{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:36:22Z","timestamp":1786649782292,"version":"build-2736575974"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>The main objective of the current systematic review was to compile and evaluate the data on opportunistic maxillofacial mycotic infections in COVID-19 patients during the treatment and post-recovery period of SARS-CoV-2 infection. Comorbidities like diabetes, corticosteroid use, and mortality among COVID-19-associated patients presenting with oral and maxillofacial fungal infections were also assessed. The review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A comprehensive search was carried out in the archives of Web of Science, Pubmed\/Medline, Scopus, Google Scholar, Lilacs, and Livivo in combination with Boolean operators till 24th June 2022, and cross-sectional studies, case series, and case reports deliberating on maxillofacial mycoses in COVID-19 were included. The included studies were meted to the risk of bias using the Joana Briggs Institute Appraisal tools for prevalence studies, case series, and case reports. In a two-stage collection, 20 studies were included: 9 observational (3269 patients), 5 case-series (42 patients), and 6 case reports (8 patients) from 7 countries. Mucormycosis was the most commonly reported maxillofacial fungal infection (96.7%\/3162 cases), followed by candidiasis (3.2%\/105 cases) associated with COVID-19. Although aspergillosis was observed in only one case and one patient, a mixed mycotic infection demonstrating both aspergillus and mucor fungal elements was identified in one patient. Comorbidities like diabetes mellitus, indiscriminate corticosteroid use and immunosuppression leads to invasive maxillofacial fungal infections in COVID-19, which may prove to be fatal.<\/jats:p>","DOI":"10.4103\/ijdr.ijdr_691_23","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T18:58:32Z","timestamp":1743361112000},"page":"459-464","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Oral and Maxillo-facial Fungal Infections in COVID-19 Patients - A Systematic Review"],"prefix":"10.4103","volume":"35","author":[{"given":"Preeti","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Oral & Maxillofacial Pathology and Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangeeta","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine and Radiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Wadhwan","sequence":"additional","affiliation":[{"name":"Department of Oral & Maxillofacial Pathology and Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kush","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anindita","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishabh","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,29]]},"reference":[{"key":"R1-20260423","doi-asserted-by":"crossref","first-page":"e2342.","DOI":"10.1002\/rmv.2342","article-title":"Assessing severe acute respiratory syndrome coronavirus 2 infectivity by reverse-transcription polymerase chain reaction: A systematic review and meta-analysis","volume":"32","author":"Fomenko","year":"2022","journal-title":"Rev Med Virol"},{"key":"R2-20260423","doi-asserted-by":"crossref","first-page":"e2345.","DOI":"10.1002\/rmv.2345","article-title":"Prevalence of oral manifestations in COVID-19: A systematic review","volume":"32","author":"Sharma","year":"2022","journal-title":"Rev Med Virol"},{"key":"R3-20260423","doi-asserted-by":"crossref","first-page":"102146.","DOI":"10.1016\/j.dsx.2021.05.019","article-title":"Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India","volume":"15","author":"Singh","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"R4-20260423","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3390\/jof7040298","article-title":"When uncontrolled diabetes mellitus and severe COVID-19 converge: The perfect storm for mucormycosis","volume":"7","author":"John","year":"2021","journal-title":"J Fungi (Basel)"},{"key":"R5-20260423","doi-asserted-by":"crossref","first-page":"5836","DOI":"10.1002\/jmv.28079","article-title":"SARS-CoV-2 RNA load in nasopharyngeal specimens from outpatients with breakthrough COVID-19 due to Omicron BA.1 and BA.2","volume":"94","author":"de Michelena","year":"2022","journal-title":"J Med Virol"},{"key":"R6-20260423","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.4103\/jfmpc.jfmpc_1125_21","article-title":"Mucormycosis following COVID-19 infection-An epidemic developing in a pandemic, a case series from a tertiary care hospital of India","volume":"11","author":"Singhai","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"R7-20260423","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10006-021-01010-5","article-title":"Post-COVID fungal infections of maxillofacial region: A systematic review","volume":"26","author":"Jain","year":"2021","journal-title":"Oral Maxillofac Surg"},{"key":"R8-20260423","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1017\/S0022215121000992","article-title":"Post coronavirus disease mucormycosis: A deadly addition to the pandemic spectrum","volume":"135","author":"Sharma","year":"2021","journal-title":"J Laryngol Otol"},{"key":"R9-20260423","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.identj.2022.02.010","article-title":"Orofacial mycoses in Coronavirus disease 2019 (COVID-19): A systematic review","volume":"72","author":"Samaranayake","year":"2022","journal-title":"Int Dental J"},{"key":"R10-20260423","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/S2666-5247(20)30027-6","article-title":"Diagnosing COVID-19-associated pulmonary aspergillosis","volume":"1","author":"Verweij","year":"2020","journal-title":"Lancet Microbe"},{"key":"R11-20260423","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/myc.13096","article-title":"COVID-19 associated pulmonary aspergillosis","volume":"63","author":"Koehler","year":"2020","journal-title":"Mycoses"},{"key":"R12-20260423","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R14-20260423","doi-asserted-by":"crossref","first-page":"e114631.","DOI":"10.5812\/archcid.114631","article-title":"Risk factors of oropharyngeal candidiasis in covid-19 patients: A case-control study","volume":"16","author":"Salehi","year":"2021","journal-title":"Archives of Clinical Infectious