Introduction: The diabetes constitutes the factor risk of mycotic infections. The pathogenic agents depend on the climate, geography and the migration. The objective of this study is to evaluate the prevalence of the mycotic infections within the hospitalized diabetic patients, to describe their localization and identify the responsible germs. Patients and methods: It is about a descriptive and retrospective study conducted from November 2015 to March 2016 in endocrinology office at CHU Ibn Roch of Casablanca. It was included all diabetic patients hospitalized with whom mycotic infection has been suspected. Results: In total 350 diabetic patients have been hospitalized during the period of research. A mycotic infection has been suspected in 138 patients corresponding to the prevalence of 39.4 percent. The means localizations of mycotic infections were feet (intertrigos: 38.4%), onychomycosis (29%), vulvovaginal (21.7%) and mouth (oral candidiasis: 13.3%). The most frequent pathogenic agents were dermatophytes ( Trichophyton rubrum: 61%, Trichophyton mentagrophytes: 6.3%) and Candida albicans (23.1%). The direct test and the culture were negative in 7.3%. Conclusion: One-third of the diabetic patients showed a mycotic infection. The feet, constitute the predilection localization of mycotic infections in the diabetic. The dermatophytes and Candida albicans constitute the most frequent pathogenic agents found in our study.
The diabetes constitutes a contributing factor to mycotic infections. This is due to altered powers of phagocytosis and chemotaxis of white blood cells. The infections frequently described are the orodigestive candidiasis, the intertrigos, the onychomycosis, the perleches, the vulvovaginitis, the balanites and the paronychia [
It is about a descriptive and retrospective study conducted from November 2015 to March 2016 in endocrinology office at CHU Ibn Roch of Casablanca.
It was included all diabetic patient hospitalized with whom mycotic infection has been suspected. The samples are taken in parasitology laboratory. The variable studied concerned the clinic signs, their localization, the paraclinics data. The data collection has been done with questionnaire and statistical analysis with software SPSS 20.0
Socio-demographic characteristic
In total 350 diabetic patients have been hospitalized during the period of research (6 months). A mycotic infection has been suspected in 138 patients corresponding to the prevalence of 39.4 percent. The average age was 50 ± 8 years and a sex-ratio (H/F) of 0.64. Antecedent of mycotic infection has been found in 50 percent of patients. The mean duration of diabetes was 13 ± 5 years (
Clinical aspects
In 138 patients the intertrigos were found in 53 patients (38.4 percent), the onychomycosis in 40 patients (29 percent), an association of intertrigos and onychomycosis in 23 patients (16.6), the oral candidiasis in 17 patients (13.3 percent), the vulvovaginitis in 12 female patients (21.7 percent), the mycosis of large folds (under breast and or inguinal) in 11 patients (7.99 percents), an association of vulvovaginitis and mycosis of the large folds in 10 female patients(7.2 percent), the urinary tract infection in three female patients (2.17 percents), digestive candidiasis revealed in the gastroscopy in two patients (1.4 percents) (
The mycosis is not linked to the sex as it shows the value of chi carre = 0.2562 (p = 0.6128), also the mycotic infection is not associated to a particular type of diabete (p = 0.2568).
| Diabete type 1 | Diabete type 2 | Total | P value | |
|---|---|---|---|---|
| Total | 20 | 118 | 138 | |
| Age (years) | 28 ± 6 | 54 ± 9 | 50 ± 8 | |
| Sex-ratio H/F | 11/9 | 43/75 | 0.64 | 0.6128 |
| HbA1c | 9.2 ± 1.5% | 10.8 ± 2.1% | 10.5 ± 2 | 0.2568 |
| Duration of diabetes (years) | 7 | 14 | 13 ± 5 | |
| Antecedent of mycotic infection | 5 | 65 | 50% |
| Localization of mycosis infection | Total | Frequence |
|---|---|---|
| Intertrigo | 53 | 38.4% |
| Onychomycosis | 40 | 29% |
| Oral candidiasis | 17 | 13.3% |
| Vulvo-vaginitis | 12 | 21.7% |
| mycosis of large folds | 11 | 8.7% |
| urinary tract infection | 3 | 2.17% |
| digestive candidiasis | 2 | 1.4% |
| Association Vulvo-vaginitis and mycosis of large folds | 10 | 7.2% |
| Association Onychomycosis and intertrigo | 23 | 16.6% |
Paraclinic aspects
They were all in chronic imbalance glycemy with an average hemoglobin glycated of 10.5 ± 2 percent.
