Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot

Most diabetic lower-limb amputations probably result from combinations of contributing causes rather than from unitary causes. Iron-induced damage might modulate the development of chronic diabetes complications. In this study, the relationship between tissue iron levels and polarization of macrophages in induction of angiogenesis was investigated in diabetic ulcer samples and the transitional zone of diabetic ulcers. Patients with diabetic ulcers who underwent amputation were included. The transitional zone of diabetic ulcers, from the same diabetic patients, was used as a control group. After tissue preparation, Perls Prussian blue staining and immunohistochemistry for CD11c, CD163, and CD68 markers were done. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), Tie2, and protein kinase B (also known as AKT) transcription of genes were measured by real-time polymerase chain reaction. For statistical analysis, we used independent samples t-test or its nonparametric equivalents, Mann–Whitney U test was used for quantitative variables, and chi-square (or Fisher's exact test) for qualitative variables. According to the results, the ratio of M2 to M1 macrophages was decreased in ulcers tissue compared to the transitional zone of diabetic ulcers. The expression of angiogenesis-related genes was increased due to hypoxia induction such as HIF and VEGF in ulcer tissue ( P < .0001), but the expression of vascular stability-related genes such as Tie2 was decreased ( P < .0001).In amputated diabetic ulcers, the polarization of macrophages is toward the classic type, but no connection was found in terms of tissue iron and help in the polarization of macrophages.

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Perbandingan efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.8.1.2016.12335 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Angelica M. J. Wagiu ◽

Richard M. Sumangkut ◽

Heber B. Sapan ◽

Louise A. J. Waworuntu

Keyword(s):

Peripheral Arterial Disease ◽

Proteus Mirabilis ◽

Peracetic Acid ◽

Arterial Disease ◽

Diabetic Patients ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Citrobacter Diversus ◽

Peripheral Arterial ◽

Topical Antimicrobial

Abstract: Diabetic ulcer is a condition of infection, ulceration, and or destruction of inner skin tissue related to neurological disorders and degrees of peripheral arterial disease (PAD) in diabetic patients. Diabetic ulcer is prone to infection due to decreased immune response, therefore, opportunistic microbes can become pathogens. Infection is sttill a serious problem in diabetic ulcer since the high cost and long duration of treatment lead to complicated neclected ulcer. This study aimed to obtain the present profile of microbes in diabetic ulcers and the effectivitveness of peracetic acid dan feracrylum in the treatment of diabetic ulcers. This was a descriptive analytical study. The ulcer degree was determined by using PEDIS criteria. Pus specimen was taken with a sterile technique using a transport media, cultured in the Baxtec machine, and the microbes were identified and further tested for sensitivity to peracetic acid dan feracrylum 1%. The results showed that of the 57 patients there were 36 females with a mean age of 58.77+ 9.077 years. Most of the patients (30 patients) had diabetic ulcers of 4th degree. The result of pus culture showed Gram negative Proteus mirabilis as the most frequent microbe (17.5%). The sensitivity test showed that 100% of 12 types of microbes, 83.3% of Citrobacter diversus, and 60% of Proteus mirabilis samples were sensitive to peracetic acid, meanwhile, all microbes were resistant to feracrylum 1% dan NaCl as controls,. Conclusion: Peracetic acid was more effective than feracrylum 1% as topical antimicrobial for diabetic ulcer.Keywords: diabetic ulcer, microbe, topical antimicrobial agentAbstrak: Ulkus diabetik adalah suatu kondisi adanya infeksi, ulserasi dan atau kerusakan jaringan kulit yang lebih dalam yang berhubungan dengan kelainan neurologik serta berbagai tingkatan peripheral arterial disease (PAD) pada penderita diabetes melitus (DM). Ulkus diabetik lebih mudah terinfeksi karena respons kekebalan tubuh penderita DM biasanya menurun, bahkan kuman oportunistik juga dapat menjadi patogen. Infeksi masih menjadi masalah yang paling serius dialami penderita ulkus diabetik oleh karena biaya pengobatan yang besar dan waktu perawatan yang lama sehingga ulkus sering dibiarkan terinfeksi dengan komplikasi tanpa perawatan adekuat. Penelitian ini bertujuan untuk memperoleh data terkini pola kuman penderita ulkus diabetik dan untuk mengetahui efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik. Jenis penelitian ini ialah deskriptif analitik. Derajat ulkus dinilai dengan kriteria PEDIS. Spesimen pus diambil secara steril dengan media transpor, ditanam dalam mesin Baxtec, kemudian dilakukan identifikasi kuman dan uji sensitivitas terhadap asam perasetik dan feracrylum 1%. Hasil penelitian memperlihatkan dari 57 penderita ulkus diabetik terbanyak ialah perempuan (36 penderita) dengan rerata usia 58,77+9,077 tahun. Sebagian besar ulkus diabetik (30 penderita) termasuk derajat 4. Hasil kultur memperlihatkan Proteus mirabilis (Gram negatif) yang tersering (17,5%). Hasil uji sensitivitas pola kuman memperlihatkan 100% sampel dari 12 jenis kuman, 83,3% dari Citrobacter diversus, dan 60% dari Proteus mirabilis sensitif terhadap asam perasetik, sedangkan terhadap feracrylum 1% dan NaCl sebagai kontrol, seluruh kuman telah resisten. Simpulan: Asam perasetik lebih efektif dibandingkan feracrylum 1% sebagai antimikroba topikal pada ulkus diabetik.Kata kunci: ulkus diabetik, mikroba, antimikroba topikal

