Mucormycosis is a rapidly progressive invasive fungal disease caused by Mucorales, which are widespread in air, soil and water. Respiratory viral infections can damage airway barriers and impair antifungal immunity, while corticosteroids and other immunosuppressive treatments may further increase susceptibility.
In 2021, India reported more than 50,000 cases of COVID-19-associated mucormycosis and over 4,000 deaths, highlighting the need for prevention alongside diagnosis and treatment.
West China Hospital, Sichuan University, coordinated 49 experts from 44 institutions across eight countries. The panel searched PubMed, Embase, the Cochrane Library, CNKI and the Wanfang Database through February 2025, and used a two-round modified Delphi process to evaluate high-risk groups and preventive measures. Recommendations required at least 80% agreement; after revision, all 12 achieved 100% agreement. Evidence was graded using the 2009 Oxford Centre for Evidence-Based Medicine system.
The consensus, published in iFungi, defines four principal high-risk groups: critically ill patients requiring mechanical ventilation; immunocompromised patients, including those with poorly controlled diabetes, hematological disease, transplantation, immunosuppressive treatment or uncontrolled HIV/AIDS; patients with stage 4–5 chronic kidney disease; and patients with structural lung disease such as bronchiectasis. Solid tumors and anticancer treatment, mold-contaminated environments, prolonged central oxygen use, broad-spectrum antibiotics combined with invasive procedures, and severe malnutrition may further increase risk.
Education and personal protection
Recommendations 1–4 cover education and personal protection. High-risk patients should be informed about exposure risks and preventive measures, while healthcare workers should be trained to recognize vulnerable patients and early warning signs. Influenza and COVID-19 vaccination are recommended when not contraindicated, together with mask use in public settings according to local guidance and availability.
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Recommendations 5–7 emphasize early diagnosis and treatment. Patients with suspected respiratory infection should be tested promptly, particularly for influenza virus and SARS-CoV-2, and effective antiviral treatment should begin early. During influenza season, high-risk patients with influenza-like illness may receive empiric antiviral treatment before test results are available. Tertiary hospitals should provide testing for mucormycosis, while secondary hospitals should establish testing, specimen-transfer or referral pathways.
Hospital infection control
Recommendations 8–11 address hospital infection control. Soil-containing items should be excluded from rooms housing high-risk patients, who should also be protected from construction and renovation dust. Bed linen should be handled gently and transported in closed containers, and ventilation systems should be properly maintained. Standard precautions apply to patients with mucormycosis. Suspected healthcare-associated outbreaks should prompt investigation of non-sterile products, invasive procedures and environmental sources.
Recommendation 12 focuses on resource-limited settings, prioritizing high-risk patient screening, direct microscopy and other affordable tests, referral and teleconsultation networks, primary healthcare training, hand hygiene, diabetes management and environmental education.
Use of antifungal prophylaxis
The panel does not recommend routine antifungal prophylaxis for all high-risk patients. Patients with hematological malignancies may be assessed individually according to existing invasive fungal disease guidelines, but evidence remains insufficient to define specific indications, drug choice, timing, dose or duration after respiratory viral infection. Evidence is also limited for immunomodulatory treatment, filtration in central oxygen systems and formal risk-prediction models.
Most available evidence is retrospective or observational, and the clinical effects of several recommendations require prospective and real-world validation. Priorities include surveillance, faster diagnostics, environmental monitoring, validated early-warning models and carefully designed prophylaxis studies. The consensus complements existing diagnostic and treatment guidelines by defining preventive actions for high-risk patients.
Addressing a gap
This consensus addresses an important gap in the prevention of mucormycosis following respiratory viral infections. Its value lies in defining the patients who require targeted prevention and translating limited evidence into practical recommendations that can be adapted across healthcare settings.
The work was supported by the National Key Research and Development Program of China (2023YFC2308800). All participating experts declared no conflicts of interest.
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