Prevalence and epidemiology of tinea pedis and toenail onychomycosis and antifungal susceptibility of the causative agents in patients with type 2 diabetes in Turkey.
BACKGROUND
Diabetes patients are particularly susceptible to fungal infections because their vascular and immunological systems are compromised.


OBJECTIVE
The present study aimed to determine prevalences of tinea pedis and onychomycosis, factors predisposing to their development, and antifungal susceptibilities of causative fungal species against fluconazole, itraconazole, and terbinafine in patients with type 2 diabetes mellitus (DM).


METHODS
Study groups were defined according to hemoglobin A1C rates of ≥6.5% for the diabetes group and ≤5.7% for control subjects. A total of 600 diabetes subjects and 152 control subjects were evaluated. Rates of onychomycosis and tinea pedis in diabetes patients, and associations with age, gender, blood glucose level, duration of diabetes and serum lipid profile were investigated, as were the distribution and antifungal susceptibility of agents isolated.


RESULTS
Patients with onychomycosis and/or tinea pedis numbered 85 in the diabetes group and nine in the control group (P = 0.006). The development of onychomycosis or tinea pedis was significantly related to increasing age and male gender. Although the most common agents were dermatophytes, non-dermatophyte fungal isolates were not uncommon. Terbinafine was the most effective drug against dermatophytes but was invalid for non-dermatophyte isolates by in vitro antifungal susceptibility testing.


CONCLUSIONS
The development of onychomycosis or tinea pedis was significantly related to type 2 DM, increasing age, and male gender. The most common isolate was Trichophyton rubrum. The isolation and identification of the fungus is important to the effective management of tinea pedis and onychomycosis in diabetes patients because non-dermatophyte fungi can cause these infections.
Department of Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Yasemin
Y
Oz
Department of Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
Iman
I
Qoraan
Department of Internal Medicine, Eskisehir State Hospital, Eskisehir, Turkey.
Ali
A
Oz
Department of Dermatology, Eskisehir State Hospital, Eskisehir, Turkey.
Ilknur
I
Balta
D000328:Adult; D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology*; D003883:Arthrodermataceae / Q000187:drug effects; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009281:Naphthalenes / Q000494:pharmacology; D014009:Onychomycosis / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D012737:Sex Factors; D000077291:Terbinafine; D014008:Tinea Pedis / Q000453:epidemiology* / Q000382:microbiology*; D014034:Toes; D014249:Trichophyton / Q000187:drug effects; D014421:Turkey
D000935:Antifungal Agents; D015725:Fluconazole; D006442:Glycated Hemoglobin; D017964:Itraconazole; D009281:Naphthalenes; D000077291:Terbinafine; C517652:hemoglobin A1c protein, human
antifungal susceptibility; diabetes; fungal infections; onychomycosis; tinea pedis