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A case series on post-covid deadly fungal infection: mucormycosis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213287 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1503

Author(s):

Kalpana G. ◽

Amol A. Patil ◽

Manohar Shaan ◽

Mitusha Verma ◽

Gayatri Harshe

Keyword(s):

Fungal Infection ◽

Opportunistic Infection ◽

Surgical Intervention ◽

Case Series ◽

Medical Intervention ◽

Morbidity And Mortality ◽

Diabetic Patients ◽

High Morbidity ◽

Per Se

<p class="abstract">The prevailing pandemic situation by SARS-CoV-2 infection is not only worrisome by the disease per se but also for the accompanying opportunistic infection are in the rise especially in diabetic patients. We presented a case series of post-covid rhino orbital cerebral mucormycosis infection in diabetic patients resulting in high morbidity. The need to present this was to emphasis on the timely surgical and medical intervention needed to reduce morbidity and mortality by the infection. The study highlighted the importance of surgical intervention in the deadly infection.</p>

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Nonhealing Wounds with Verrucous Presentation in the Neuropathic Patient: A Report of Two Cases

Journal of the American Podiatric Medical Association ◽

10.7547/17-153 ◽

2019 ◽

Vol 109 (6) ◽

pp. 471-476

Author(s):

David H. Truong ◽

Ellianne M. Nasser

Keyword(s):

Diabetic Neuropathy ◽

Current Literature ◽

Verrucous Carcinoma ◽

Foot Ulcer ◽

Skin Lesions ◽

Wide Excision ◽

Diabetic Patients ◽

Diabetic Ulcer ◽

Underlying Malignancy ◽

Neuropathic Foot

Verrucous skin lesions on the feet of diabetic patients in conjunction with a neuropathic foot ulcer is an uncommon incident. Currently, there are approximately 20 reported cases in the literature. Herein we report two cases of verrucous lesions superimposing a chronic diabetic ulcer. Patients failed several conservative treatments, and several biopsies were performed with inconclusive results, suggesting possible underlying verrucous carcinoma. Given the possibility of underlying malignancy, both patients were treated with wide excision, and both were negative for malignancy, thus confirming verrucous skin lesions on the feet in diabetic neuropathy. We also summarize the current literature on verrucous skin lesions on the feet in diabetic neuropathy.

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Pattern of Cutaneous Dermatoses in Type 2 Diabetes Mellitus in a Tertiary Hospital: A Cross Sectional Study

TAJ Journal of Teachers Association ◽

10.3329/taj.v31i1.41569 ◽

2019 ◽

Vol 31 (1) ◽

pp. 21-28

Author(s):

Mahfuza Akhter ◽

Ishrat Bhuiyan ◽

Zubaida Akter ◽

Homayra Tahseen Hossain ◽

Syed Ghulam Mogni Mowla

Keyword(s):