Diseases"},{"key":"R15-20260423","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s12663-021-01532-1","article-title":"SARS-CoV-2, uncontrolled diabetes and corticosteroids\u2014An unholy trinity in invasive fungal infections of the maxillofacial region? A retrospective, multi-centric analysis","volume":"20","author":"Moorthy","year":"2021","journal-title":"J Maxillofac Oral Surg"},{"key":"R16-20260423","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1","volume":"69","author":"Sen","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R17-20260423","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s10384-021-00845-5","article-title":"Susceptibility of severe COVID-19 patients to rhino-orbital mucormycosis fungal infection in different clinical manifestations","volume":"65","author":"Bayram","year":"2021","journal-title":"Jpn J Ophthalmol"},{"key":"R18-20260423","doi-asserted-by":"crossref","first-page":"102322.","DOI":"10.1016\/j.dsx.2021.102322","article-title":"COVID-19 associated mucormycosis: A descriptive multisite study from India","volume":"15","author":"Gupta","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"R19-20260423","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/qjmed\/hcab190","article-title":"COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients","volume":"114","author":"Ramaswami","year":"2021","journal-title":"QJM"},{"key":"R20-20260423","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1111\/myc.13351","article-title":"Increased incidence of rhino-orbital mucormycosis in an educational therapeutic hospital during the COVID-19 pandemic in western Iran: An observational study","volume":"64","author":"Avatef Fazeli","year":"2021","journal-title":"Mycoses"},{"key":"R21-20260423","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.4103\/ijo.IJO_2366_21","article-title":"A clinico-pathological study of COVID-19 associated rhino-orbital-cerebral mucormycosis","volume":"70","author":"Mani","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R22-20260423","doi-asserted-by":"crossref","first-page":"837.","DOI":"10.3390\/jof7100837","article-title":"COVID-19-associated mucormycosis (CAM): Case-series and global analysis of mortality risk factors","volume":"7","author":"Riad","year":"2021","journal-title":"Journal of Fungi"},{"key":"R23-20260423","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s10072-021-05740-y","article-title":"Rhino-orbito-cerebral mucormycosis during the COVID-19 third wave in 2021: An Egyptian preliminary report from a single tertiary hospital","volume":"43","author":"Alloush","year":"2022","journal-title":"Neurol Sci"},{"key":"R24-20260423","doi-asserted-by":"crossref","first-page":"867","DOI":"10.18203\/issn.2454-5929.ijohns20211583","article-title":"A case series of invasive mucormycosis in patients with COVID-19 infection","volume":"7","author":"Mishra","year":"2021","journal-title":"Int J Otorhinolaryngol Head Neck Surg"},{"key":"R25-20260423","doi-asserted-by":"crossref","first-page":"e757","DOI":"10.1016\/j.jormas.2022.06.003","article-title":"A case series of mucormycosis after covid infection in two hospitals","volume":"123","author":"Martins","year":"2022","journal-title":"J Stomatol Oral Maxillofac Surg"},{"key":"R26-20260423","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.ijmmb.2021.05.009","article-title":"Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India","volume":"39","author":"Nehara","year":"2021","journal-title":"Indian J Med Microbiol"},{"key":"R27-20260423","doi-asserted-by":"crossref","first-page":"227","DOI":"10.14712\/18059694.2022.7","article-title":"Dual fungal infections (Aspergillosis and Mucormycosis) in a diabetic mellitus patient leading to maxillary sinusitis as a post-COVID manifestation: First case report","volume":"64","author":"Jawanda","year":"2021","journal-title":"Acta Medica (Hradec Kralove)"},{"key":"R28-20260423","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1097\/IOP.0000000000001889","article-title":"Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome","volume":"37","author":"Mekonnen","year":"2021","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"R29-20260423","first-page":"e13163.","article-title":"A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19","volume":"13","author":"Waizel-Haiat","year":"2021","journal-title":"Cureus"},{"key":"R30-20260423","doi-asserted-by":"crossref","first-page":"264.e5","DOI":"10.1016\/j.ajem.2020.09.032","article-title":"Mucormycosis with orbital compartment syndrome in a patient with COVID-19","volume":"42","author":"Werthman-Ehrenreich","year":"2021","journal-title":"Am J Emerg Med"},{"key":"R31-20260423","first-page":"11206721211009450","article-title":"Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report","author":"Veisi","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"R32-20260423","doi-asserted-by":"crossref","first-page":"101203","DOI":"10.1016\/j.mycmed.2021.101203","article-title":"First report of COVID-19-associated rhino-orbito-cerebral mucormycosis in pediatric patients with type 1 diabetes mellitus","volume":"31","author":"Diwakar","year":"2021","journal-title":"J Mycol Med"},{"key":"R33-20260423","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1177\/00220345211029637","article-title":"Oral manifestations in patients with COVID-19: A 6-month update","volume":"100","author":"Amorim Dos Santos","year":"2021","journal-title":"J Dent Res"},{"key":"R34-20260423","first-page":"CD014963","article-title":"Systemic corticosteroids for the treatment of COVID-19","volume":"8","author":"Wagner","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"R35-20260423","article-title":"Evidence for secondary thrombotic microangiopathy in COVID-19","author":"Sweeny","journal-title":"medRxiv 2020:2020.10.20.20215608"}],"container-title":["Indian Journal of Dental Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijdr.ijdr_691_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:58:21Z","timestamp":1786647501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijdr.ijdr_691_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijdr.ijdr_691_23","relation":{},"ISSN":["0970-9290","1998-3603"],"issn-type":[{"value":"0970-9290","type":"print"},{"value":"1998-3603","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2023-08-09","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}