Infections in the diabetic patient: The role of immune dysfunction and pathogen virulence factors

Bessman, Alice N.; Sapico, Francisco L.

doi:10.1016/1056-8727(92)90062-p

Cited by 48 publications

(31 citation statements)

References 31 publications

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“…This nonhomogenous distribution of AGEs in the body may account for the apparent paradox between an increase in AGE-mediated neutrophil ROS generation and the observation that diabetic patients, especially those with poor metabolic control, appear to have a greater frequency of infective complications (36). The reversibility of the AGE effect may lead to neutrophils being only transiently in an activated state at sites of heavy AGE accumulation and reverting to a nearer normal state on relocation to other parts of the circulation or nonvascular compartments.…”

Section: Discussionmentioning

confidence: 99%

Augmentation of the Neutrophil Respiratory Burst Through the Action of Advanced Glycation End Products

et al. 2002

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An accelerated accumulation of advanced glycation end products (AGEs) occurs in diabetes secondary to the increased glycemic burden. In this study, we investigated the contribution of AGEs to intravascular oxidant stress by examining their action on the neutrophil burst of reactive oxygen species (ROS); this may be a significant donor to the overall vascular redox status and to vasculopathy. AGEs exerted a dose-dependent enhancement on the neutrophil respiratory burst in response to a secondary mechanical stimulus (up to 265 ؎ 42%, P ‫؍‬ 0.022) or chemical stimulation with formyl-methylleucylphenylalanine 100 nmol/l (up to 218 ؎ 19%, P < 0.001), although they possessed no ability to augment the neutrophil respiratory burst alone. This phenomenon was both immediate and reversible and depended on the simultaneous presence of AGEs with the additional stimulus. It appeared to work through an upregulation of the neutrophil NADPH oxidase, the enzyme responsible for ROS generation, as seen by a diphenyleneiodonium-dependent suppression of basal and augmented ROS output. Moreover, this action of AGEs was found to be complementary to that of neutrophil priming agents, also known to upregulate neutrophil ROS production, implying the presence of distinct intracellular transduction pathways mediating the effect of these two classes of agents.

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Section: Discussionmentioning

confidence: 99%

Augmentation of the Neutrophil Respiratory Burst Through the Action of Advanced Glycation End Products

et al. 2002

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“…Foot ischemia certainly appears to be associated with an increased severity of an infection (36). Diabetic patients often have a diminished inflammatory response to injury or infection (37)(38)(39)(40)(41)(42)(43); this deficit could be further impaired by ischemia. Diminished blood flow could result in a lack of erythema or induration, visual cues of infection.…”

Section: Statistical Analysesmentioning

confidence: 99%

Risk Factors for Foot Infections in Individuals With Diabetes

Lavery

Armstrong

Wunderlich³

et al. 2006

Diabetes Care

631

414

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OBJECTIVE -To prospectively determine risk factors for foot infection in a cohort of people with diabetes.RESEARCH DESIGN AND METHODS -We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.RESULTS -During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture-proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3-102.2; P Ͻ 0.001) and the risk of amputation was 154.5 times greater (58.5-468.5; P Ͻ 0.001). Foot wounds preceded all but one infection. Significant (P Ͻ 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration Ͼ30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).CONCLUSIONS -Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.

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“…9 Diabetic patients have been reported to be immunocompromised. 1,[10][11][12] Intestinal parasites have gained increasing attention as important opportunistic pathogens responsible for clinically important infections in immunosuppressed patients.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Parasites in Diabetes Mellitus Patients in the Limbe and Buea Municipalities, Cameroon

Tangi¹,

Fokam²,

Longdoh³

et al. 2016

Diabetes Res Open J

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Background:Intestinal parasites are an important cause of morbidity and mortality and a public health problem especially in tropical developing countries including Cameroon. The two main types of intestinal parasites are helminths and protozoa which are important causes of infections in immunocompromised individuals. Diabetes Mellitus (DM) is a metabolic non-communicable disease in which a person has high blood glucose. DM is an increasing problem in our community today and diabetics have been reported to be immunocompromised. The purpose of this study was to determine the prevalence and type of intestinal parasites in DM patients living in Buea and Limbe municipalities. Methods: This hospital based cross sectional study involved a total 150 diabetic patients and 85 non-diabetic individuals which served as control group. Questionnaires were administered to the Diabetic patients only. Fresh stool specimens were collected and processed using Direct Microscopy, Formalin-Ether Concentration, Stoll's technique and Modified Ziehl Nielsen staining techniques. Data was analyzed using Microsoft Office Excel 2013 and Statistical Package for Social Sciences (SPSS) version 20.

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Infections in the diabetic patient: The role of immune dysfunction and pathogen virulence factors

Cited by 48 publications

References 31 publications

Augmentation of the Neutrophil Respiratory Burst Through the Action of Advanced Glycation End Products

Augmentation of the Neutrophil Respiratory Burst Through the Action of Advanced Glycation End Products

Risk Factors for Foot Infections in Individuals With Diabetes

Intestinal Parasites in Diabetes Mellitus Patients in the Limbe and Buea Municipalities, Cameroon

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