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. Materials and Methods: A cross-sectional study was performed on 100 diabetic patients with...

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Main Authors: Azam Moslemi, Tahereh Shokohi, Maryam Salimi, Leila Faeli, Lotfollah Davoodi, Zahra Kashi, Mahdi Abastabar, Iman Haghani, Sabah Mayahi, Seyed Reza Aghili
Format: Article
Language:English
Published: Mazandaran University of Medical Sciences 2024-12-01
Series:Current Medical Mycology
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Online Access:https://cmm.mazums.ac.ir/article_150697_0ab91dd4441fb61ac50bb816d2693ec2.pdf
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author Azam Moslemi
Tahereh Shokohi
Maryam Salimi
Leila Faeli
Lotfollah Davoodi
Zahra Kashi
Mahdi Abastabar
Iman Haghani
Sabah Mayahi
Seyed Reza Aghili
author_facet Azam Moslemi
Tahereh Shokohi
Maryam Salimi
Leila Faeli
Lotfollah Davoodi
Zahra Kashi
Mahdi Abastabar
Iman Haghani
Sabah Mayahi
Seyed Reza Aghili
author_sort Azam Moslemi
collection DOAJ
description 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. Materials and Methods: A cross-sectional study was performed on 100 diabetic patients with a foot ulcer from December 2019 to November 2020 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 using MspI enzyme and the partial amplification of hyphal wall proteins (HWP1) gene were performed.Results: Mean age of the participants was 62.1 ± 10.8 years old, and 95% of them had type 2 diabetes. Moreover, more than 83% of them had diabetes for a duration of 10 years. In addition, 59% of the patients were male, and 66% > of them had poor education levels. Besides, 99% of them were married, and 52% were rural. Furthermore, 95% of the participants had neuropathic symptoms and 88% used antibiotics. The HbA1C level was > 9% in 69% of them, and the mean ulcer grade of the patients was 2.6±1.05. Candida infection was detected in 13% of the deep tissue and 7% of the tissue surrounding the wound. The predominant Candida isolate was C. parapsilosis (71.5%) and C. albicans (14.3%). Infections caused by filamentous fungi were not detected. There was a statistically significant relationship between Candida infection and gender, rural lifestyle, HbA1C, and ulcer grade.Conclusion: Mycological evaluations of diabetic foot ulcers are often ignored. The present study revealed that C. parapsilosis is the most common causative agent of deepseated foot ulcer infection in these patients and may require specific treatment. Therefore, more attention of physicians to Candida infections, early diagnosis, and prompt treatment can help accelerate wound healing and prevent amputation.
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publishDate 2024-12-01
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spelling doaj-art-9dba77ffcdfb4b5b9888946f4581d9802025-08-20T02:32:57ZengMazandaran University of Medical SciencesCurrent Medical Mycology2423-34392423-34202024-12-019491610.22034/cmm.2024.345165.1484150697Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospitalAzam Moslemi0Tahereh Shokohi1Maryam Salimi2Leila Faeli3Lotfollah Davoodi4Zahra Kashi5Mahdi Abastabar6Iman Haghani7Sabah Mayahi8Seyed Reza Aghili9Student Research Committee, Mazandaran University of Medical Sciences, Sari, IranInvasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranStudent Research Committee, Mazandaran University of Medical Sciences, Sari, IranStudent Research Committee, Mazandaran University of Medical Sciences, Sari, IranAntimicrobial Resistance Research Center, Communicable Diseases Institute, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, IranDiabetes Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranInvasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranInvasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranInvasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranInvasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, IranBackground 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. Materials and Methods: A cross-sectional study was performed on 100 diabetic patients with a foot ulcer from December 2019 to November 2020 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 using MspI enzyme and the partial amplification of hyphal wall proteins (HWP1) gene were performed.Results: Mean age of the participants was 62.1 ± 10.8 years old, and 95% of them had type 2 diabetes. Moreover, more than 83% of them had diabetes for a duration of 10 years. In addition, 59% of the patients were male, and 66% > of them had poor education levels. Besides, 99% of them were married, and 52% were rural. Furthermore, 95% of the participants had neuropathic symptoms and 88% used antibiotics. The HbA1C level was > 9% in 69% of them, and the mean ulcer grade of the patients was 2.6±1.05. Candida infection was detected in 13% of the deep tissue and 7% of the tissue surrounding the wound. The predominant Candida isolate was C. parapsilosis (71.5%) and C. albicans (14.3%). Infections caused by filamentous fungi were not detected. There was a statistically significant relationship between Candida infection and gender, rural lifestyle, HbA1C, and ulcer grade.Conclusion: Mycological evaluations of diabetic foot ulcers are often ignored. The present study revealed that C. parapsilosis is the most common causative agent of deepseated foot ulcer infection in these patients and may require specific treatment. Therefore, more attention of physicians to Candida infections, early diagnosis, and prompt treatment can help accelerate wound healing and prevent amputation.https://cmm.mazums.ac.ir/article_150697_0ab91dd4441fb61ac50bb816d2693ec2.pdfdiabetic footfungal infectioncandida infectioncandida parapsilosis
spellingShingle Azam Moslemi
Tahereh Shokohi
Maryam Salimi
Leila Faeli
Lotfollah Davoodi
Zahra Kashi
Mahdi Abastabar
Iman Haghani
Sabah Mayahi
Seyed Reza Aghili
Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
Current Medical Mycology
diabetic foot
fungal infection
candida infection
candida parapsilosis
title Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
title_full Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
title_fullStr Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
title_full_unstemmed Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
title_short Clinic-mycological spectrum of Candida infection in diabetic foot ulcers in a tertiary care hospital
title_sort clinic mycological spectrum of candida infection in diabetic foot ulcers in a tertiary care hospital
topic diabetic foot
fungal infection
candida infection
candida parapsilosis
url https://cmm.mazums.ac.ir/article_150697_0ab91dd4441fb61ac50bb816d2693ec2.pdf
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