COVID-19-associated mucormycosis: the rise and fall of an epidemic within a pandemic - a systematic review of 1,482 cases (2019-2025)
ABSTRACT During the COVID-19 pandemic, an unprecedented outbreak of mucormycosis affected tens of thousands of patients, mainly in India. This study reviewed the available published cases up to 2022 and updated the epidemiological curve up to November 2025. PRISMA-guided systematic review of PubMed, Embase, and SciELO (Dec. 2019-Dec. 2022), supplemented by official reports and cohort studies published until 2025. We analyzed 1,482 cases from 39 studies (90.8% conducted in India; 69.7% male individuals; mean age 52 years). Diabetes mellitus was present in >78% of patients, and 64.3% received corticosteroids. Rhino-orbital (40.7%) and rhino-orbito-cerebral (33.9%) were the dominant forms of mucormycosis. Amphotericin B was used in 49.5% of cases, and surgical debridement in 55.5%. The mortality rate was 25%. After 2022, the incidence collapsed globally: India dropped from >47,000 cases in 2021 to <100 cases/year; Europe, the Middle East, and Latin America reported zero outbreaks in 2024-2025. COVID-19-associated mucormycosis represented a major opportunistic infection during the acute phase of the pandemic. Although its incidence declined markedly after widespread vaccination implementation, improved corticosteroid use, and better glycemic control, it remains a serious and life-threatening condition in vulnerable populations. The findings highlight important risk factors, clinical challenges, and management considerations that remain relevant to inform current clinical practice and future post-pandemic scenarios.