The Indian Practitioner

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Invasive Fungal Infections in Diabetes Mellitus


Affiliations
1 Dept of Medicine, 1st Floor College Building, LTMGH, Sion, Mumbai, India
2 LTMGH, Sion, Mumbai, India
3 Department of Medicine, LTMGH, Sion, Mumbai, India
     

   Subscribe/Renew Journal


Background and objective: Invasive fungal infections (IFI) are increasingly diagnosed in the immunocompromised patients due to improved diagnostic modalities. Major risk factors for IFI are diabetes mellitus, HIV infection, neutropenia, prolonged use of corticosteroids; recipients of bone marrow or solid organ transplant, haematological malignancies and inherited immunodeficiency disorders. In systemic fungal infections the outcome of the disease depends more on the host factors rather than the fungal virulence. Zygomycosis (Mucor) is the most lethal opportunistic fungal infection particularly among patients with diabetes mellitus and haematological malignancies. Rhino cerebral zygomycosis most common and fulminant type of zygomycosis leads to fatal consequences within a week of onset. Diagnosis of fungal infection include routine microscopy, cultures and advanced serological methods. Management of fungal infections depending on the type of infection and aetiologic agents. Antifungal agents have varying spectrum of activity, dosing, safety profiles and costs. Common antifungal agents used are polyene (AmphotericinB), Azole (Fluconazole, Itraconazole, and Voriconazole etc), Echinocandins (caspofungin, anidulafungin etc). Along with antifungal drugs treatment of co-morbid disease is important for better outcomes.

Methods: This was a prospective observational study performed in hospitalised patients. Patients hospitalised with suspected fungal infection or the patients hospitalised for any illness and suspected to have fungal illness during course of stay were screened and worked up in detail for fungal aetiology. Radiologicaly suspected fungal infection cases were worked up and specific samples collected for microbiology. Patient who were diagnosed to have definitive invasive fungal disease were included in the study.

Results: In present study 34 patients of conformed IFI were included and observed. 15 patients were diabetic with IFI. Male patients 19(55.9%) in age group12 to 70 years with the average age being 47.15 years were predominantly affected. Most common risk factor in the present study was diabetes mellitus which was noted in 15 out of 34 cases(44.11%). Mucor is commonest fungus in diabetic patients(60%) followed by aspergillus (26.66%).Naso-orbital infection was most common site of affection. Mortality was 46.7% in diabetic patients with fungal infections. Better outcomes observed in patients treated with combined medical and surgical treatment (64.3%) than medical treatment 45% alone.


Subscription Login to verify subscription
User
Notifications
Font Size


  • Chander J.Chapter 1:Introduction,Textbook of Medical Mycol.3rd edition, Mehta publishers.2012, 1-3.

  • John E. Edward’s,Jr.chapter 198:Diagnosis and Treatment of fungal infections,Harrisons Principles of Internal Medicine; and eds:Longo DL,Fauci AS, Kasper DL, Hauser SL et al.18th edition 2012, Mcgraw-Hill Companies New Yark 1637.

  • Chander J. Chapter 24;Aspergillosis,Textbook of Medical Mycol.3rd edition, Mehta publishers. 2012, 345-49.

  • Chander J. Chapter 25:Zygomycosis,Textbook of Medical Mycol.3rd edition, Mehta publishers. 2012, 365-68.

  • Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. ClinMicrobiol Rev. 2000 Apr;13(2):236-301

  • Baddley JW. Clinical risk factors for invasive aspergillosis. Med Mycol. 2011 Apr;49 Suppl 1:S7-S12

  • El-Mahallawy HA, Shaker HH, Ali Helmy H, Mostafa T, Razak Abo-Sedah A. Evaluation of pan-fungal PCR assay and Aspergillus antigen detection in the diagnosis of invasive fungal infections in high risk paediatric cancer patients. Med Mycol 2006; 44:733-739.

  • Greene R E, Schlamm HT, Oestmann JW, Stark P, Durand C, Lortholary O, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis 2007; 44 : 373-9.

  • Ostrosky-Zeichner L, Alexander BD, Kett DH, Vazquez J, Pappas PG, Saeki F, et al. Multicenter clinical evaluation of the (1.3)beta-D- glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 2005; 41 : 654-9.

