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Shahabudin S, Azmi NS, Lani MN, Mukhtar M, Hossain MS. Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management. Mycoses 2024; 67:e13753. [PMID: 38877612 DOI: 10.1111/myc.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans-induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.
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Affiliation(s)
- Sakina Shahabudin
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Nina Suhaity Azmi
- Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
| | - Mohd Nizam Lani
- Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | | | - Md Sanower Hossain
- Centre for Sustainability of Mineral and Resource Recovery Technology (Pusat SMaRRT), Universiti Malaysia Pahang Al-Sultan Abdullah, Kuantan, Pahang, Malaysia
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Manjit M, Kumar K, Kumar M, Jha A, Bharti K, Tiwari P, Tilak R, Singh V, Koch B, Mishra B. Fabrication of gelatin coated polycaprolactone nanofiber scaffolds co-loaded with luliconazole and naringenin for treatment of Candida infected diabetic wounds. Int J Biol Macromol 2024; 261:129621. [PMID: 38278381 DOI: 10.1016/j.ijbiomac.2024.129621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
The current study focuses on the development of gelatin-coated polycaprolactone (PCL) nanofibers co-loaded with luliconazole and naringenin for accelerated healing of infected diabetic wounds. Inherently, PCL nanofibers have excellent biocompatibility and biodegradation profiles but lack bioadhesion characteristics, which limits their use as dressing materials. So, coating them with a biocompatible and hydrophilic material like gelatin can improve bioadhesion. The preparation of nanofibers was done with the electrospinning technique. The solid state characterization and in-vitro performance assessment of nanofibers indicate the formation of uniformly interconnected nanofibers of 200-400 nm in diameter with smooth surface topography, excellent drug entrapment, and a surface pH of 5.6-6.8. The antifungal study showed that the nanofiber matrix exhibits excellent biofilm inhibition activity against several strains of Candida. Further, in-vivo assessment of nanofiber performance on C. albicans infected wounds in diabetic rats indicated accelerated wound healing efficacy in comparison to gauge-treated groups. Additionally, a higher blood flow and rapid re-epithelialization of wound tissue in the treatment group corroborated with the results obtained in the wound closure study. Overall, the developed dual-drug-loaded electrospun nanofiber mats have good compatibility, surface properties, and excellent wound healing potential, which can provide an extra edge in the management of complex diabetic wounds.
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Affiliation(s)
- Manjit Manjit
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
| | - Krishan Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
| | - Manish Kumar
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
| | - Abhishek Jha
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
| | - Kanchan Bharti
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
| | - Punit Tiwari
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India
| | - Ragini Tilak
- Department of Microbiology, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India
| | - Virendra Singh
- Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi 221005, India.
| | - Biplob Koch
- Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi 221005, India.
| | - Brahmeshwar Mishra
- Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology, (BHU), Varanasi 221005, Uttar Pradesh, India.
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Venkatesan A, Noel C, Akeel W. An Orthopedic Perspective on Diabetic Foot Attack - A Case Report. J Orthop Case Rep 2024; 14:114-118. [PMID: 38292109 PMCID: PMC10823834 DOI: 10.13107/jocr.2024.v14.i01.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Diabetic foot attack (DFA), also known as diabetic foot ulceration, is a severe and potentially limb-threatening complication of diabetes mellitus. It refers to the development of open sores or ulcers on the feet of individuals with diabetes, often leading to infections, tissue damage, and, in extreme cases, amputation. The underlying cause of DFAs is multifactorial and involves a complex interplay of various factors, including peripheral neuropathy, peripheral arterial disease, foot deformities, impaired wound healing, and poor glycemic control. This case report would be first of its kind from an orthopedic perspective. Case Report A 55-year-old white British gentleman, a chronic uncontrolled Type 2 diabetic, was referred by the medical team on a busy on-call night. He presented with a sudden onset pain, swelling, and difficulty in weight bearing on his left foot. He had a non-healing plantar ulcer for over a year. His inflammatory markers were abnormally high and magnetic resonance imaging of his leg and foot showed massive collection in his foot with gas extending along the posterior compartment. Diagnosis of a severe DFA was made, and urgent debridement and washout were carried out. Despite aggressive debridement, patient progressively deteriorated warranting an admission into intensive care unit. After subsequent debridement and local antibiotic therapy, he recovered and was discharged with clinic follow-up. Conclusion Effective management strategies for DFAs encompass a multidisciplinary approach. Preventive measures play a key role in reducing the incidence of DFAs. Regular foot examinations, self-care education, proper glycemic control, and foot hygiene are essential components of preventive strategies. Patient education regarding self-monitoring, appropriate footwear, and early recognition of foot-related complications is crucial to empower individuals with diabetes to take proactive measures.
