Title : Fungal feet infection in patients with diabetes mellitus
Abstract:
According to the International Diabetes Federation, the number of adults living with diabetes mellitus (DM) is 589 million and will increase in the coming decades, diagriosis of mycoses of the skin of the leet and nail plates in patients with diabetes presents certain difficulties. Clinical manifestations do not have sufficient specificity, and the laboratory methods used vary in sensitivity and diagnostic capabilities. In this regard, the clinical assessment in all cases should be supplemented by laboratory verification. The use of PCR can increase the detection of pathogens compared with traditional methods, however, the results obtained should be interpreted taking into account the clinical picture, especially when several pathogens are detected in combination.
The aim of the study is to evaluate the prospects for using PCR in the diagnosis of onychomycosis in patients with DM.
In type 1 and type 2 diabetes, changes in the nalls of the feet are observed in 50.5% of patients, among whom half of the cases are represented by onychomycosis. Mycelium is also detected in 20% of patients in scrapings from clinically unaffected feet in the presence of symptoms of foot skin lesions (peeling, hyperkeratosis). The total incidence of onychomycosis in DM was 39.1%. Pathogenic fungi (Trichophyton spp., Candida albicans, Aspergillus niger) were found in 21.7% ol patients, all of them with type 2 diabetes, aged over 60 years. The pathogens of onychomycosis were not verified using, the PCIl panel under consideration (crosporum canis, Microsporum gypseum, Trichophyton spp., Fpidermophyton floccosum, Trichophyton rubrum, Aspergillus furmigatus, Aspergillus flavus, Aspergillus niger. Aspergillus terreus and Candida albicans) in 17.4% of patients. Of the 18 people with onychomycosis, 16 had a positive microscopy result, 2 patients were diagnosed only by PCR results, given that microscopy in two of these cases was negative in the presence of Trichophyton rubrum, we consider it advisable to conduct this examination in all patients with DM, even in the absence of lesions of the nail plates. In the case of Calbicans fungi, all patients had positive microscopic examination results. Thus, the data obtained require further study of the spectrum of pathogens of onychomycosis in patients with DM and the inclusion of PCR studies on Tr.rubrum in the surveillance program.
