of cases reported from India (36.5%) was less than the globally reported cases (61.9%), probably due to the predominance of rhino-orbital
mucormycosis. On a multivariate analysis, we found that pulmonary or disseminated
mucormycosis cases and admission to the intensive care unit were associated with increased mortality, while combination medical
therapy improved survival. The paucity of pulmonary and disseminated
mucormycosis cases from India suggests that these cases were either not diagnosed or reported, further supported by a trend of search data from the Google search engine. In this review, we discuss the factors explaining the substantial rise in cases of CAM. We also propose a hypothetical model describing the epidemiologic triad of CAM.