Professional Documents
Culture Documents
Infections in Diabetes:
an over view
Bhaskar Borgohain
MS,DNB,Fellow (Arthroplasty).
AMERICAN DIABETIC ASSOCIATION
Rhino-Cerebral Mucormycosis
Collagen synthesis
Wound healing
PREDISPOSING FACTORS
Hyperglycemia
Statistically
Significant Risk: > 250mg%
Diabetic Microangiopathy
Neurovasculopathy
Sensory Neuropathy
Distal Vasculopathy
Unrecognized Injury
P.V.D.
Atherosclerosis
Smoking
VASCULOPATHY: EFFECTS
Major cause of death: PVD: More prevalent &
US data Younger age.
Risk of myocardial Additional risk factors:
infarction & stroke: 3-4 Hypertension,
times Hyperlipidemia,
Accelerated Smoking & Family
atherosclerosis Cumulative damage
RBC DEFORMABILITY
Group B streptococci.
High risk: Patient with peripheral vascular disease & diabetes mellitus
BACTERIOLOGY OF N.F.
Anaerobes with >1 facultative aerobes
90%
Associated with GAS + S aureus 10%
Recent Study: Necrotizing fasciitis
caused by CA-MRSA
Current or past IVDU represented 43%
of patients
21% patients with D.M.
CLINICAL FEATURES: N.F.
Serial debridement
ICU set up
NECROTIZING FASCIITIS:
EPILOGUE
Untreated, it is universally fatal;
Even if recognized early mortality is high
PYOMYOSITIS
Deep infection of the skeletal muscles.
Infection deep: No erythema or warmth; But
tenderness & swelling
Thigh quadriceps , glutei muscles, iliopsoas:
common.
If S pyogenes: Primary Streptococcal
Necrotizing Myositis, severe systemic toxicity.
Frequent bacteremia, shock, and organ failure.
Pyomyositis
S aureus common
Common in Tropic rare in temperate
Necrotic fasciitis
Focal inflammatory myositis
Trauma
Tumor
Diabetic amyotrophy
PYOMYOSITIS
MUSCULOSKELETAL
TUBERCULOSIS IN DM
Good results
Vigilance needed
Antimicrobial therapy
Co morbid factors
Debridement
SUMMARY
Infection in DM is just the tip of the iceberg-
look beyond the infection!
Clinical & lab features may be misleading
High index of suspicion on clinical evaluation
Glycemic control is as important as
antimicrobials and selective debridement
Co-morbid conditions must be addressed
Epilogue
“As the virulence of pathogens wax &
wane, as antibiotic resistance
progresses and as host responsiveness
changes as a result of
immunocompromising diseases, we will
forever be challenged to describe novel
clinical presentations, new etiologies and
innovative treatments”
BEST IS BEST
THANK YOU