Fungal infections may prove deadly for diabetics
10 Jan 2020
Infectious fungal diseases (IFDs) are potentially lethal complications in patients with type 2 diabetes mellitus (T2DM) and are primarily caused by Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus, a new study has found. Prolonged hyperglycaemia may further worsen outcomes.
This retrospective study included 120 T2DM patients (mean age, 60.5±11.7 years; 73 males) who had been diagnosed with IFDs after a median diabetes duration of 54 months. The overall diabetic inpatient population was 30,984, with an IFD prevalence rate of 0.4 percent. The corresponding rate in nondiabetics was 0.2 percent.
More than half of the IFDs were proven cases and a third were nosocomial cases. Yeast infections accounted for almost half of the infections, including 31 cases of candidiasis and 25 of cryptococcosis. The urinary tract was the most common site of involvement.
Majority of the participants received antifungal treatment (90.0 percent; n=108) or antifungal medications (83.3 percent; n=90). Twelve underwent operations alone, while six received medications after surgery. Over a median follow-up of -0.9 months, 28 patients died, yielding a mortality rate of 23.3 percent.
Levels of glycated haemoglobin were significantly higher in those who died (8.8±2.5 percent vs 7.7±2.1 percent; p=0.02) and may explain the worse prognosis. The same was true for diabetic nephropathy (50.0 percent vs 23.9 percent; p=0.01), having mixed fungal infections (28.6 percent vs 7.6 percent; p=0.01), coinfections (92.9 percent vs 34.8 percent; p<0.001) and disseminated IFD (25.0 percent vs 6.5 percent; p=0.01).