Fungal infection of the diabetic foot: two distinct syndromes

Heald, AH; O'Halloran, D.J.; Richards, K. L.; Webb, Frank; Jenkins, Stephen G.; Hollis, Sally; Denning, David W.; Young, Richard L.

doi:10.1046/j.1464-5491.2001.00523.x

Cited by 36 publications

(27 citation statements)

References 10 publications

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“…The fungal profile showed the occurrence of non Candida albicans (NCA) namely Candida glabrata as the predominant yeast isolates followed by Candida albicans, Candida dubliniensis, Candida tropicalis and Candida krusei. The results of the study similar with the studies of Chincholikar and Pal [33]; Heald et al [34] which reported non Candida albicans as the predominant yeast isolates from cases of diabetic foot infections. Bader et al [35] reported that Candida glabrata as the emerging group of non Candida albicans (NCA) as it causes candidemia among diabetic patients.…”

Section: Discussionsupporting

confidence: 93%

“…So species identification of Candida was essential for successful management [37]. Moreover, candidal infection in diabetic foot was a rare entity and was previously described in five reports by Heald et al [34]; Missoni et al [36]; Yener et al [38]; Chellan et al [8] and Nithyalakshmi et al [9]. Since, our reports confirmed the prevalence of Candida albicans and non albicans in diabetic foot infections along with antifungal susceptibility pattern.…”

Section: Discussionsupporting

confidence: 93%

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Prevalence of yeast in diabetic foot infections

Sugandhi

Prasanth

2016

Int J Diabetes Dev Ctries

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Diabetic foot infections are a serious threat which cause a long term of hospitalization of diabetes patients and lead to amputations. Hence, prompt diagnosis is an important criterion in the treatment of these infections. This study was carried out to determine the prevalence of yeast in diabetic foot infections. The pus samples were collected from patients presenting with diabetic foot ulcer and processed for microbiological investigation. The patients investigated comprised of 82 males and 78 females. Most of the patients were grade I ulcers followed by grade II ulcers. Out of 160 samples, 138 samples were culture positive, in which yeast isolate Candida glabrata was the predominant isolate followed by Candida albicans, Candida dubliniensis, Candida krusei and Candida tropicalis. C. albicans and C. dubliniensis were differentiated by using tobacco agar due to the presence of hyphal fringes. The methylene blue sabouraud dextrose agar and corn meal agar were also used to differentiate C. albicans from non albicans. The antifungal susceptibility pattern showed 29 % of C. albicans was sensitive to Amphotericin B and Clotrimazole, while 75 % of C. glabrata was sensitive to Amphotericin B, Ketoconazole and Itraconazole. C. dublinensis and C. albicans showed the highest percentage of resistant to Ketoconazole, Fluconazole, Nystatin and Itraconazole. Thus, the results indicating that effective alternate drug of choice are required and the proper selection of antifungal agents will play an important role for the treatment of fungal foot infections. This study will also add substantial knowledge of yeast as one of the pathogenic organisms in diabetic foot infections.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Prevalence of yeast in diabetic foot infections

Sugandhi

Prasanth

2016

Int J Diabetes Dev Ctries

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“…Some authors have attempted to explain the clinical importance of Candida isolations from the diabetic foot ulcers by assessing the healing of lesions through the application of antimycotics [19]. The explanation that we would offer is chemotyping of isolates of the same species of Candida from foot ulcer and interdigital spaces of the same and/or the other foot by using GC method.…”

Section: Discussionmentioning

confidence: 98%

Differentiation between Candida species isolated from diabetic foot by fatty acid methyl ester analysis using gas chromatography

Missoni¹,

Rade

Neđeral

et al. 2005

Journal of Chromatography B

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“…Mlinaric Missoni et al from Croatia had reported the fungal incidence in tissue biopsy specimens of 22 diabetic patients who had clinical evidence of fungal infections (12,24). The predominant isolates were C. parapsilosis (45.5%), C. tropicalis (22.7%), C. albicans (9.1%), and C. glabrata (9.1%).…”

Section: Discussionmentioning

confidence: 99%

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

et al. 2010

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The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5-؋ 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.Diabetes is now a worldwide epidemic. Among the 191 WHO member states, India has the highest number of people with diabetes (37). Fifteen percent of patients with diabetes develop lower-extremity ulcers during their lifetimes. Diabetes is the most common cause for nontraumatic amputation of lower extremities (1, 39). Eighty-five percent of these lowerlimb amputations are preceded by polymicrobial infections of the wound (23,26,36). Despite proper surgical and antibacterial therapy for infected diabetic lower-limb wounds (DLWs), the global long-term outcome of patients was found to be poor; only Ͻ50% of these patients had global therapeutic success (16,22).Fungal infections among immunocompromised patients are one of the major health concerns worldwide (5, 13, 19), but the spectrum of fungi infecting DLWs and their pathogenicity have not yet been studied thoroughly. Therefore, clinicians and surgeons treating diabetic foot wounds suspect only bacterial infections and treat them with antibacterial agents. They do not routinely send deep tissue from the wound bed for fungal culture and sensitivity, either due to lack of literature support or due to the assumption that there would not be any fungal infections in the DLWs. Surprisingly, our retrospective pilot study showed 27.9% positive fungal cultures in 3...

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Fungal infection of the diabetic foot: two distinct syndromes

Abstract: Candida spp. is associated with two distinctive patterns of protracted ulceration in diabetic feet which improve following systemic antifungal therapy. Diabet. Med. 18, 567-572 (2001)

Cited by 36 publications

References 10 publications

Prevalence of yeast in diabetic foot infections

Prevalence of yeast in diabetic foot infections

Differentiation between Candida species isolated from diabetic foot by fatty acid methyl ester analysis using gas chromatography

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

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