Invasive Fungal Infections in Diabetes Mellitus
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.
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