Proportion of lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital in Sri Lanka.
BACKGROUND
Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome. Sixteen percent of urban population is suffering from diabetes in Sri Lanka. As the diabetes patients are more prone to get fungal foot infections, early intervention is advisable owing to the progressive nature of the infection. There is no data on the prevalence of SFFIs in diabetic patients in Sri Lanka.


OBJECTIVE
To determine the etiological agents causing SFFI in patients with type 2 diabetes.


METHODS
Three hundred eighty five diabetic patients were included. Nail clippings and swabs were collected from the infected sites using the standard protocol. Laboratory identification was done and pathogens were identified to the species level by morpho physiological methods.


RESULTS
Clinically 295 patients showed SFFI, of which 255 (86%) were mycologically confirmed for infection. Out of 236 direct microscopy (KOH) positives, 227 (96%) were culture positive. Two hundred and fifty one patients (98%) with SFFI had diabetes for more than 10 years. Of the patients with SFFIs 92% had >100 mg/dl FBS and 81% had >140 mg/dl PPBS levels and 80% had both elevated FBS and PPBS. Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes.


CONCLUSIONS
Aspergillus niger was the commonest pathogen followed by Candida albicans. SFFIs were seen significantly with the increasing age, gender, duration of diabetes and with less controlled glycaemic level.
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
T M
TM
Wijesuriya
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
M M
MM
Weerasekera
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
J
J
Kottahachchi
Tangalle Base Hospital, Sri Lanka.
K N P
KN
Ranasinghe
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
M S S
MS
Dissanayake
Department of Community Medicine, University of Sri Jayewardenepura, Sri Lanka.
S
S
Prathapan
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
T D C P
TD
Gunasekara
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
A
A
Nagahawatte
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
L D
LD
Guruge
Diabetic Clinic, Colombo South Teaching Hospital, Kalubowila, Sri Lanka.
U
U
Bulugahapitiya
Department of Microbiology, University of Sri Jayewardenepura, Sri Lanka.
S S N
SS
Fernando
Diabetes; fungal foot infections; superficial mycosis