Pattern of bacteria and fungi growth in the non-insulin dependent diabetes mellitus'toe webs

ABSTRACT

To assess the growth of bacteria and fungi in the Non Insulin Dependent Diabetes Mellitus [NIDDM] toe webs and to correlate with the glycaemic control and to frequent feet washing. Sixty one NIDDM patients [28 males, 33 females] with a mean age of 51.7 years, and mean diabetes duration of 7 years [0.5-30 years]. Compared with 29 non-diabetic healthy subjects as a control group with mean age 45.5 years, were randomly selected, evaluated and examined in the Endocrine Clinic - KHMC for skin peripheral pulse status. Skin scrapings were taken from both 4th toe webs regardless of the presence or absence of any lesion. These were cultured on Saboroud's dextrose and blood agar media. Gram stain and lactophenol cotton blue stain were also obtained. Venous blood for blood sugar and HbA 1c was also extracted. HbA 1c was considered as a measure of control. Levels < 7% were considered good control, 7.1-9.5% fair control, > 9.5% poor control. In the NIDDM group, there were 21 [34.4%] patients with superficial skin lesions over the fourth toe web, 28 [45.9%] were having absent tibialis posterior and dorsalis pedis pulses bilaterally and 5 unilaterally. 55.7% were having associated diseases and 80.33% were using frequent foot washings for religious purposes. Seventeen patients were having good control of their diabetes, 29 fair control and 15 with poor control. The mean HbA1c was 8.68 +/- 1.16 [ +/- SD]. In the control group 2 were having skin lesions and 75.86% were using frequent foot washings. 7.4% of the diabetic sample were having positive cultures, gram positive cocci, candida albicans, mixed growth of gram positive and negative, gram negative cocci and dermatophytes in decrescendo manner were obtained [19.7%, 14.7%, 13.2%, 4.9%, 4.9% versus 6.9% in the control group [Candida Albicans 100%] P <0.05. All patients with poor glycaemic control were having positive cultures, versus 41.7% with fair control and 47% with good glycaemic control P<0.001. None of the patients with dermatophytes were having intact skin, while 55% of patients with candida were having superficial lesions. Positive cultures with normal skin occurred in 27.9% in NIDDM group versus 6.9% in control group, and with toe lesions in 29.5% in NIDDM group, versus none in control group P <0.05. 61.2% of feet washers in NIDDM group have positive cultures versus 4.5% in control group. Diabetic patients have a higher carriage rate of both bacteria and fungi which increases with skin breakdown. Susceptibility of infection in increased by poor glycaemic control. Diabetes does not predispose to the carriage of dermatophytes in the toe webs of normal appearance. Frequent feet washing predisposes more to infection in diabetics and needs special attention