When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes

Caruso, Paola; Gicchino, Maurizio; Longo, Miriam; Scappaticcio, Lorenzo; Campitiello, Ferdinando; Esposito, Katherine

doi:10.1111/jdi.13627

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…The discovery that that T1DM and its complications did not exhibit a causal association with OM challenges our conventional understanding and contradicts some previous study findings. [27][28][29] . Traditionally, diabetes, including both T1DM and T2DM, has been linked to an elevated risk of various infection complications, such as OM.…”

Section: Discussionmentioning

confidence: 99%

Differential Causal Effects of Type 1 and Type 2 Diabetes on Osteomyelitis Risk: Insights from Mendelian Randomization Analysis

Li,

Zhou,

Yang

et al. 2024

Preprint

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Background: Osteomyelitis (OM) poses a significant clinical challenge, especially among individuals with diabetes mellitus (DM). While both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have been linked to an elevated risk of OM, the precise causal relationships remain uncertain. Methods: We conducted Mendelian randomization (MR) analyses using summary statistics from genome-wide association studies (GWAS) to explore the causal effects of T1DM, T2DM, their complications, and glycemic traits on OM risk. The study utilized the inverse variance weighted (IVW) method, along with weighted median and MR-Egger for causal estimation, and performed various sensitivity analyses to ensure robustness. Multivariable MR (MVMR) analysis assessed direct effects, while two-step mediation MR analyses investigated the mediating role of DM between rheumatoid arthritis (RA) and OM. Results: The MR analysis unveiled distinct causal effects of T1DM and T2DM on OM risk. Genetically determined T2DM, rather than its complications, significantly increased OM risk (primary dataset: IVW: OR = 1.13, 95% CI 1.056-1.209, p = 4E-04; validation dataset: IVW: OR = 1.317, 95% CI 1.14-1.522, p =2E-04; Meta-analysis: OR=1.206; 95% CI 1.037-1.402; p=0.014), with no observable heterogeneity or horizontal pleiotropy. MVMR analysis confirmed the robustness of the causal association between T2DM and OM, even after adjusting for potential confounders such as body mass index. Conversely, T1DM and its complications showed no significant causal link with OM in either the primary dataset (IVW: p = 0.071), the validation dataset (IVW: p = 0.276), or the meta-analysis (IVW: p = 0.242). Additionally, there was no robust evidence supporting the causal risk of glycemic traits on OM. Mediation MR analysis underscored T2DM as a pivotal contributor to the differential effects of RA on OM. Conclusions: Mendelian randomization analysis provides compelling evidence of a significant causal relationship between genetically determined T2DM and increased OM risk, while T1DM exhibits distinct causal effects. Additionally, our findings highlight the role of T2DM in mediating the association between RA and OM. Further research is warranted to elucidate the underlying mechanisms and guide targeted interventions for OM prevention and management in diabetic populations.

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Section: Discussionmentioning

confidence: 99%

Differential Causal Effects of Type 1 and Type 2 Diabetes on Osteomyelitis Risk: Insights from Mendelian Randomization Analysis

Li,

Zhou,

Yang

et al. 2024

Preprint

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“…This vulnerability is further exacerbated by fluctuating blood sugar levels, a lack of oxygen and blood circulation problems that reduce white blood cells' capacity to combat pathogenic fungi and bacteria 116 . As a result, diabetic patients are more susceptible to skin, soft tissue and bone infections, especially in the lower extremities, which can lead to hospitalization and even amputation 27,117 …”

Section: Albicans: a Causative Agent Of Candidiasismentioning

confidence: 99%

Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management

Shahabudin,

Azmi,

Lani

et al. 2024

Mycoses

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Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans‐induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.

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“…Wound infection is a common complication in diabetic patients. 51 The interaction between the pathogen and the host tissue leads to the formation of an acidic microenvironment in the infected wound. 52 By harnessing this characteristic, abundant acidity-sensitive systems were developed for infected wound management.…”

Section: Stimuli-responsive Systemsmentioning

confidence: 99%

Stimuli-responsive therapeutic systems for the treatment of diabetic infected wounds

et al. 2022

Nanoscale

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When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes

Cited by 4 publications

References 12 publications

Differential Causal Effects of Type 1 and Type 2 Diabetes on Osteomyelitis Risk: Insights from Mendelian Randomization Analysis

Differential Causal Effects of Type 1 and Type 2 Diabetes on Osteomyelitis Risk: Insights from Mendelian Randomization Analysis

Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management

Stimuli-responsive therapeutic systems for the treatment of diabetic infected wounds

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