Table 1 Morphological features, pathogenicity, clinical findings, and laboratory diagnosis of the fungi causing coinfection with SARS-CoV-2

Black Fungi

Mucor spp.

1. Saprophytic colonizers

Infection is assumed to spread by

Involved in creating infections to immunocompromised patients such as

Mucormycosis symptoms are mild and nonspecific, such as

Diagnosis is performed by

[56]

2. Encompasses filamentous mycelium or budding yeast cells that are spherical

1. Inhalation, traumatic inoculation or ingestion

1. Pulmonary mucormycosis

1. Chest discomfort

1. Calcofluor white

3. Contain branched sporangiospores

2. Invasion of blood vessels, which results in tissue infarction, necrosis, and thrombosis

2. Rhinocerebral mucormycosis

2. Dyspnea

2. Fluorescent in situ hybridization

4. Contain rigid cell walls with the presence of cellulose or chitin

3. Subcutaneous mucormycosis

3. Fever

3. Gomori methenamine silver stain

5. Cell wall consists of lipids, proteins, phosphates, amino sugars, Phosphorus, Magnesium, and Calcium

4. Maxillofacial mucormycosis

4. Headache

4. Immunohistochemistry analysis

5. Gastrointestinal mucormycosis

5. Fatigue

5. Periodic acid–Schiff stain

6. Cough

6. Wet mount

7. Mucosal necrosis

7. Conventional PCR

8. Ophthalmologic abnormalities such as proptosis, ptosis, aphasia, and visual alterations

8. DNA sequencing

9. Nasal bridge or upper inside of black mouth lesions that rapidly worsen

9. Real-time PCR

10. Breathing problems

10. Restriction fragment length polymorphism

11. Infected skin might develop blisters or ulcers, and the region may turn black

11. API ID32C and API ID50C

12. Discomfort, warmth or redness or swelling surrounding the affected area

12. ELIspot

13. Bleeding in the digestive tract

13. Computed tomography (CT) scan

14. Stomachache

Rhizopus spp.

Differ with Mucor spp. in having unbranched sporangiospores and having stolon

Infection is assumed to spread by

Involved in creating infections to immunocompromised patients such as

Rhizopus spp. also cause Mucormycosis; thus, the symptoms are the same

Diagnosis is carried out by-

[57, 58]

1. Inhalation, traumatic inoculation or ingestion

1. Pulmonary mucormycosis

1. Chest discomfort

1. Computed tomography (CT) scan

2. Invasion of blood vessels, which results in tissue infarction, necrosis, and thrombosis

2. Rhinocerebral mucormycosis

2. Dyspnea

3. Subcutaneous mucormycosis

3. Fever

4. Maxillofacial mucormycosis

4. Headache

5. Gastrointestinal mucormycosis

5. Fatigue

6. Cough

7. Skin blisters

8. Stomach pain

White Fungi

Aspergillus spp.

1. Appear in velvety yellow to green or blue or brown mold

Infection routes are

Clinical significances are

Clinical signs and symptoms are

Diagnostic procedures are

[59]

2. Comprise conidiophores that could be lengthy, rough, pitted, or spiny

1. Respiratory route

1. Chronic cavitary pulmonary aspergillosis and aspergilloma

1. Anorexia

1. Wet mount

3. Conidiophores are either uniseriate or biseriate

2. In tissue where hyphal growth forms

2. Allergic bronchopulmonary aspergillosis

2. Weight loss

2. Gomori’s methenamine silver stain (GMS)

4. Conidia are globose or subglobose, thorny and size varies from 3.5 to 4.5 µm in diameter

3. Dissemination in extrapulmonary tissues

3. Allergic fungal sinusitis

3. Malaise

3. Periodic acid–Schiff (PAS)

5. Produces toxins

4. Paranasal sinuses

4. Rhinosinusitis

4. Sweating

4. Galactomannan (GM) detection in fluids

5. Fungal colonization in the gastrointestinal tract at the sites of the cornea

5. Cutaneous infection

5. Fever

5. Early bronchoalveolar lavage (BAL)

6. Central nervous system infection

6. Persistent productive cough

6. CT scan

7. Dyspnea

7. Thin-section chest computed tomography

8. Chest pain

8. Multidetector computed tomography (MDCT)

9. Rare occasional hemoptysis

9. Multislice spiral computed tomography (MSCT)

10. Pain in the face

10. High resolution computed tomography

11. Erythema

11. Abdominal computed tomography

12. Development of eschar

12. Paranasal computed tomography or MRI of the central nervous system (CNS)

13. Infected and swollen eyelids

13. In vivo confocal microscopy (IVCM)

14. Irritation in the nose

14. Tomographic imaging probe

15. Consciousness loss

15. Two-photon microscopy (TPM)

16. A change in mental state

16. PCR

17. Hemiparesis

17. DNA sequencing

18. Convulsions

18. Image-based automatic hyphae detection

19. Double-sandwich (ds) ELISA

Candida spp.

1. Diploid

Causing candidiasis by

Clinical symptoms are

All candidiasis disease signs include

Diagnosis could be made by

[60]

2. Acquire dimorphism characteristic

1. Adhering to epithelial cells

1. Vulvovaginal candidiasis

1. Discharge from the uterus

1. Wet Mount

3. Comprise filamentous hyphae

2. Forming colonization

2. Onychomycosis

2. Irritation in the vaginal region

2. PCR

4. Secrets toxin

3. Penetrating epithelia or invading hyphae

3. Candidemia

3. Burning sensation in the vagina

3. Nucleic acid amplification tests (NAATs)

4. Disseminating vascular tissue

4. Intra-abdominal candidiasis

4. Dyspareunia

4. Mass spectrometry

5. Colonizing endothelia

5. Peritonitis

5. Dysuria

5. 1,3-1β D glucan

6. Biliary candidiasis

6. White patches emerge that resemble curd in the mouth, throat, tongue, and gum linings

6. Mannan–antimannan

7. Candida endophthalmitis

7. White lesions on the retinal surface

8. Loss of vision, which may be gradual or occur suddenly

9. Edema of the retina or papillary

10. Inflammation and stricture development in both intrahepatic and extrahepatic biliary systems

11. Vascular choroid

12. Eyestrain, headaches, and floaters