Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors. Issue 3 (20th December 2019)

• Record Type: Journal Article
• Authors: Lao, Minxi; Li, Chen; Li, Jin; Chen, Dubo; Ding, Meilin; Gong, Yingying
• Is Part Of: Journal of diabetes investigation. Volume 11:Issue 3(2020)
• Page Start: 731
• Page End: 744
• Publication Date: 2019-12-20
• Subjects: Diabetes mellitus -- Diabetic nephropathy -- Invasive fungal disease; Diabetes -- Periodicals; Diabetes -- Research -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1111/jdi.13183
• Languages: English
• ISSNs: 2040-1116

Abstract

Abstract: Aims/Introduction: A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results: Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (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. The 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 the lung (34/49, 69.4%). A total of 15 (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 invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non‐survivors than survivors (8.8 ± 2.5 vs 7.7 ± 2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95–6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14–9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07–4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions: Invasive fungal disease is a life‐threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis. Abstract : We investigated the characteristics and associated factors of invasive fungal disease in patients with type 2 diabetes mellitus from Southern China for the first time. We found that Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus were the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.