COVID-19-associated fungal infections in Iran: A systematic review

Tina Nazari; Fatemeh Sadeghi; Alireza Izadi; Setayesh Sameni; Shahram Mahmoudi

doi:10.1371/journal.pone.0271333

COVID-19-associated fungal infections in Iran: A systematic review

PLoS One. 2022 Jul 11;17(7):e0271333. doi: 10.1371/journal.pone.0271333. eCollection 2022.

Authors

Tina Nazari¹, Fatemeh Sadeghi², Alireza Izadi^{3

4}, Setayesh Sameni⁵, Shahram Mahmoudi²

Affiliations

¹ Department of Medical Geriatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
³ Department of Medical Parasitology and Mycology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
⁴ Medical Mycology and Bacteriology Research Center, Kerman University of Medical Sciences, Kerman, Iran.
⁵ Department of Medical Sciences, Shahrood Branch, Islamic Azad University, Shahrood, Iran.

Abstract

Objectives: This systematic review aims to summarize the mycological and clinical features of COVID-19-associated fungal infections (CAFIs) in Iran.

Methods: PubMed, Web of Science, Scopus, Cochrane Library, SID, Magiran, IranDoc, and Google Scholar were searched for Persian and English articles published from January 1, 2020, to November 5, 2021, using a systematic search strategy. Studies on Iranian patients suffering from CAFIs were included in the review.

Results: Twenty-two studies comprising 169 patients were retrieved. Reported CAFIs included candidiasis (85, 50.30%), mucormycosis (35, 20.71%), aspergillosis (29, 17.16%), fusariosis (6, 3.55%), three cases caused by rare pathogens (Rhodotorula mucilaginosa, Diaporthe foeniculina, and Sarocladium kiliense) and 11 (6.51%) uncharacterized mold infections. The most common underlying diseases were diabetes (67/168, 39.88%), cardiovascular diseases (55/168, 32.74%), and hypertension (43/168, 25.59%). The use of antibiotics (111/124, 89.52%), corticosteroids (93/132, 70.44%), and mechanical ventilation (66, 51.16%) were the most common predisposing factors. Totally, 72 (50.35%) of 143 patients with CAFIs died (data were not available for 26 patients).

Conclusion: Fungal infections are evident to be a complication of COVID-19 in Iran; thus, clinicians should consider them as a differential diagnosis, especially in patients with comorbidities and previous antibiotic or corticosteroid use.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Diabetes Mellitus*
Humans
Iran / epidemiology

Grants and funding

SM received a grant (grant number: 1400-3-99-22062) from Iran University of Medical Sciences, Tehran, Iran. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.