Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India

econdary infections are known to complicate the clinical course of coronavirus disease .Bacterial infections are the most common secondary infections, but increasing reports of systemic fungal infections are causing concern.In the early part of the COVID-19 pandemic, <1% of secondary infections reported in COVID-19 patients were fungal (1,2).Preexisting conditions, indiscriminate use of antimicrobial and glucocorticoid drugs, and lapses in infection control practices are putative factors contributing to the emergence of systemic fungal infections in severe COVID-19 cases (3).After incidence of candidemia and invasive aspergillosis in COVID-19 patients increased (4,5), awareness of possible fungal co-infections increased among clinicians and microbiologists.One study reported invasive fungal infections in ≈6% of hospitalized COVID-19 patients (6).Occasional reports of COVID-19-associated mucormycosis (CAM) from various centers (7,8) and a series of 18 cases from a city in South India increased our concerns about CAM (9).India has a high burden of mucormycosis among patients with uncontrolled diabetes mellitus, and many severe COVID-19 patients have diabetes (8,10).India also is one of the countries worst affected by the COVID-19 pandemic.Thus, we would expect India to have many CAM cases.We conducted a nationwide multicenter study to evaluate the epidemiology and outcomes of CAM and compare the results with cases of mucormycosis unrelated to COVID-19 (non-CAM).