Infections and diabetes

Abstract

Infections and diabetes illustrate the health problems facing India, and more. The two often coexist, making each other the worse for it. Subjects with diabetes have a greater frequency and severity of many common infections (urinary, pulmonary, soft tissue) whereas some rare infections are seen almost exclusively in the diabetic population viz. rhino-cerebral mucormycosis, malignant otitis-externa and emphysematous cholecystitis, cystitis, and pyelonephritis.These infections should be sought in patients presenting with DKA and hyperglycemic hyperosmolar syndrome. Fournier's gangrene and infections of the foot occur predominantly in diabetics.The increased susceptibility to infections and impaired wound healing is due to diminished vascularity, autonomic dysfunction, and abnormalities in cell-mediated immunity and phagocytic function. The common pathogens are Escherichia coli, Klebsiella, Campylobacter, and Salmonella enteritidis.Infections may worsen glycemic control. Periodontal infection is linked with dysglycemia and cardiorenal complications.Prevention from infection requires good glycemic control, good hygiene, and preventive vaccination.Beside the well-recognized association of infection and diabetes, a recent study from India reported that the prevalence of hepatitis C in these subjects is higher; it was positive in 11 out of 192 (5.7 %) with a higher prevalence in men and in those with poorer glycemic control [1]. Similarly in an earlier study also from India, hepatitis B virus was more common in subjects with acute viral hepatitis having diabetes (58.33 vs. 25.3 % in controls) [2]. In a multiple variable logistic regression analysis, acute hepatitis B and diabetes were shown to be related to severe hepatitis.Interestingly, Helicobacter pylori infection was higher in subjects with diabetes (n 62; 77.5 %) compared to controls (n 62; 77.5 %). It was correlated with poorer glycemic control, suggesting that chronic inflammation with the infection may be associated with subsequent development of insulin resistance [3].Urinary tract infection is commonly observed in diabetes. Among Indian subjects with culture-positive urinary infection, nearly 30 % were asymptomatic. Diabetes was associated with a higher prevalence of pyelonephritis and with poorer glycemic control. In descending order, cultured pathogenic bacteria were E. coli (64.6 %), Klebsiella (12.1 %), and Enterococcus (9.9 %). Extended-spectrum beta-lactamaseproducing E. coli was more common in diabetes [4]. With clinical introduction of antidiabetic agents acting through inducing glycosuria (SGLT2 inhibitors), counseling about genital hygiene must be integrated to reduce the risk of genital and urinary infections.The enormous physical and financial burden of diabetic foot infection has been highlighted in a recent journal editorial [5]. The current issue describes diabetic foot involvement from Saudi Arabia [6] and China [7] and an uncommon bacteriological infection [8]. In India, smoking and barefoot walking are common underlying factors in foot com...

Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Risk Factors in Older Adult Patients

“…In contrast to the current study, a previous study reported that malignancy was protective against CRKP infection, especially in patients hospitalized under isolation conditions. 31 …”

“…In contrast to the current study, a previous study reported that malignancy was protective against CRKP infection, especially in patients hospitalized under isolation conditions. 31 Diabetic patients are more prone to developing infections due to abnormal vascularity, autonomic function, cell-mediated immunity, and phagocytic function. 32 Patients with CVDs may be at an increased risk of CRKP infection due to frequent hospitalizations and invasive interventions.…”

Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

“…Poor glycemic control contributed to nearly two quarters (23/31; 74.19%) of the total amputees. In the diabetic population chronic hyperglycemia leads to impaired wound healing due to increased susceptibility to infections, chronic inflammation state, diabetic micro and macro-angiopathy leading to diminished vascularity, impaired collagen synthesis, impaired hyaluronan, autonomic dysfunction and abnormality in cell-mediated immunity and phagocytic function [ 13 , 14 ]. A high glycated hemoglobin also impairs endothelium mediated vasoactive responses.…”

Infections and diabetes: Risks and mitigation with reference to India

“…Most cases of diabetic foot infection have been shown to be polymicrobial in nature, with predominance of Gram-negative organisms [ [15] , [16] , [17] ]. Prevalence of antimicrobial drug resistance was also found to be higher among patients with diabetes, which could be attributed, at least partially, to the production of biofilms by the causative organisms [ 18 ].…”