Document Type : Systematic Review


1 Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran

2 Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran, Iran

4 Faculty of Biological Sciences, Islamic Azad University, Tehran-North Branch, Tehran, Iran



Background & Objective: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies.
Methods: To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization.
Results: We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality.
Conclusion: This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.


Main Subjects

  1. Saini S, Singh SP, Singh VK, Kumar S, Singh S, Rajak SD. COVID-19-Associated Rhino-orbital mucormycosis: Presentation and outcome. Saudi J Ophthalmol. 2023;37(1):72-5. [DOI:10.4103/SJOPT.SJOPT_154_21] [PMID]
  2. Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AAR, et al. COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection. 2023;51(2):407-16. [DOI:10.1007/s15010-022-01891-y] [PMID]
  3. Ramos R, de la Villa S, García-Ramos S, Padilla B, García-Olivares P, Piñero P, et al. COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital. Enferm Infecc Microbiol Clin (Engl Ed). 2023;41(5):278-83. [DOI:10.1016/j.eimc.2021.10.014]
  4. Qadri H, Shah AH, Alkhanani M, Almilaibary A, Mir MA. Immunotherapies against human bacterial and fungal infectious diseases: A review. Front Med (Lausanne). 2023;10:1135541. [DOI:10.3389/fmed.2023.1135541] [PMID]
  5. Shoaee S, Rezaie F, Payab M, Bakhtiari F, Heydari M-H. Experiences from the management of COVID-19 pandemic in a nursing home in Iran (March-April, 2020). Journal of Diabetes & Metabolic Disorders. 2022;21(1):1195-9. [DOI:10.1007/s40200-022-01005-3] [PMID]
  6. Valizadeh J, Boloukifar S, Soltani S, Jabalbarezi Hookerd E, Fouladi F, Andreevna Rushchtc A, et al. Designing an optimization model for the vaccine supply chain during the COVID-19 pandemic. Expert Syst Appl. 2023;214:119009. [DOI:10.1016/j.eswa.2022.119009] [PMID]
  7. Tsotsolis S, Kotoulas SC, Lavrentieva A. Invasive Pulmonary Aspergillosis in Coronavirus Disease 2019 Patients Lights and Shadows in the Current Landscape. Adv Respir Med. 2023;91(3):185-202. [DOI:10.3390/arm91030016] [PMID]
  8. Thornton CR. The potential for rapid antigen testing for mucormycosis in the context of COVID-19. Expert Rev Mol Diagn. 2023:1-7. [DOI:10.1080/14737159.2023.2233906] [PMID]
  9. Tayabali K, Pothiwalla H, Narayanan S. Epidemiology of COVID-19-Associated Mucormycosis. Curr Fungal Infect Rep. 2023:1-20. [DOI:10.1007/s12281-023-00464-2] [PMID]
  10. Sun Y, Tao Q, Cao Y, Yang T, Zhang L, Luo Y, et al. Kaempferol has potential anti-coronavirus disease 2019 (COVID-19) targets based on bioinformatics analyses and pharmacological effects on endotoxin-induced cytokine storm. Phytother Res. 2023;37(6):2290-304. [DOI:10.1002/ptr.7740] [PMID]
  11. Sun M, Lai H, Huang J, Liu J, Li Y, Tian J, et al. Molnupiravir for the treatment of non-severe COVID-19: a systematic review and meta-analysis of 14 randomized trials with 34 570 patients. J Antimicrob Chemother. 2023. [DOI:10.1093/jac/dkad216] [PMID]
  12. Singh A, Kumar V, Kumar V, Verma N. The baneful alliance of COVID-19 and mucormycosis: Histopathological concerns. Indian J Pathol Microbiol. 2023;66(1):106-10. [DOI:10.4103/ijpm.ijpm_192_22] [PMID]
  13. Siasios P, Arvaniti K, Zachrou E, Poulopoulou A, Pisanidou P, Vasileiadou G, et al. COVID-19-Associated Pulmonary Aspergillosis (CAPA) in Northern Greece during 2020-2022: A Comparative Study According to the Main Consensus Criteria and Definitions. J Fungi (Basel). 2023;9(1). [DOI:10.3390/jof9010081] [PMID]
