Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital

Background and Purpose: In diabetic foot ulcers, if fungal agents such as Candida species penetrate the cutaneous or depth of the ulcer, it can increase the wound severity and make it more difficult to heal.Material and Methods: A cross-sectional study was performed on ۱۰۰ diabetic patients with a foot ulcer from December ۲۰۱۹ to November ۲۰۲۰ in northern Iran. Patient data and wound grades were recorded in a questionnaire. Candida infection was confirmed by direct microscopic examination and culture. To identify the causative agent, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using Msp۱ enzyme and the partial amplification of hyphal wall proteins (HWP۱) gene were performed.Results: Of ۱۰۰ patients, the mean age ۶۲.۱ ± ۱۰.۸ years, ۹۵% type ۲ diabetes, ۸۳%>۱۰ years duration diabetes, ۵۹% male, ۶۶%> poor education level, ۹۹% married, ۵۲% rural, ۹۵% neuropathic symptoms, ۸۸% using antibiotics, ۶۹%HbA۱C >۹%, and mean ulcer grade ۲.۶±۱.۰۵ were. Candida infection was seen in ۱۳% of the deep tissue and ۷% surrounding the wound. The predominant Candida isolate was C. parapsilosis (۷۱.۵%) and C .albicans (۱۴.۳%). Infections caused by filamentous fungi were not detected. There was a statistically significant relationship between Candida infection and gender, rural, HbA۱C, and ulcer grade.Conclusion: Mycological evaluations of diabetic foot ulcers often are ignored. Our study revealed that Candida parapsilosis is the most common causative agent of deep-seated foot ulcer infection in these patients and may require specific treatment. Therefore, more attention from physicians to Candida infections particularly, early diagnosis and prompt treatment, can help faster-wound healing and prevent amputation.

Keywords:

Diabetic foot , Fungal infection , Candida infection , Candida parapsilosis