Prevalence of Fungal Foot Infections in Patients with Diabetes Mellitus Type 1 - Underestimation of Moccasin-Type Tinea

Abstract

In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome. However, few data are available on the prevalence of fungal foot infections in patients with diabetes. During a conference attended by patients with long-term diabetes, 95 individuals with type 1 diabetes mellitus (52 men, 43 women, mean disease duration 35.8 years) were examined for fungal infections of the feet. As well as frequency of infection and risk profiles, the level of patient awareness and preventive measures taken were assessed by means of a questionnaire. Clinically, 78 patients (82.1 %) showed probable pedal fungal infections, of which 84.6 % (66/78) were mycologically confirmed by direct microscopy and/or culture. Skin mycoses were found in 9 patients (toe webs 5, soles 4), onychomycosis in 29 patients and simultaneous infection of nails and skin in 28 patients (toe webs 8, soles 20). Thirty-seven (47.4 %) of these patients had positive cultures, particularly for the dermatophyte Trichophyton rubrum (69.2 % of isolates). A significant correlation was found between infection and gender (men more frequently affected) and the age of the patients. The actual frequency of mycoses was underestimated by the patients. This correlated with the assessment of their own knowledge level concerning fungal infections: 83.2 % of patients with skin mycoses and 88.4 % of those with onychomycosis of the feet felt that they needed more information about their disease. Marked mycoses on the soles were often considered to be dry skin by the patients. The high number of infections detected is especially remarkable in that this group of patients were highly motivated. It therefore appears that diabetics require more diagnostic, therapeutic and preventive care in terms of mycotic diseases than has been previously thought.

Gangrenous necrosis of the diabetic foot caused byFusarium acutatum

“…In the majority of reported cases, diabetic foot infections are polymicrobial in nature [26]. The fungi isolated from diabetic foot are almost always superficially pathogenic when found in skin or nail scraping; such infections are predominately caused by Trichophyton rubrum, Trichophyton metagrophytes, Scytalidium dimidiatum , Candida, and Fusarium species [9,10,12]. F. solani is reported as the etiological agent of infected leg ulcers in a diabetic patient [27], and in severe infections, it may progress to cause osteomyelitis of the diabetic foot [13].…”

Skin Infections in Diabetes: A Review

“…Perlèche remains atypical warning of diabetes onset in children. Whereas, the correlation between localized candidal infection of the female genitalia (vulvovaginitis) and diabetes have been found strongly correlated [35].…”

pH-Wert und mikrobielle Infektionen

“…Tatsächlich sind solche Hautinfektionen bei jedem zweiten Diabetespatienten zu beobachten, und bei 15-28% handelt es sich hierbei um eine Candida -Infektion [17]. In einer Studie, deren Teilnehmer seit Langem an insulinabhängigem Diabetes litten, lagen bei 82,1% wahrscheinliche Fußpilzinfektionen vor; dies korrelierte mit dem Lebensalter [18]. Studienteilnehmer mit nicht insulinabhängigem Diabetes im Alter von 32-76 Jahren hatten in intertriginösen Bereichen (Leiste und Achselhöhle) signifikant höhere Haut-pH-Werte (mittlerer pH-Wert 6,84-7,18) als gesunde Kontrollpersonen (mittlerer pH-Wert 5,84-6,22), wohingegen zwischen dem pH-Wert der Haut am Unterarm (mittlerer pH-Wert 5,01-5,62) sowie der Hautfeuchtigkeit kein Unterschied festzustellen war.…”