  • Obayashi T, Yoshida M, Mori T, Goto H, Yasuoka A, Iwasaki H, et al. Plasma (1.3)-beta-D-glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 1995; 345 : 17-20.

  • J. P. Barrett, K. A. Vardulaki, C. Conlon et al., “A systematic review of the antifungal effectiveness and tolerability of amphotericin B formulations,” Clinical Therapeutics, 2003; 25(5): 1295-1320.

  • F. Marco, M. A. Pfaller, S. A. Messer, and R. N. Jones, “Antifungal activity of a new triazole, voriconazole (UK-109,496), compared with three other antifungal agents tested against clinical isolates of filamentous fungi,” Medical Mycology, 1998; 36(6): 433-436[67].Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008; 47 : 503-9.

  • Eucker J, Sezer O, Graf B, Possinger K. Mucormycoses. Mycoses 2001; 44 : 253-60

  • Dodds-Ashley ES, Lewis R, Lewis JS, Martin C, Andes D. Pharmacology of systemic antifungal agents. Clin Infect Dis 2006; 43 (Suppl 1): S28-39. Etween toxicity and pharmacokinetic parameters. Chemotherapy 2000; 46 : 86-94.

  • Rickerts V, Böhme A, Just-Nübling G. [Risk factor for invasive zygomycosis in patients with hematologic malignancies]. Mycoses. 2002;45 Suppl 1:27-30. German[95]. Ruping, M.J., Heinz, W.J., Kindo, A.J., Rickerts, V., Lass-Florl, C., Beisel, C. et al. (2010) Forty-one recent cases of invasive zygomycosis from a global clinical registry. J Antimicrob Chemother 65: 296–302


Abstract Views: 337

PDF Views: 1




  • Invasive Fungal Infections in Diabetes Mellitus

Abstract Views: 337  |  PDF Views: 1

Authors

S. V. Pawar
Dept of Medicine, 1st Floor College Building, LTMGH, Sion, Mumbai, India
S. D. Chiraniya
LTMGH, Sion, Mumbai, India
S. Yadav
LTMGH, Sion, Mumbai, India
N. D. Moulick
Department of Medicine, LTMGH, Sion, Mumbai, India

Abstract


Background and objective: Invasive fungal infections (IFI) are increasingly diagnosed in the immunocompromised patients due to improved diagnostic modalities. Major risk factors for IFI are diabetes mellitus, HIV infection, neutropenia, prolonged use of corticosteroids; recipients of bone marrow or solid organ transplant, haematological malignancies and inherited immunodeficiency disorders. In systemic fungal infections the outcome of the disease depends more on the host factors rather than the fungal virulence. Zygomycosis (Mucor) is the most lethal opportunistic fungal infection particularly among patients with diabetes mellitus and haematological malignancies. Rhino cerebral zygomycosis most common and fulminant type of zygomycosis leads to fatal consequences within a week of onset. Diagnosis of fungal infection include routine microscopy, cultures and advanced serological methods. Management of fungal infections depending on the type of infection and aetiologic agents. Antifungal agents have varying spectrum of activity, dosing, safety profiles and costs. Common antifungal agents used are polyene (AmphotericinB), Azole (Fluconazole, Itraconazole, and Voriconazole etc), Echinocandins (caspofungin, anidulafungin etc). Along with antifungal drugs treatment of co-morbid disease is important for better outcomes.

Methods: This was a prospective observational study performed in hospitalised patients. Patients hospitalised with suspected fungal infection or the patients hospitalised for any illness and suspected to have fungal illness during course of stay were screened and worked up in detail for fungal aetiology. Radiologicaly suspected fungal infection cases were worked up and specific samples collected for microbiology. Patient who were diagnosed to have definitive invasive fungal disease were included in the study.

Results: In present study 34 patients of conformed IFI were included and observed. 15 patients were diabetic with IFI. Male patients 19(55.9%) in age group12 to 70 years with the average age being 47.15 years were predominantly affected. Most common risk factor in the present study was diabetes mellitus which was noted in 15 out of 34 cases(44.11%). Mucor is commonest fungus in diabetic patients(60%) followed by aspergillus (26.66%).Naso-orbital infection was most common site of affection. Mortality was 46.7% in diabetic patients with fungal infections. Better outcomes observed in patients treated with combined medical and surgical treatment (64.3%) than medical treatment 45% alone.


References