[Analysis of the inflammation reaction and selected indicators of immunity in patients with an infected diabetic ulcer].
BACKGROUND
Patients with diabetes represent 50 to 70% of patients who undergo nontraumatic foot or leg amputation, caused mostly by infection and necrosis of soft tissues accompanied with osteomyelitis. Signs and symptoms of infections may often be absent in patients with infected foot ulcers--the syndrome of "diabetic foot" (DF). The course and consequences of the infection may be influenced by the immune system dysfunction. The aim of our study was to assess presence of the chronic inflammation and specific immune responses, both humoral and cellular in patients with diabetic foot infection.


RESULTS
34 patients treated over one month for an infected DF in our foot clinic (mean age 54 +/- 8 years, mean duration of diabetes 20 +/- 9 years, mean HbAlc 8.8 +/- 1.5%), were matched with 27 healthy subjects. All patients were without clinical signs of acute deep foot infection and without critical leg ischemia. The inflammatory response was assessed by white blood cells count and C-reactive protein (CRP), humoral immune response was assessed by immunoglobulins (Ig) and cellular immunity was evaluated by T lymphocytes subpopulations. Patients with DF compared with healthy controls exhibited the laboratory signs of infection--significantly increased white blood cells count (7.6 +/- 2.1 vs. 6.4 +/- 1.3.10(9)/l, p < 0.01) and neutrophil count (4.6 +/- 1.8 vs. 3.8 +/- 0.9.10(9)/l, p < 0.05) and significantly increased CRP (7 +/- 12 vs. 2 +/- 6 mg/l, p < 0.01). Patients with DF had also significantly higher IgA levels (3.5 +/- 1.6 vs. 2.7 +/- 1.1 g/l, p < 0.05) and significantly more CD3+ T cells (76 +/- 8 vs. 71 +/- 10%, p < 0.05) and suppressor/cytotoxic CD8+ T cells (32 +/- 11 vs. 26 +/- 10%, p < 0.05). Other followed parameters IgG, IgM and serum monocyte and lymphocyte counts, CD4+ helper T cells and CD4+/CD8+ T-cell ratio did not differ between patients with DF and healthy controls.


CONCLUSIONS
We did not anticipate a severe secondary immunodeficiency in followed cellular and humoral immune parameters in patients with chronic bacterial foot infection. It is necessary to assess the sufficiency of immune system activation with respect to chronic inflammation in next research.
Jirkovská
A
A
Centrum diabetologie IKEM, Praha. alji@medicon.cz
Fejfarová
V
V
Hosová
J
J
Stríz
I
I
Kalanin
J
J
Skibová
J
J
D000368:Aged; D001424:Bacterial Infections / Q000276:immunology*; D002097:C-Reactive Protein / Q000032:analysis; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000276:immunology*; D017719:Diabetic Foot / Q000276:immunology* / Q000382:microbiology; D006801:Humans; D007109:Immunity; D007136:Immunoglobulins / Q000097:blood; D007249:Inflammation / Q000276:immunology; D007958:Leukocyte Count; D008875:Middle Aged
D007136:Immunoglobulins; D002097:C-Reactive Protein