Rapid communication Open Access
Like 0


We describe four secondary fungal infections caused by Mucorales species in COVID-19 patients. Three COVID-19 associated mucormycosis (CAM) occurred in ICU, one outside ICU. All were men aged > 50 years, three died. Clinical presentations included pulmonary, rhino-orbital cerebral and disseminated infection. Infections occurred in patients with and without diabetes mellitus. CAM is an emerging disease and our observations underscore the need to be aware of invasive mucormycosis, including in COVID-19 patients without (poorly controlled) diabetes mellitus and outside ICU.


Article metrics loading...

Loading full text...

Full text loading...



  1. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. , ISARIC4C investigators. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.  https://doi.org/10.1136/bmj.m1985  PMID: 32444460 
  2. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. , the Northwell COVID-19 Research Consortium. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9.  https://doi.org/10.1001/jama.2020.6775  PMID: 32320003 
  3. Alanio A, Dellière S, Fodil S, Bretagne S, Mégarbane B. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med. 2020;8(6):e48-9.  https://doi.org/10.1016/S2213-2600(20)30237-X  PMID: 32445626 
  4. White PL, Dhillon R, Cordey A, Hughes H, Faggian F, Soni S, et al. A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin Infect Dis. 2020;ciaa1298.  PMID: 32860682 
  5. Bartoletti M, Pascale R, Cricca M, Rinaldi M, Maccaro A, Bussini L, et al. Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study. Clin Infect Dis. 2020;ciaa1065.  PMID: 32719848 
  6. Sarrazyn C, Dhaese S, Demey B, Vandecasteele S, Reynders M, Van Praet JT. Incidence, risk factors, timing, and outcome of influenza versus COVID-19-associated putative invasive aspergillosis. Infect Control Hosp Epidemiol. 2020;1-2.  PMID: 32900411 
  7. van Arkel ALE, Rijpstra TA, Belderbos HNA, van Wijngaarden P, Verweij PE, Bentvelsen RG. COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med. 2020;202(1):132-5.  https://doi.org/10.1164/rccm.202004-1038LE  PMID: 32396381 
  8. Chong WH, Neu KP. The Incidence, Diagnosis, and Outcomes of COVID-19-associated Pulmonary Aspergillosis (CAPA): A Systematic Review. J Hosp Infect. 2021:S0195-6701(21)00163-8.  https://doi.org/10.1016/j.jhin.2021.04.012 
  9. John TM, Jacob CN, Kontoyiannis DP. When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis. J Fungi (Basel). 2021;7(4):298.  https://doi.org/10.3390/jof7040298  PMID: 33920755 
  10. Hoenigl M, Seidel D, Carvalho A, Rudramurthy SM, Arastehfar A, Gangneux JP, et al. The Emergence of COVID-19 Associated Mucormycosis: Analysis of Cases From 18 Countries. SSRN Electronic Journal (Preprint) DOI:102139/ssrn3844587. 2021.
  11. Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel). 2020;6(4):E265.  https://doi.org/10.3390/jof6040265  PMID: 33147877 
  12. Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms. 2021;9(3):523.  https://doi.org/10.3390/microorganisms9030523  PMID: 33806386 
  13. Falcone M, Tiseo G, Giordano C, Leonildi A, Menichini M, Vecchione A, et al. , Pisa COVID-19 Study Group. Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study. J Antimicrob Chemother. 2021;76(4):1078-84.  https://doi.org/10.1093/jac/dkaa530  PMID: 33374002 
  14. van de Veerdonk FL, Brüggemann RJM, Vos S, De Hertogh G, Wauters J, Reijers MHE, et al. COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion. Lancet Respir Med. 2021;S2213-2600(21)00138-7. PMID: 34051176 
  15. Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, et al. , Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405-21.  https://doi.org/10.1016/S1473-3099(19)30312-3  PMID: 31699664 
  16. Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2020;71(6):1367-76.  https://doi.org/10.1093/cid/ciz1008  PMID: 31802125 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error