Comparative analysis of coronavirus disease 2019 and diabetes in mucormycosis: a scoping review

Background Rhino-orbital-cerebral mucormycosis (ROCM) has re-emerged as a serious threat since the coronavirus disease 2019 (COVID-19) pandemic. How diabetes and COVID-19 jointly shape its clinical course remains poorly characterized. Objective This scoping review aimed to map the clinical features, radiological staging, treatment, and outcomes of ROCM across subgroups defined by diabetes and COVID-19 status. Methods: Following PRISMA-ScR guidelines, we searched PubMed and Web of Science (January 2010–August 2025), screening 769 records and including 155 studies with 258 ROCM patients. Cases were divided into four subgroups according to diabetes status and the presence of COVID-19-associated mucormycosis (CAM): diabetic CAM, diabetic non-CAM, non-diabetic CAM, and non-diabetic non-CAM. Data were described and summarized by subgroup. Results Diabetes mellitus was the most common comorbidity (70.9%), followed by COVID-19 (38.4%), with cases predominantly reported from Asia. Across all subgroups, early presentations were mainly nonspecific sinonasal symptoms. Radiological staging using the Ebaid system showed that most cases were diagnosed at intermediate-to-advanced stages (predominantly Stage IV–V). Surgical debridement combined with systemic amphotericin B was the most frequently documented treatment, while severity-stratified regimens were rarely reported. The prognostic role of corticosteroids in COVID-19-related cases remained unresolved. Non-diabetic non-CAM patients showed a distinct immunocompromised profile, with hematologic malignancies and transplant-related immunosuppression more prevalent. Conclusions This review describes the clinical and radiological characteristics of ROCM across four host backgrounds. The findings suggest that clinicians should not rely solely on classic clinical signs and support the use of standardized imaging assessment for earlier detection. Prospective, multicenter cohorts with standardized staging and outcome reporting are needed to better characterize ROCM and inform severity-based management.