Diabetes Mellitus ◽

Bacterial Infection ◽

Viral Infection ◽

Fungal Infection ◽

Parasitic Infection ◽

Parasitic Infections ◽

Diabetic Patients ◽

Cutaneous Manifestations ◽

Female Patients

Background: Diabetes mellitus (DM) continues to be a major public health problem. Multiple factors have a role in the skin manifestations of DM. Cutaneous manifestations of DM are very important to the clinician. Methods: Current study was carried out in the Department of Dermatology and Venereology, Shaheed Suhrawrdy Medical College Hospital, Dhaka, spanning from 1st January 2017 till 30th June 2017 over a period of six months. Adult patients already diagnosed to be suffering from type 2 DM presenting with cutaneous manifestations were included in the study. Results: Majority (68.0%) patients had diabetes >5 years, 16.7% had < 1 year and 15.3% had 1-5 years. Family history of DM was found in 70.7% in this study. In this study bacterial infection and fungal infection were more common in female patients (60.0% vs 62.0% respectively). Regarding types of dermatoses, fungal infection was more common in this study 50(33.3%). Others were bacterial infection 20(13.3%), viral infection 7(4.7%) and parasitic infection 7(4.7%). Papulo squamous disease was found 31(20.7%) patients, other diseases were 32(21.3%).Viral infection was more in male patients (71.4%). Parasitic infection was high in female patients 6(85.7%). Papulo squamous diseases was found 21(67.7%) in female patients. Conclusion: In this study fungal infection, bacterial infection, viral infection and parasitic infections were found to be the more common cutaneous dermatoses among adult diabetic patients. Bacterial infection and fungal infection were more common in female patients. TAJ 2018; 31(1): 21-28

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A Rare Form of Melanoma Masquerading as a Diabetic Foot Ulcer: A Case Report

Case Reports in Endocrinology ◽

10.1155/2012/502806 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Susan Thomas ◽

Yuan-Xiang Meng ◽

Vijaykumar G. Patel ◽

Gregory Strayhorn

Keyword(s):

Case Report ◽

Diabetic Foot ◽

Primary Care Clinic ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Care Clinic ◽

Acral Lentiginous Melanoma ◽

Diabetic Ulcer ◽

Formidable Challenge

Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion’s location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer.Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark’s Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy.Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients.Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.

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Effect of Health Education on Improving the Knowledge among Diabetes Mellitus Patients in the Prevention of Diabetic Ulcer in Regional Hospital of Tidore Island

International Journal of Nursing and Health Services (IJNHS) ◽

10.35654/ijnhs.v4i4.452 ◽

2021 ◽

Vol 4 (4) ◽

pp. 379-384

Author(s):

Haeril Amir ◽

Nur Wahyuni Munir

Keyword(s):

Diabetes Mellitus ◽

Health Education ◽

Diabetic Foot ◽

Regional Hospital ◽

Foot Ulcers ◽

Control Group ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer ◽

Diabetic Ulcers

International Diabetes Federation (IDF) reported that the number of diabetes mellitus patients worldwide increases every year. Diabetes mellitus is a chronic disease due to damage to the pancreas in producing enough insulin and characterized by impaired metabolism of fats, increased blood sugar, carbohydrates and protein both absolutely and relatively. Diabetic foot ulcers (DFU) are among the most common complications in diabetic patients and are associated with high mortality, morbidity, and health costs. This study was to determine the effect of health education on knowledge improvement about diabetic ulcers in the regional hospital of Tidore Islands. This research is a quasi-experimental type with a pretest-posttest without a control group design. The research sample consisted of 30 respondents who met the inclusion criteria. Data were analyzed using a paired test and processed with statistic version 21. Based on the research results, there was an improved knowledge in pre and post-health education counseling, where the average score before health education counseling was 11.6. After health counseling, the average value was 15.0. The results showed the effect of knowledge in the prevention of diabetic ulcers with a p-value =0,000. Health education is an effort to improve patient's ability to prevent diabetic foot ulcers that have been proven in several scientific studies. Health education methods provide additional information so that patients who previously wondered about their disease can directly ask health workers. Health education affects the knowledge improvement of Diabetes Mellitus patients in the Regional hospital of Tidore Islands

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A study to test the validity of diabetic ulcer severity score (DUSS) at tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20175401 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4010

Author(s):

V. Hari Kumar ◽

Abdul Ghader Barazandeh Moghadam

Keyword(s):