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Affiliation(s)
- Aakaash Venkatesan
- Department of Trauma and Orthopaedics, Grange University Hospital, Aneurin Bevan Trust, NP44 8YN, United Kingdom
| | - Chandan Noel
- Department of Trauma and Orthopaedics, Stepping Hill Hospital, Stockport, M23 0BS, United Kingdom
| | - Waleed Akeel
- Department of Trauma and Orthopaedics, Grange University Hospital, Aneurin Bevan Trust, NP44 8YN, United Kingdom
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Saud B, Chand K, Amatya N, Paudel G, Adhikari S, Shrestha V. Factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. Access Microbiol 2023; 5:000495.v4. [PMID: 37841102 PMCID: PMC10569662 DOI: 10.1099/acmi.0.000495.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 08/11/2023] [Indexed: 10/17/2023] Open
Abstract
This study was conducted to assess factors associated with cutaneous colonization of Mucormycetes in diabetic and non-diabetic individuals. A total of 800 swab samples from 200 participants including 100 diabetics and 100 non-diabetics were collected from four different body sites: (1) the forehead, (2) nasal cavity, (3) hands and (4) feet. Fungal isolation, fungal identification and antibiotic sensitivity tests were performed on the isolates. Overall, 12.0 % of the participants showed Mucormycetes colonization while the commonest fungal isolates were Mucor Species (Spp.). followed by Rhizopus spp. Diabetics had a 11 times higher odds of colonization compared to non-diabetics. The majority of the isolates were resistant to itraconazole; however, all isolates were sensitive to amphotericin B. A significant association was observed between profession and Mucormycetes (P=0.03) with significantly higher colonization in retired people compared to business people. Higher odds of colonization were demonstrated among older ages, lower class status and individuals with prolonged contact time with soil.
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Affiliation(s)
- Bhuvan Saud
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Kajal Chand
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Neetu Amatya
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Govinda Paudel
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
| | - Saroj Adhikari
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Vikram Shrestha
- Department of Medical Laboratory Technology, Janamaitri Foundation Institute of Health Sciences, Lalitpur, Nepal
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Ge Y, Wang Q. Current research on fungi in chronic wounds. Front Mol Biosci 2023; 9:1057766. [PMID: 36710878 PMCID: PMC9874004 DOI: 10.3389/fmolb.2022.1057766] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
The occurrence of chronic wounds is a major global health issue. These wounds are difficult to heal as a result of disordered healing mechanisms. The most common types of chronic wounds are diabetic ulcers, pressure ulcers, arterial/venous ulcers and nonhealing surgical wounds. Although bacteria are an important cause of chronic nonhealing wounds, fungi also play a substantial role in them. The fungal infection rate varies with different chronic wound types, but overall, the prevalence of fungi is extremely underestimated in the clinical treatment and management of chronic wounds. Wounds and ulcers can be colonized by host cutaneous, commensal or environmental fungi and evolve into local infections, causing fungemia as well as invasive fungal disease. Furthermore, the fungi involved in nonhealing wound-related infections help commensal bacteria resist antibiotics and the host immune response, forcing wounds to become reservoirs for multiresistant species, which are considered a potential key factor in the microbial bioburden of wounds and ulcers. Fungi can be recalcitrant to the healing process. Biofilm establishment is the predominant mechanism of fungal resistance or tolerance to antimicrobials in chronic nonhealing wounds. Candida albicans yeast and Trichophyton rubrum filamentous fungi are the main fungi involved in chronic wound infection. Fungal species diversity and drug resistance phenotypes in different chronic nonhealing wound types will be emphasized. In this review, we outline the latest research on fungi in chronic wounds and discuss challenges and future perspectives related to diagnosing and managing chronic wounds.
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Affiliation(s)
- Yumei Ge
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China,Institute of Immunology, Zhejiang University, Hangzhou, China,The Key Laboratory for Immunity and Inflammatory Diseases of Zhejiang Province, Hangzhou, China,The Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang province, Hangzhou, China
| | - Qingqing Wang
- Institute of Immunology, Zhejiang University, Hangzhou, China,The Key Laboratory for Immunity and Inflammatory Diseases of Zhejiang Province, Hangzhou, China,*Correspondence: Qingqing Wang,
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