{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T02:46:29Z","timestamp":1792118789470,"version":"4.4.0"},"reference-count":56,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T00:00:00Z","timestamp":1627257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Reports are increasing on the emergence of COVID\u201019\u2013associated mucormycosis (CAM) globally, driven particularly by low\u2010 and middle\u2010income countries. The recent unprecedented surge of CAM in India has drawn worldwide attention. More than 28,252 mucormycosis cases are counted and India is the first country where mucormycosis has been declared a notifiable disease. However, misconception of management, diagnosing and treating this infection continue to occur. Thus, European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) felt the need to address clinical management of CAM in low\u2010 and middle\u2010income countries. This article provides a comprehensive document to help clinicians in managing this infection. Uncontrolled diabetes mellitus and inappropriate (high dose or not indicated) corticosteroid use are the major predisposing factors for this surge. High counts of\n                    <jats:italic>Mucorales<\/jats:italic>\n                    spores in both the indoor and outdoor environments, and the immunosuppressive impact of COVID\u201019 patients as well as immunotherapy are possible additional factors. Furthermore, a hyperglycaemic state leads to an increased expression of glucose regulated protein (GRP\u2010 78) in endothelial cells that may help the entry of\n                    <jats:italic>Mucorales<\/jats:italic>\n                    into tissues. Rhino\u2010orbital mucormycosis is the most common presentation followed by pulmonary mucormycosis. Recommendations are focused on the early suspicion of the disease and confirmation of diagnosis. Regarding management, glycaemic control, elimination of corticosteroid therapy, extensive surgical debridement and antifungal therapy are the standards for proper care. Due to limited availability of amphotericin B formulations during the present epidemic, alternative antifungal therapies are also discussed.\n                  <\/jats:p>","DOI":"10.1111\/myc.13335","type":"journal-article","created":{"date-parts":[[2021,6,16]],"date-time":"2021-06-16T12:17:31Z","timestamp":1623845851000},"page":"1028-1037","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":187,"title":["ECMM\/ISHAM recommendations for clinical management of COVID\u201019 associated mucormycosis in low\u2010 and middle\u2010income countries"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9097-9253","authenticated-orcid":false,"given":"Shivaprakash M.","family":"Rudramurthy","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hoenigl","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Internal Medicine Medical University of Graz Graz Austria"},{"name":"Division of Infectious Diseases and Global Public Health University of California San Diego San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques F.","family":"Meis","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases Center of Expertise in Mycology Radboud University Medical Center\/Canisius Wilhelmina Hospital Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver A.","family":"Cornely","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Excellence Center for Medical Mycology (ECMM) Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany"},{"name":"Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging\u2010Associated Diseases (CECAD) Faculty of Medicine University of Cologne Cologne Germany"},{"name":"German Centre for Infection Research (DZIF) Partner Site Bonn\u2010Cologne Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-5607","authenticated-orcid":false,"given":"Jean Pierre","family":"Gangneux","sequence":"additional","affiliation":[{"name":"CHU Rennes Inserm EHESP Irset (Institut de recherch\u00e9 en sant\u00e9, environnement et travail) \u2013 UMR_S 1085 Universit\u00e9 de Rennes Rennes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Perfect","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Duke University Medical Center Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1555-3807","authenticated-orcid":false,"given":"Arunaloke","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ECMM and ISHAM","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41479-021-00083-w"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.08.005"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30847-1"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2607.201603"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2704.204895"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-021-00528-2"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2021.05.019"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jof7040298"},{"key":"e_1_2_13_10_1","article-title":"The emergence of COVID\u201019 associated mucormycosis: analysis of cases from 18 countries","author":"Hoenigl M","year":"2021","journal-title":"Bioxriv"},{"issue":"9","key":"e_1_2_13_11_1","article-title":"Multicenter epidemiologic study of coronavirus disease\u2010associated mucormycosis","volume":"27","author":"Patel A","year":"2021","journal-title":"India. 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