Classification System ◽

Severity Score ◽

Low Cost ◽

Tertiary Care ◽

Skin Grafting ◽

Diabetic Patients ◽

Care Hospital ◽

Diabetic Ulcer ◽

The Mean ◽

Mean Time

Background: For classification of ulcer of feet in diabetes, various systems of classification are in use. Notable among them are the University of Texas (UT) system and the Wagner system. One of the most recent such type of classification system is DUSS (Diabetic Ulcer Severity Score). Studies are required to validate the same. Objective was to test the validity of Diabetic Ulcer Severity Score (DUSS).Methods: Present follow up study was carried out among 50 known cases of diabetes having ulcer over foot. DUSS scoring was applied. Ulcer was graded into five grades. Patients were followed till the outcome was noted.Results: Most common ulcers were of DUSS score of 3. Major amputation was done in 15 (30%) patients and minor amputation in 12 (24%) patients. Toe amputation was done in total of 15 patients. None of the patients had forefoot amputation. Below knee amputation was done in total of 11 (22%) patients. Majority of the foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intension or skin grafting i.e., 1 (100%), 3 (75%) and 6 (46.15%) respectively. However, among those with score 3 and 4 majority required amputation i.e., 14 (70%) and 10 (83.33%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P=0.004). The probability of healing with DUSS score 0 was 100%, 75% with DUSS score 1, 84.61% with DUSS score 2, 30% with DUSS score 3, 16.67% with DUSS score 4. The mean time for healing was 77 days. The mean time for amputation was 100 days.Conclusions: The proposed score classification system for the diabetic foot may enable better quality of life for diabetic patients and promote better low-cost care for millions of individuals worldwide.

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A study of effect of tarsal tunnel decompression on sensory improvement in diabetic foot: a prospective randomized control trial

International Surgery Journal ◽

10.18203/2349-2902.isj20184635 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3627

Author(s):

Lakshmanan S. ◽

Viswanathan M. S. ◽

R. Anbazhagan

Keyword(s):

Statistical Significance ◽

Diabetic Patients ◽

Decompression Surgery ◽

Tarsal Tunnel ◽

Ulcer Formation ◽

Diabetic Ulcer ◽

Entrapment Neuropathies ◽

Sensory Recovery ◽

Control Limb ◽

Adequate Decompression

Background: In India approximately, 45000 legs are amputated every year and almost 75% of these amputations are carried out in neuropathic feet which are potentially preventable. Diabetic peripheral nerves are at risk of entrapment neuropathies focally, where these nerves are contained in a closed space. The aim of the study was to find out the effect of decompression of compressed posterior tibial nerve and its branches at tarsal tunnel in restoration of sensation in diabetic foot.Methods: A total of 70 diabetic patients with ulcer foot in one limb (test limb) and with no ulcer on the other limb (control limb) were selected for study. The test limb was subjected to tarsal tunnel release. Sensory recovery was evaluated in the ulcer limb and compared with normal limb in same patient and results were evaluated statistically for significance.Results: Present study shows that following tarsal tunnel decompression surgery on test limb, 65 patients (93%) had sensory gain and 5 patients (7%) had documented no sensory gain on test limb, with statistical significance. After de-compressive surgery on the test limb, 69 patients (98.6%) were documented to have resolving of Tinel sign in the test limb with sensory improvement, suggesting adequate decompression and 1 patient (1.4%) was documented to have persistent Tinel sign suggesting possibility of inadequate decompression with no recovery of sensation, with statistical significance.Conclusions: Present study reveals that decompression of tarsal tunnel in diabetic ulcer foot patients leads to definite improvement in sensation of foot which will prevent further ulcer formation and resultant complications ending in amputations.

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A prospective observation study on diabetic foot ulcer using diabetic ulcer severity score at tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20214744 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3553

Author(s):

Bharti Saraswat ◽

Kapil Kumar Gill ◽

Ashok Yadav ◽

Krishan Kumar

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Scoring Systems ◽

Foot Ulcers ◽

Diabetic Patients ◽

Care Hospital ◽

Age Group ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer

Background: A number of scoring systems and classifications are available for diabetic foot ulcers with intention to compare the treatment modalities and future outcomes. Many of them are complex and don’t predict future outcome within the patients. Aim and objectives of current study were to establish a wound-based clinical scoring systems (DUSS) as daily clinical practice by assessing the efficacy of diabetic ulcer severity score.Methods: A total of 73 diabetic patients with foot ulcers were included in this prospective observational study conducted at Dr. S.N. Medical college, Jodhpur and attached hospitals from July 2018 to August 2020. Ulcers were assessed and DUSS score created. Patients were followed up for six months or until healing or amputation if either.Results: In this prospective study of 73 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean age group was 58.57±12.66 years. Mean duration of diabetes was 7.61±5.72 years. Most commonly ulcers were of DUSS score 2. Mean DUSS score was 1.97±1.15. Majority of diabetic foot ulcer patients (37 out of 51) with DUSS score 0, 1 and 2 healed by primary intention after wound debridement. Those with score 3 & 4 majority of them (20 out of 22) had amputation.Conclusions: This is a very simple scoring system that provides an easily accessible and a streamlined approach in the clinical setting without need of any advanced investigative equipment. Hence this can be applied in any set up.

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