Prevalence of fungal infections among diabetic foot ulcer patients in a rural area in south India.

ABSTRACT

Introduction: Infections among the diabetic patients play a vital role in the morbidity and to an extent mortality of the diabetic patients. Among the bacteriology of diabetic foot ulcers which had been documented by various researchers mixed aerobic - anaerobic microbes seems to be more common. Fungal infections among immunocompromised patient’s particularly diabetic patients are one of the major health concern in the world today. Very few studies in India was previously done on assessing the magnitude of fungal infections in diabetic foot ulcers particularly among the rural patients. This study was undertaken to assess the prevalence of infections among the diabetic patients with foot ulcers and see for the presence of fungal infections and to describe the spectrum of those fungal infections. Material and Methods: A prospective study was carried out on diabetic patients with foot ulcer during the period of 1 year from June 2014 – May 2015 at Thanjavur medical college. A total of 100 cases with diabetic foot ulcers were included for the study. The power of the study was kept as 89.7%, which was calculated by using the formula of Z power = test statistics/ S.E – 1.96. Where the test statistics was taken as 0.2and the SE was taken as square root of 0.5/n and where n= 100. Specimens (pus, wound, exudates or tissue biopsy) for microbiological studies were obtained from the ulcer region. All the 100 specimens were immediately transported to the microlab for further processing, culture and isolation. Identification of the microorganisms were done according to the standard microbiological procedures. Results: Among the study subjects males constitutes to 83% and females 17%. The mean random blood sugar among the subjects was 316.35±54 mgs/dl. The average duration of the foot ulcer among the study subjects was 13±7.58 months. Of the various microorganisms which was found in the foot ulcer bacterial agents were present in almost 100% of the patients. The fungal growth was seen in 29% of the patients with foot ulcers. The most common fungus identified were Aspergillus flavus (17%), Aspergillus fumigates (5%), Candida albicans (6%) and Mucor (1%). Conclusions: The present study insists on the evaluation of fungal pathogen for long standing diabetic foot ulcers even after effective treatment with antibacterial agents.