  14. Shah M, Reveles K, Moote R, Hand E, Kellogg Iii D, Attridge RL, et al. Risk of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients. Open Forum Infect Dis. 2023;10(3):ofad062. [DOI:10.1093/ofid/ofad062] [PMID]
  15. Sasani E, Bahrami F, Salehi M, Aala F, Bakhtiari R, Abdollahi A, et al. Pneumocystis pneumonia in COVID-19 patients: A comprehensive review. Heliyon. 2023;9(2):e13618. [DOI:10.1016/j.heliyon.2023.e13618] [PMID]
  16. Sánchez-Castellano M, Marcelo C, Marco J, Figueira-Iglesias JC, García-Rodríguez J. A Tale of Two Hospitals: Comparing CAPA Infections in Two ICUs During the Spanish Fourth Pandemic Wave. Mycopathologia. 2023:1-10. [DOI:10.21203/]
  17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372. [DOI:10.1136/bmj.n71] [PMID]
  18. Al Mutair A, Elhazmi A, Alhumaid S, Ahmad GY, Rabaan AA, Alghdeer MA, et al. Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study. Medicina (Kaunas). 2021;57(9). [DOI:10.3390/medicina57090878] [PMID]
  19. Allaw F, Haddad SF, Habib N, Moukarzel P, Naji NS, Kanafani ZA, et al. COVID-19 and C. auris: A Case-Control Study from a Tertiary Care Center in Lebanon. Microorganisms. 2022;10(5). [DOI:10.3390/microorganisms10051011] [PMID]
  20. Alshrefy AJ, Alwohaibi RN, Alhazzaa SA, Almaimoni RA, AlMusailet LI, AlQahtani SY, et al. Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU. Int J Gen Med. 2022;15:7475-85. [DOI:10.2147/IJGM.S382687] [PMID]
  21. Avkan-Oğuz V, Çelİk M, Eren-Kutsoylu O, Nazli A, Uğur YL, Taylan A, et al. Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital. Respir Med Res. 2022;82:100937. [DOI:10.1016/j.resmer.2022.100937] [PMID]
  22. Ayalon O, Cohen MJ, Orenbuch-Harroch E, Sviri S, van Heerden PV, Korem M. Invasive fungal infections in critically ill COVID-19 patients in a large tertiary university hospital in Israel. J Crit Care. 2022;69:154004. [DOI:10.1016/j.jcrc.2022.154004] [PMID]
  23. Bartoletti M, Pascale R, Cricca M, Rinaldi M, Maccaro A, Bussini L, et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin Infect Dis. 2021;73(11):e3606-e14. [DOI:10.1093/cid/ciaa1065] [PMID]
  24. Bentvelsen RG, Arkel A, Rijpstra TA, Kant MKM, Brugge SVS, Loth DW, et al. Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave. J Fungi (Basel). 2022;8(2). [DOI:10.3390/jof8020096] [PMID]
  25. Bergmann F, Jorda A, Blaschke A, Gabler C, Bohdan S, Nussbaumer-Pröll A, et al. Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study. J Fungi (Basel). 2023;9(3). [DOI:10.3390/jof9030315] [PMID]
  26. Bishburg E, Okoh A, Nagarakanti SR, Lindner M, Migliore C, Patel P. Fungemia in COVID-19 ICU patients, a single medical center experience. Journal of Medical Virology. 2021;93(5):2810-4. [DOI:10.1002/jmv.26633] [PMID]
  27. Calderón-Parra J, Mills-Sanchez P, Moreno-Torres V, Tejado-Bravo S, Romero-Sánchez I, Balandin-Moreno B, et al. COVID-19-associated pulmonary aspergillosis (CAPA): Risk factors and development of a predictive score for critically ill COVID-19 patients. Mycoses. 2022;65(5):541-50. [DOI:10.1111/myc.13434] [PMID]
  28. Calvo G, Araújo GRS, Llopis-Pastor E, Carrillo J, Hernández-Hernández M, Rey L, et al. Prevalence of opportunistic invasive aspergillosis in COVID-19 patients with severe pneumonia. Mycoses. 2021;64(2):144-51. [DOI:10.1111/myc.13219] [PMID]
  29. Dellière S, Dudoignon E, Fodil S, Voicu S, Collet M, Oillic PA, et al. Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort. Clin Microbiol Infect. 2020;27(5):790.e1-5. [DOI:10.1016/j.cmi.2020.12.005] [PMID]
