Challenges in Antifungal Therapy in Diabetes Mellitus

Lim, Sazlyna Mohd Sazlly; Sinnollareddy, Mahipal G.; Sime, Fekade Bruck

doi:10.3390/jcm9092878

Cited by 8 publications

(6 citation statements)

References 52 publications

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“…infections due to disease-related immunosuppression, enriching glycosuria and various other physiological alterations. [10][11][12][13] The rate of candiduria is 10% among T2DM patients, where Candida albicans constituted 50% of the isolates and non-albicans Candida were more linked to symptomatic candiduria. Nearly, 80% of these T2DM patients had hemoglobin A1c >7%.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Diabetic urinary auto-brewery and review of literature

Alduraywish

2021

F1000Res

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Background: Although candiduria is an expected encounter and should not be surprising in uncontrolled diabetes with glucose-enriched urine, urinary auto-brewery is rarely thought of by diabetologists. Moreover, endogenous ethanol production in humans from gut microbiome, urinary tract fungi and bacteria, and intermediary metabolism, has been reported for a long time, particularly in diabetics. Case description: To alert physicians to the overlooked implication of endogenously produced ethanol both as a biomarker for poor control of diabetes and as a complicating factor, we report this case of an elderly male smoker alcohol-abstinent insulin-dependent Type 2 diabetic patient. Because of circumstantial treatment and incompliance for one week, he developed endogenously produced alcohol intoxication. We proposed candidal urinary auto-brewery evidence sourced from the case history, urinalysis, and culture/identification tests - without excluding other sources. Fortunately, his diet and glycemic control were fairly controlled and, liver and kidney functions were almost normal. Amphotericin B I/V for five days, insulin, and a fluid therapy regimen greatly improved the case and cleared both the candiduria and ethanol from the urine and blood and the patient regained his base-line normal life. Conclusion: Symptoms of alcohol intoxication should be expected in patients with uncontrolled diabetes that most often correlates with candiduria and/or constipation. These symptoms can be exaggerated in those already suffering a degree of dementia and/or comorbid psychiatric/neurologic affections. Direct wet mount examination of urine under phase contrast microscopy would show the budding yeast cells. Appropriate antifungal, insulin and fluid therapies regained the base-line norms.

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Section: Discussionmentioning

confidence: 99%

“…The known susceptibility of these patients to carriage/infection with the sugar-fermenting Candida species is usually overlooked. 10 - 13 The present case report is a red flag for diabetologists to start appreciating urinary auto-brewery among diabetic patients as a potential complicating factor.…”

Section: Introductionmentioning

confidence: 86%

Case Report: Diabetic urinary auto-brewery and review of literature

Alduraywish

2021

F1000Res

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“…For instance, histoplasmosis or cryptococcosis are strongly associated with acquired immunodeficiency [87,88]. Nevertheless, predisposing nonimmunological conditions can significantly contribute to the development of infections caused by Candida spp., namely diabetes, pregnancy and age, but also burn-patients and healthcare associated infections [15,18,21,89,90]. Although NTM can cause infection at a wide variety of body sites (e.g., skin, soft tissues and lymphatic nodes), lung infections are the most frequent.…”

Section: The Human Host: Predisposing Conditions For Ntm Fungal Infementioning

confidence: 99%

“…and the environmental pathogens (Cryptococcus neoformans, Cryptococcus gattii, Aspergillus fumigatus, and thermally dimorphic fungi) [11]. Fungi have frequently caused diseases in immunocompromised patients with HIV, cancer, diabetes and patients treated with immunosuppressive drugs [12][13][14][15][16][17]. In a separate category are healthy individuals with flaws in the immune system due to age (children and elderly), antibiotic treatment or pregnancy [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Opportunist Coinfections by Nontuberculous Mycobacteria and Fungi in Immunocompromised Patients

2020

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Nontuberculous mycobacteria (NTM) and many fungal species (spp.) are commonly associated with opportunistic infections (OPIs) in immunocompromised individuals. Moreover, occurrence of concomitant infection by NTM (mainly spp. of Mycobacterium avium complex and Mycobacterium abscessus complex) and fungal spp. (mainly, Aspergillus fumigatus, Histoplasma capsulatum and Cryptococcus neoformans) is very challenging and is associated with poor patient prognosis. The most frequent clinical symptoms for coinfection and infection by single agents (fungi or NTM) are similar. For this reason, the accurate identification of the aetiological agent(s) is crucial to select the best treatment approach. Despite the significance of this topic it has not been sufficiently addressed in the literature. This review aims at summarizing case reports and studies on NTM and fungi coinfection during the last 20 years. In addition, it briefly characterizes OPIs and coinfection, describes key features of opportunistic pathogens (e.g., NTM and fungi) and human host predisposing conditions to OPIs onset and outcome. The review could interest a wide spectrum of audiences, including medical doctors and scientists, to improve awareness of these infections, leading to early identification in clinical settings and increasing research in the field. Improved diagnosis and availability of therapeutic options might contribute to improve the prognosis of patients’ survival.

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“…Besides, fluconazole is described for prophylaxis to reduce the incidence of candidiasis for patients undergoing bone marrow transplantation who are using radiation therapy and/or cytotoxic chemotherapy [3,4]. Fluconazole was also prescribed recently for patients with diabetes mellitus [10]. Interestingly, fluconazole possesses unique and distinguished pharmacokinetic characteristics [3,4,11] in comparison to many other widely used drugs such as azithromycin [12], betahistine [13], doxazocin [14], cefixime [15], cyclosporine [16], amlodipine, valsartan, and hydrochlorothiazide [17].…”

Section: Introductionmentioning

confidence: 99%