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| ORIGINAL ARTICLE |
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| Year : 2016 | Volume
: 4
| Issue : 2 | Page : 26-31 |
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Study of clinical and microbial profile of infections in type 2 diabetes mellitus
CG Adroja1, MM Sheta2, SI Shah3, MJ Sonagara4
1 Resident, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
2 Resident, Department of Microbiology, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
3 Assistant Professor, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
4 Associate Professor, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
| Date of Web Publication | 30-Aug-2018 |
Correspondence Address:
M M Sheta
Resident, Department of Microbiology, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2347-6486.240198
Introduction: Diabetes mellitus predisposes to infection. Clinical data on infections in diabetes mellitus patients from rural areas of India are lacking. We intended to determine the clinical profile and pattern of infections in type 2 diabetes mellitus patients in rural area.
Methods: This prospective observational study was conducted in type 2 diabetes patients admitted in Medicine department at a tertiary care hospital from December 2014 to November 2015.
Results: In this study, 627 patients with diabetes mellitus admitted during December 2014 to November 2015 were observed. Out of these 627 patients 263 had various types of infections. Maximum number of patients belonged to age group of 46 to 60 years and there was male predominance. The commonest comorbidity was hypertension (51.33 %). Common infections encountered were urinary tract infection (40.30 %), respiratory tract infection (28.90 %) and Skin and soft tissue infections (12.93 %). Escherichia coli, Candida, Klebsiella pneumonaie and Staphylococcus aureus were the common causative organisms of all these infections.
Conclusion: Physicians should be aware of risk factors and type of infections present in patients with diabetes in order to provide proper care and for their prevention.
Keywords: Diabetes mellitus, Infections, Risk factor, Tuberculosis, UTI
How to cite this article:
Adroja C G, Sheta M M, Shah S I, Sonagara M J. Study of clinical and microbial profile of infections in type 2 diabetes mellitus. J Integr Health Sci 2016;4:26-31 |
How to cite this URL:
Adroja C G, Sheta M M, Shah S I, Sonagara M J. Study of clinical and microbial profile of infections in type 2 diabetes mellitus. J Integr Health Sci [serial online] 2016 [cited 2023 Jun 9];4:26-31. Available from: https://www.jihs.in/text.asp?2016/4/2/26/240198 |
| Introduction | |  |
Diabetes mellitus (DM) is a common non communicable disease in India. The prevalence of type 2 DM is 11 % in urban areas and 3 - 9 % in rural areas.[1] Infections play a significant role in morbidity and mortality of diabetic patients.[2] Studies have revealed that defect in the function of neutrophils, lymphocytes, and monocytes were the reason for increased infections in diabetics.[3],[4] Other reasons are low levels of leucotriene B4, thromboxane B2, and prostaglandin E.[5],[6] Some studies showed decreased lymphocyte function and decreased phagocytosis by monocyte in diabetics.[7],[8] There is also evidence that improving glycemic status in diabetics, improves cellular immunity.[9] Although DM is very common in India, studies on various types of infections in patients with DM from rural Indian areas are lacking. Therefore, the aim of this study was to explore this problem in our own setup.
| Methodology | | |
Aim of the study was to find out various infections and also to identify their causative microorganism from hospitalized patients having type 2 diabetes mellitus. After approval from institutional ethics committee, this prospective observational study was conducted in type 2 diabetes patients admitted in medicine department at a tertiary care hospital from December 2014 to November 2015. All type 2 diabetes patients admitted were enrolled in the study. All the patients were subjected to routine investigations and to investigations to identify presence of infection. A culture of the infected tissue was done to isolate the microorganism responsible. All study data were entered in predesigned format and analyzed by using SPSS version 17.
| Results | | |
During the study period of one year, there were total 627 type diabetes mellitus patients admitted in the medicine department. Out of these 627 patients, 263 (41.95 %) people suffered from various infections. These 263 type 2 diabetes mellitus patients with various infections were included in the study.
[Table 1] indicates that infections in patients with diabetes mellitus were more in age group between 46-60 years.
In our study, hypertension was the most common co morbid condition while second common co morbidity was cardiovascular disease other than hypertension [Table 2].
In our study, hypertension was the most common co morbid condition while second common co morbidity was cardiovascular disease other than hypertension [Table 2].
Most common infections encountered in this study were urinary tract infection [Table 3].
Escherichia coli were the most common causative organisms [Table 4].
| Discussion | | |
Patients with DM have been associated with increased rate of infections compared with patients without DM.[10],[11],[12] Early diagnosis and aggressive treatment of infections in these vulnerable patients is clinical priority. Several parts of immune system are altered in diabetic patients. Multiple functions of leukocyte like adherence, chemotaxis, and phagocytosis are affected.[3],[4],[13] Rate of infection in diabetics is low in developed countries compared to developing countries like India.[14] Out of 627 DM patients, 263 (41.95 %) had evidence of infections. In our study maximum numbers of cases were in 46 to 60- year age group. This increase in incidence of infection with age was observed in Gillani et al. study.[15] In this study 176 (66.92 %) patients were males. Gender differences between men and women in the development of foot infections have been observed in other studies.[16],[17]Prevalence of UTI in diabetics increased 1.9-fold with each 10-year increase in diabetes duration.[18] We observed similar finding of more UTI cases in our study. Hypertension and cardiovascular diseases were the most prevalent co morbidities in our study. However, from our data it cannot be concluded that these conditions predispose to infection, since a control population group was not studied. Among the diabetics who had infection, UTI was found in highest number of patients (40.30 %). Infections caused by certain microorganisms (Staphylococcus aureus, gram negative organisms) occur with increased frequency in diabetics.[19] Pneumococcal pneumonias is associated with increased mortality in DM patients.[20] Staphylococcus aureus and Klebsiella pneumonia were the most common microorganisms causing respiratory tract infections in our studied patients. Majority of UTI cases in our study were asymptomatic. Eschericia coli and Candida were the common causative organisms.
Several studies have showed a higher incidence of bacteriuria in DM patients than non- diabetics.[21],[22],[23] DM is a common risk factor for urinary tract infection caused by fungi, particularly Candida species.[24] DM patients are more prone for severe infections of the upper urinary tract.[25] Complications also occur more frequently in DM patients than in non DM patients with urinary tract infections.[26] In one study Escherichia coli was the commonest cause of urinary tract infection.[27] Our study showed similar finding.
In this study 34 (12.93 %) DM patients had skin infections. Among the diabetics who had skin lesions, fungal infection was more common. Rest of skin infections were due to bacterial invasions. Same results are found by Foss NT, et al.[28]
In our study 16 (6.08 %) patients had tuberculosis. Several studies showed that tuberculosis is more common in DM patients.[29],[30],[31],[32] Multiple factors like hyperglycemia, glycosylation, long term oxidative stress, cell medicated immune dysfunctions and genetic determinants contribute to the susceptibility of severe tuberculosis in diabetes.[29],[31] Patients presented with pyrexia of unknown origin and infection invading GI tract as well as nervous system.
| Conclusion | | |
The study showed that patients with type 2 DM are at increased risk for common infections. Therefore, it is essential to provide health education to promote good glycemic control. Long term hygiene care and maintenance of normal health may prevent infective complications in DM patients.
| References | | |
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[Table 1], [Table 2], [Table 3], [Table 4]
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