  30. Dixit D, Jen P, Maxwell TD, Smoke S, McCracken JA, Cardinale-King M, et al. Risk Factors and Clinical Outcomes of Candidemia Associated With Severe COVID-19. Crit Care Explor. 2022;4(9):e0762. [DOI:10.1097/CCE.0000000000000762] [PMID]
  31. Dursun Z, Sipahioğlu H, Civan Yüksel R, Sav H, Çelik İ. Risk factors and lethality associated with Candidemia in severe COVID-19 patients. Curr Med Mycol. 2022;8(1):32-8. [DOI:10.18502/cmm.8.1.9212] [PMID]
  32. Erami M, Hashemi SJ, Raiesi O, Fattahi M, Getso MI, Momen-Heravi M, et al. COVID-19-associated pulmonary aspergillosis (CAPA) in Iranian patients admitted with severe COVID-19 pneumonia. Infection. 2023;51(1):223-30. [DOI:10.1007/s15010-022-01907-7] [PMID]
  33. Erami M, Raiesi O, Momen-Heravi M, Getso MI, Fakhrehi M, Mehri N, et al. Clinical impact of Candida respiratory tract colonization and acute lung infections in critically ill patients with COVID-19 pneumonia. Microb Pathog. 2022;166:105520. [DOI:10.1016/j.micpath.2022.105520] [PMID]
  34. Ergün M, Brüggemann RJM, Alanio A, Dellière S, van Arkel A, Bentvelsen RG, et al. Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients. J Clin Microbiol. 2021;59(12):e0122921. [DOI:10.1128/JCM.01229-21] [PMID]
  35. Fekkar A, Lampros A, Mayaux J, Poignon C, Demeret S, Constantin JM, et al. Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU. Am J Respir Crit Care Med. 2021;203(3):307-17. [DOI:10.1164/rccm.202009-3400OC] [PMID]
  36. Gangneux JP, Dannaoui E, Fekkar A, Luyt CE, Botterel F, De Prost N, et al. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med. 2022;10(2):180-90. [DOI:10.1016/S2213-2600(21)00442-2] [PMID]
  37. Gangneux JP, Reizine F, Guegan H, Pinceaux K, Le Balch P, Prat E, et al. Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience. J Fungi (Basel). 2020;6(3). [DOI:10.3390/jof6030105] [PMID]
  38. Ghazanfari M, Arastehfar A, Davoodi L, Yazdani Charati J, Moazeni M, Abastabar M, et al. Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients. Front Med (Lausanne). 2021;8:649675. [DOI:10.3389/fmed.2021.649675] [PMID]
  39. Grootveld R, van der Beek MT, Janssen NAF, Ergün M, van Dijk K, Bethlehem C, et al. Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy. J Crit Care. 2023;76:154272. [DOI:10.1016/j.jcrc.2023.154272] [PMID]
  40. Huang JR, Shen HC, Sun CY, Chen WC, Chen YM, Feng JY, et al. COVID-19-associated pulmonary aspergillosis is associated with increased in-hospital mortality and prolonged SARS-CoV-2 viral shedding. J Formos Med Assoc. 2022;121(12):2617-25. [DOI:10.1016/j.jfma.2022.07.006] [PMID]
  41. Iqbal A, Ramzan M, Akhtar A, Ahtesham A, Aslam S, Khalid J. COVID-Associated Pulmonary Aspergillosis and Its Related Outcomes: A Single-Center Prospective Observational Study. Cureus. 2021;13(8):e16982. [DOI:10.7759/cureus.16982]
  42. Irfan A, Kamran AH, Ammar M, Rahman SU. Frequency and survival of Covid associated mucormycosis patients at tertiary care hospitals in Pakistan: A retrospective observational study. Health Sci Rep. 2023;6(2):e1083. [DOI:10.1002/hsr2.1083] [PMID]
  43. Janssen NAF, Nyga R, Vanderbeke L, Jacobs C, Ergün M, Buil JB, et al. Multinational Observational Cohort Study of COVID-19-Associated Pulmonary Aspergillosis(1). Emerg Infect Dis. 2021;27(11):2892-8. [DOI:10.3201/eid2711.211174] [PMID]
  44. Lahmer T, Kriescher S, Herner A, Rothe K, Spinner CD, Schneider J, et al. Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study. PLoS One. 2021;16(3):e0238825. [DOI:10.1371/journal.pone.0238825] [PMID]
