Oral and Maxillo-facial Fungal Infections in COVID-19 Patients - A Systematic Review

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.