Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

Abstract

Aims/Introduction: A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results: Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria.The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 -2.5 vs 7.7 -2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions: Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.

Hypoalbuminemia as Surrogate and Culprit of Infections

“…The prognostic value of low serum albumin levels has been demonstrated not only for the development and complications of acute viral, bacterial, and fungal infections [ 95 ], but also for infectious complications in chronic conditions including malignant diseases [ 66 , 96 ], chronic inflammatory diseases [ 97 , 98 ], diabetes [ 95 ], hemodialysis [ 99 ], and solid organ transplantation [ 100 ]. In chronic infectious diseases, hypoalbuminemia is associated with disease reactivation/recurrence and secondary infections [ 101 , 102 , 103 ].…”

Disseminated Cryptococcal Disease in A Patient With Chronic Chylothorax and a Pleurovenous Catheter, a Case Report With Autopsy Findings

“…In vitro studies have demonstrated that human IgM and immunoglobulin G (IgG) change the morphology of C. neoformans and that IgM inhibits titian-like cell formation, which can reduce virulence and the risk of disseminated disease [ 35 ] . Previous reports have described an association between hypogammaglobulinemia and increased risk for cryptococcal disease, including in HIV-infected patients [ 6 , 36–38 ] . Hypogammaglobulinemia—as a surrogate marker for immunodeficiency and nutritional status—can be a clinically helpful marker risk for cryptococcosis in HIV-uninfected patients.…”

Hemoptysis in a patient with pulmonary aspergilloma and type 2 diabetes mellitus: A rare case in an Indonesian adult

“…T2DM increases the risk for several fungal infections including Candida sp (21.6%), Cryptococcus sp (17.1%), and Aspergillus sp . (12.6%) [ 9 ].…”