  45. Marta GC, Lorena FE, Laura MV, Angela LM, Blanca LG, Rodrigo AA, et al. COVID-19-Associated Pulmonary Aspergillosis in a Tertiary Hospital. J Fungi (Basel). 2022;8(2). [DOI:10.3390/jof8020097] [PMID]
  46. Nasir N, Farooqi J, Zubair SM, Ayub M, Khan S, Wiqar MH, et al. Comparison of risk factors and outcome of patients with and without COVID-19-associated pulmonary aspergillosis from Pakistan: A case-control study. Mycoses. 2023;66(1):69-74. [DOI:10.1111/myc.13529] [PMID]
  47. Negm EM, Mohamed MS, Rabie RA, Fouad WS, Beniamen A, Mosallem A, et al. Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country. BMC Infect Dis. 2023;23(1):246. [DOI:10.1186/s12879-023-08226-8] [PMID]
  48. Ozturk A, Bozok T, Erdogan M, Ibrahim BM, Bozok TS. COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles. Folia Microbiol (Praha). 2023:1-9. [DOI:10.1007/s12223-023-01069-5] [PMID]
  49. Permpalung N, Chiang TP, Massie AB, Zhang SX, Avery RK, Nematollahi S, et al. Coronavirus Disease 2019-Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients. Clin Infect Dis. 2022;74(1):83-91. [DOI:10.1093/cid/ciab223] [PMID]
  50. Pintado M, Camiro-Zúñiga A, Aguilar Soto M, Cuenca D, Mercado M, Crabtree-Ramirez B. COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City. Med Mycol. 2021;59(8):828-33. [DOI:10.1093/mmy/myab009] [PMID]
  51. Prattes J, Wauters J, Giacobbe DR, Salmanton-García J, Maertens J, Bourgeois M, et al. Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients-a multinational observational study by the European Confederation of Medical Mycology. Clin Microbiol Infect. 2022;28(4):580-7. [DOI:10.1016/j.cmi.2021.08.014] [PMID]
  52. Roman-Montes CM, Bojorges-Aguilar S, Corral-Herrera EA, Rangel-Cordero A, Díaz-Lomelí P, Cervantes-Sanchez A, et al. Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico. J Fungi (Basel). 2023;9(5). [DOI:10.3390/jof9050583] [PMID]
  53. Roman-Montes CM, Martinez-Gamboa A, Diaz-Lomelí P, Cervantes-Sanchez A, Rangel-Cordero A, Sifuentes-Osornio J, et al. Accuracy of galactomannan testing on tracheal aspirates in COVID-19-associated pulmonary aspergillosis. Mycoses. 2021;64(4):364-71. [DOI:10.1111/myc.13216] [PMID]
  54. Rouzé A, Lemaitre E, Martin-Loeches I, Povoa P, Diaz E, Nyga R, et al. Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study. Crit Care. 2022;26(1):11. [DOI:10.1186/s13054-021-03874-1] [PMID]
  55. Tiseo G, Galfo V, Occhineri S, Forniti A, Caroselli C, Falcone M, et al. Risk factors and outcomes of fungal superinfections in patients with severe COVID-19: an observational study from Pisa academic hospital. Infez Med. 2022;31(1):55-61. [DOI:10.53854/liim-3101-8]
  56. White PL, Dhillon R, Cordey A, Hughes H, Faggian F, Soni S, et al. A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care Unit. Clin Infect Dis. 2021;73(7):e1634-e44. [DOI:10.1093/cid/ciaa1298] [PMID]
  57. Xu J, Yang X, Lv Z, Zhou T, Liu H, Zou X, et al. Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study. Front Med (Lausanne). 2021;8:753659. [DOI:10.3389/fmed.2021.753659] [PMID]
  58. Yazdanpanah S, Ahmadi M, Zare Z, Nikoupour H, Arabsheybani S, Jabrodini A, et al. Assessment of Risk Factors and Clinical Outcomes in Hospitalized COVID-19 Patients with Candida spp. Co-infections: Species Distribution and Antifungal Susceptibility Patterns of Isolates. Mycopathologia. 2023;188(1-2):9-20. [DOI:10.1007/s11046-022-00694-x] [PMID]
