Multicenter Epidemiologic Study of Coronavirus Disease-Associated Mucormycosis, India

Emerg Infect Dis. 2021 Sep;27(9):2349-2359. doi: 10.3201/eid2709.210934. Epub 2021 Jun 4.


During September-December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)-associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September-December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19-related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.

Keywords: COVID-19; India; SARS; SARS-CoV-2; amphotericin; coronavirus; coronavirus disease; diabetes; epidemiology; fungi; isavuconazole; mucormycosis; posaconazole; respiratory infections; severe acute respiratory syndrome coronavirus 2; viruses; zoonoses.

Publication types

  • Multicenter Study

MeSH terms

  • Antifungal Agents / therapeutic use
  • COVID-19*
  • Humans
  • India / epidemiology
  • Mucormycosis* / diagnosis
  • Mucormycosis* / drug therapy
  • Mucormycosis* / epidemiology
  • Pandemics
  • Retrospective Studies
  • SARS-CoV-2


  • Antifungal Agents