By the lack of means, it is only in 95 patients that we have been able to realize a mycological test. The Trichophyton rubrum was identified in 58 patients (61 percents), the Trichophyton mentagrophytes in 6 patients (6.3 percents), the Candida albicans in 23 patients (23.1 percents) and the Candida parapsilosis in two patients (2.1 percents).
The direct test and the culture were negative in seven patients (7.3 percent). It therefore appears that the confirmation rate is 92.6 percent (
The mean age of our study population is 50 ± 8 years and this is due to the predominance of the type 2 diabetic patients. This mean age is inferior to what found by El Fékih N and al [
J. Fergermann and al have estimated at least the third of diabetic patients who would present an onycomychosis which corroborate our results in which 29% of the patients show an onychomycosis [
In our study the mycosis is not linked to the sex whereas Eckhard M and al have found that foot mycosis infections are more frequent in males [
The mycotic infection is not associated to a particular diabete in our research.
The mean duration of diabetes was 13 ± 5 years in our research which is similar to 15.3 ± 1.2 years found by Gupta A.K and al [
The most frequent localizations of mycosis are the inter toe space and the nail which correspond with the results of El Fékih and al [
Our research reveals the rate of suspicions of mycosis infection at 39.4percent, inferior to the rates of 46 percent and 53.7 percent found respectively by Gupta and al and El Fékih and al.
| Total | T rubrun | T mentagrophytes | C albicans | C parasilosis | Sterile | |
|---|---|---|---|---|---|---|
| Intertrigo | 39 | 34 | 3 | - | - | 2 |
| Onychomycosis | 27 | 24 | 1 | 1 | 1 | |
| Oral candidiasis | 12 | 9 | 1 | 2 | ||
| Vulvovaginitis | 7 | 6 | 1 | |||
| Mycosis of large folds | 5 | 2 | 2 | 1 | ||
| Urinary tract infection | 3 | 3 | ||||
| Digestive candidiasis | 2 | 2 | ||||
| TOTAL | 58 (61%) | 6 (6.3%) | 22 (23.1%) | 2 (2.1%) | 7 (7.3%) |
Abbreviation: T = trichophyton C = candida.
The rates of confirmation of mycotic infections in our study are 92.6 percent (88/95) comparable to that of El Fékih and al who have confirmed the mycotic infection in 81 patients over the 86 patients suspected of mycotic infection. Our rate is superior to that of Gupta A. K and al who have confirmed the mycosic infection in 144 patients over 253 patients suspected.
In our research the dermatophytes are the pathogenic agents most frequents in mycotic infection of feet. This is similar to results of a lot of authors [
Candida albicans appears to be more common in the mucosa in our study, which is comparable to the results of Jhugroo C et al., who found that mycotic infections in the mouth of the diabetic were due mainly to Candida albicans [
The glycemic imbalance noticed in our patients could explain itself by the fact they have been hospitalized in the framwork of glycemic imbalance or of a diabete decompensation. This glycemic imbalance is seen in most study [
One third of the diabetic patients showed a mycotic infection. All the diabetics’ patients presenting a mycotic infection were in chronic glycemic imbalance. The feet constitute the predilection localization of mycotic infections in the diabetic. The dermatophytes constitute the most frequent pathogenic agents found.
The authors declare no conflicts of interest regarding the publication of this paper.
Kérékou, A., El Aziz, S., Dédjan, A., Chadli, A. and Farouqi, A. (2019) Mycotic Infections in Diabetic Patients in Casablanca. Journal of Diabetes Mellitus, 9, 146-151. https://doi.org/10.4236/jdm.2019.93014