Frequency of Cutaneous Fungal Infections and Azole Resistance of the Isolates in Patients with Diabetes Mellitus

Abstract

Background:Diabetic patients are more susceptible to cutaneous fungal infections. The higher blood sugar levels cause increasing the cutaneous fungal infections in these patients. The main objective of this study was to find the frequency of fungal infections among cutaneous lesions of diabetic patients and to investigate azole antifungal agent susceptibility of the isolates.Materials and Methods:In this study, type 1diabetes (n = 78) and type 2 diabetes (n = 44) comprised 47 cases (38.5%) with diabetic foot ulcers and 75 cases (61.5%) with skin and nail lesions were studied. Fungal infection was confirmed by direct examination and culture methods. Antifungal susceptibility testing by broth microdilution method was performed according to the CLSI M27-A and M38-A references.Results:Out of 122 diabetic patients, thirty (24.5%) were affected with fungal infections. Frequency of fungal infection was 19.1% in patients with diabetic foot ulcer and 28% of patients with skin and nail lesions. Candida albicans and Aspergillus flavus were the most common species isolated from thirty patients with fungal infection, respectively. Susceptibility testing carried out on 18 representative isolates (13 C. albicans, five C. glabrata) revealed that 12 isolates (10 C. albicans and two C. glabrata isolates) (66.6%) were resistant (minimum inhibitory concentration [MIC] ≥64 mg/ml) to fluconazole (FCZ). Likewise, eight isolates (80%) of Aspergillus spp. were resistant (MIC ≥4 mg/ml), to itraconazole.Conclusion:Our finding expands current knowledge about the frequency of fungal infections in diabetic patients. We noted the high prevalence of FCZ-resistant Candida spp., particularly in diabetic foot ulcers. More attention is important in diabetic centers about this neglected issue.

Candida sp. Infections in Patients with Diabetes Mellitus

“…was identified as C. tropicalis (34.6%), C. albicans (29.3%), C. krusei (16.0%), C. parapsilosis (10.6%), and C. glabrata (9.33%) [332]. In order to find the frequency of fungal infections among cutaneous lesions of diabetic patients and to investigate azole antifungal agent susceptibility of the isolates, Raiesi et al [333] studied type 1 and type 2 DM patients with foot ulcers (38.5%) and with skin and nail lesions (61.5%). Results showed that 24.5% had fungal infections and were at a higher frequency in patients with skin and nail lesions (28%) than in foot ulcers (19.1%).…”

“…Results showed that 24.5% had fungal infections and were at a higher frequency in patients with skin and nail lesions (28%) than in foot ulcers (19.1%). C. albicans and Aspergillus flavus were the most common species isolated, and a high prevalence of fluconazole-resistant Candida sp., particularly in diabetic foot ulcers, was determined [333].…”

NSG2 (ORF19.273) Encoding Protein Controls Sensitivity of Candida albicans to Azoles through Regulating the Synthesis of C14-Methylated Sterols

“…MIC 80 was determined by growth in RPMI1640 medium for 24 h as mentioned in CLSI M27-A ( Raiesi et al, 2017 ). Briefly, C. albicans was cultured in YPD for 16 h, and washed with PBS for three times.…”

Fungal infection in foot diabetic patients

“…Diabetes mellitus (DM) is the most common endocrine metabolic disease (1). The prevalence of diabetes mellitus in Iran has been reported 7-17% and is increasing in most populations (2,3). Among persons diagnosed as having diabetes mellitus, the prevalence of foot ulcers is 4% to 10%, the annual population-based incidence is 1.0% to 4.1%, and the lifetime incidence may be as high as 25% (4).…”