Infections in Diabetes Mellitus and Hyperglycemia

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Infections in diabetes mellitus are relatively more common and serious. Diabetic patients run the risk of acute metabolic decompensation during infections, and conversely patients with metabolic decompensation are at higher risk of certain invasive infections. Tight glycemic control is of paramount importance during acute infected or high stress state. Infections in diabetic patients result in extended hospital stays and additional financial burden. Given the risks of not alleviating the metabolic dysregulation and the benefits of decent glycemic control, it is necessary that besides antimicrobial therapy, equal emphasis be placed on intensified glycemic control.

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Innate immunity

The early phase of the innate immune response is inflammatory. It includes vasoactive components of the complement system, mast cell secretions, and the kinin-bradykinin system, which induce local vasodilation and increase vascular permeability and blood flow. In diabetes, dysregulation of the nitric oxide production and blunted nitric oxide response to bradykinin leads to vasoconstriction instead. This could potentially attenuate the ability of phagocytes to reach their target [5], [6], [7].

A

Urinary tract infections

The most frequently observed category of urinary tract involvement in diabetic patients is asymptomatic bacteriuria (ASB), which is defined as presence of at least 105 colony-forming units per milliliter of a bacterial species in a culture of clean-voided midstream urine sample from an individual without symptoms of a urinary tract infection. It is three times more common in diabetic women compared with diabetic men [39]. Upper urinary tract is involved in more than half of the patients with

Respiratory tract infections

At autopsy, lungs in patients with diabetes mellitus show changes of microangiopathy, vascular hyalinosis, interseptal nodular fibrosis, granulomas, and focal proteinosis with emphysema-like septal obliteration [53]. Reduced activity of glutathione peroxidase, endothelial dysfunction, microsomal disorders, increased heparan sulphate at the level of the vascular basement membrane, increased levels of advanced glycation end products, and the derangement of bronchial mucus production by amylin

Periodontal infections

The association between diabetes and periodontal disease has been very well recognized in dental literature. It was identified as the sixth complication of diabetes in 1993 [70]. There is an increased prevalence, severity, and progression of periodontal disease in both type 1 and type 2 diabetes. Periodontal destruction can start very early in life in diabetes and become more prominent as children become adolescents [71].

The NHANES data reported a prevalence of 17.3% in diabetic patients as

Skin and soft tissue infections

Skin and soft tissue infections are more common in the diabetic population. Patients with diabetes have a higher prevalence of staphylococcal skin and nasal carriage, and this correlates with an increased risk of local and systemic infections leading to significant morbidity and mortality.

Some of the soft tissue infections that are more prone to occur in patients with diabetes include impetigo, furuncles and carbuncles, cellulitis, necrotizing fasciitis, and septic bursitis. Necrotizing

Mucormycosis (zygomycosis)

Mucormycosis is an uncommon, acutely fatal fungal infection that predominantly affects immunocompromised patients. It carries a high mortality ranging from 15% to 34%. Rhinocerebral mucormycosis, the most common form of infection, predominantly affects patients with poorly controlled diabetes, especially with diabetic ketoacidosis. Patients with rhinocerebral mucormycosis with concomitant diagnosis of diabetes ranged from 60% to 81% [97], [98], [99]. Mucormycosis originates in the nasal or oral

Infections related to therapeutic interventions

Infections related to injection sites and insulin pump infusion sites are uncommon, and deserve attention if and when these occur. Proper hygiene in handling devices should minimize such infections. Because penile implants have become less popular, thanks to better medical treatment for erectile dysfunction, infections are no longer a problem. There is no increase in pacemaker insertion site infections in diabetic patients. This was once foreseen as a potential problem.

Thrombosis of

Infections in special populations with diabetes

Infections in the elderly can be serious if not promptly treated. Because infections present in subtle and atypical fashion, a high index of suspicion is advised [127]. Often dosage adjustments are needed for many antimicrobial therapies because of altered renal and fluid electrolyte status. These are discussed by Bergman SJ, Speil C, Short M et al elsewhere in this issue.

Infections in burn victims with diabetes also deserve special attention because of high risk of sepsis and

Summary

Infections in diabetes mellitus are relatively more common and serious. Diabetic patients run the risk of acute metabolic decompensation during infections, and conversely patients with metabolic decompensation are at higher risk of certain invasive infections, such as rhinocerebral mucormycosis. Tight glycemic control is of paramount importance during acute infected or high-stress state. Infections in diabetic patients result in extended hospital stays and additional financial burden. In one

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