  59. Soltani S, Zandi M, Faramarzi S, Shahbahrami R, Vali M, Rezayat SA, et al. Worldwide prevalence of fungal coinfections among COVID-19 patients: a comprehensive systematic review and meta-analysis. Osong Public Health Res Perspect. 2022;13(1):15-23. [DOI:10.24171/j.phrp.2021.0293] [PMID]
  60. Shafiekhani M, Shekari Z, Boorboor A, Zare Z, Arabsheybani S, Azadeh N. Bacterial and fungal co-infections with SARS-CoV-2 in solid organ recipients: a retrospective study. Virol J. 2022;19(1):35. [DOI:10.1186/s12985-022-01763-9] [PMID]
  61. Seyedjavadi SS, Bagheri P, Nasiri MJ, Razzaghi-Abyaneh M, Goudarzi M. Fungal Infection in Co-infected Patients With COVID-19: An Overview of Case Reports/Case Series and Systematic Review. Front Microbiol. 2022;13:888452. [DOI:10.3389/fmicb.2022.888452] [PMID]
  62. Seitz T, Holbik J, Hind J, Gibas G, Karolyi M, Pawelka E, et al. Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19. Microbiol Spectr. 2022;10(3):e0014022. [DOI:10.1128/spectrum.00140-22] [PMID]
  63. Sebastian SK, Kumar VB, Gupta M, Sharma Y. Covid Assossiated Invasive Fungal Sinusitis. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):2883-6. [DOI:10.1007/s12070-021-02471-6] [PMID]
  64. Salazar F, Bignell E, Brown GD, Cook PC, Warris A. Pathogenesis of Respiratory Viral and Fungal Coinfections. Clin Microbiol Rev. 2022;35(1):e0009421. [DOI:10.1128/CMR.00094-21] [PMID]
  65. Mortazavi H, Sadeghian A, Hazrati P, Heydari M-H, Madihi S. Oral hemorrhagic blister and its possible related factors: Analyzes of reported cases in the literature. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2023;35(4):358-67. [DOI:10.1016/j.ajoms.2022.12.009]
  66. Sah SK, Shariff A, Pathakamuri N, Ramaswamy S, Ramesh M, Undela K, et al. Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis. PLoS One. 2022;17(7):e0271795. [DOI:10.1371/journal.pone.0271795] [PMID]
  67. Rovina N, Koukaki E, Romanou V, Ampelioti S, Loverdos K, Chantziara V, et al. Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum. J Clin Med. 2022;11(7). [DOI:10.3390/jcm11072017] [PMID]
  68. Rafat Z, Ramandi A, Khaki PA, Ansari S, Ghaderkhani S, Haidar H, et al. Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units. Gene Rep. 2022;27:101588. [DOI:10.1016/j.genrep.2022.101588] [PMID]
  69. Sofi-Mahmudi A, Masinaei M, Shamsoddin E, Tovani-Palone MR, Heydari M-H, Shoaee S, et al. Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: a systematic analysis of the Global Burden of Disease Study 1990-2017. BMC Oral Health. 2021;21(1):558. [DOI:10.1186/s12903-021-01918-0] [PMID]
  70. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266-75. [DOI:10.1016/j.jinf.2020.05.046]
  71. Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251170. [DOI:10.1371/journal.pone.0251170] [PMID]
  72. Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi A, Hessari H, Heydari M-H, et al. Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017. BMC Oral Health. 2022;22(1):634. [DOI:10.1186/s12903-022-02634-z] [PMID]
  73. Soni S, Namdeo Pudake R, Jain U, Chauhan N. A systematic review on SARS-CoV-2-associated fungal coinfections. J Med Virol. 2022;94(1):99-109. [DOI:10.1002/jmv.27358] [PMID]
  74. Soman R, Chakraborty S, Joe G. Posaconazole or isavuconazole as sole or predominant antifungal therapy for COVID-19-associated mucormycosis. A retrospective observational case series. Int J Infect Dis. 2022;120:177-8. [DOI:10.1016/j.ijid.2022.04.009] [PMID]
  75. Peng J, Wang Q, Mei H, Zheng H, Liang G, She X, et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis. Aging (Albany NY). 2021;13(6):7745-57. [DOI:10.18632/aging.202742] [PMID]