Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: clinical features and associated factors.

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Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: clinical features and associated factors.

J Diabetes Investig. 2019 Nov 22;:

Authors: Lao M, Li C, Li J, Chen D, Ding M, Gong Y

Abstract
OBJECTIVES: A retrospective study was performed to investigate the clinical characteristics and associated factors for invasive fungal disease (IFD) in patients with type 2 diabetes mellitus (T2DM).
METHODS: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis.
RESULTS: IFD was diagnosed in 120 patients with T2DM (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%) was the most common. Urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved lung (34/49, 69.4%). Fifteen (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%), and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by gram-negative bacteria. The inpatient mortality rate of IFD was 23.3% (28/120). HbA1c level was higher in non-survivors than survivors (8.8±2.5 vs 7.7±2.1 %, P=0.02). Anemia (adjusted odds ratio (OR) 3.50, 95% confidence interval (CI) 1.95-6.27, P<0.001), hypoalbuminemia (adjusted OR 5.42, 95% CI 3.14-9.36, P<0.001), and elevated serum creatinine (adjusted OR 2.08, 95% CI 1.07-4.04, P=0.03) were associated with IFD in T2DM patients.
CONCLUSIONS: IFD is a life-threatening complication in T2DM patients. Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.

PMID: 31758642 [PubMed - as supplied by publisher]