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Diabetes and Infection

  • Atulya Atreja
  • Sanjay Kalra
  • Joel Rodriguez-Saldana
Chapter

Abstract

By comparison with persons without diabetes, the risk and frequency of infections is higher in persons with type 1 and type 2 diabetes. Uncontrolled diabetes affects innate and adaptive immune function; T cell and B cell responses are both impaired. Increased susceptibility to infections may precipitate metabolic complications in diabetes; at the same time, hyperglycemia increases the risk of infections. Awareness of the large spectrum of diabetes-related infectious diseases is very helpful to mitigate the symptoms and to decrease morbidity and mortality. Infections in people with diabetes can occur in almost every organ system and have been classified in three categories: infections possibly related, infections strongly associated, and infections related to therapeutic interventions. Microorganisms involved include bacteria, fungi, and viruses; by comparison, rates of parasitic infections are lower and may actually have a protective role in the pathogenesis of type 1 diabetes. The risk of life-threatening infections can be minimized with diabetes self-care and support education, along with optimal glycemic control. Appropriate choice of empirical antibiotics can limit the severity of symptoms. Immunization against influenza and pneumococcus is often recommended. Complicated cases should be referred for specialist consultations.

Keywords

Infection Innate immune response Cellular immune response Bacteria Fungi Viruses Parasites Malignant otitis Rhinocerebral mucormycosis Periodontal infections Community-acquired pneumonia Tuberculosis Herpes zoster Hepatic abscess Urinary tract infection Vaginitis Balanitis Soft tissue infection Diabetic foot infection 

References

  1. 1.
    Peleg AY, Weerarathna T, McCarthy JS, Davis TM. Common infections in diabetes: pathogenesis, management and relationship to glycemic control. Diabetes Metab Res Rev. 2007;23:3–13.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Flynn JM. The changing cause of death in diabetes mellitus. Am J Med Sci. 1935;189:157.CrossRefGoogle Scholar
  3. 3.
    Drivsholm T, de Fine ON, Nielsen ABS. Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycaemia, blood pressure and weight. Diabetologia. 2005;48:210–4.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Larkin JG, Frier BM, Ireland JT. Diabetes mellitus and infection. Postgrad Med J. 1985;61:233–7.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341:1906–12.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26:510–3.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Knapp S. Diabetes and infection: is there a link? A mini-review. Gerontology. 2012;59:99–104.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Pearson-Stuttard J, Blundell S, Harris T, Cook DG, Critchley J. Diabetes and infection: assessing the association with glycaemic control in population-based studies. Lancet Diabetes Endocrinol. 2016;4:148–58.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Muller LMA, Gorter KJ, Hak E, Goudzwaard WL, Schevellis FG, AIM H. Increased risk of common infections in patients with Type 1 and Type 2 diabetes mellitus. Clin Infect Dis. 2005;41:281–8.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, Smith H. Infection and diabetes: the case for glucose control. Am J Med. 1982;72:439–50.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Mazade MA, Edwards MS. Impairment of type III group B streptococcus - stimulated superoxide production and opsonophagocytosis by neutrophils in diabetes. Mol Genet Metab. 2001;73:259–67.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Casqueiro J, Alves C. Infections in patients with diabetes mellitus: a review of pathogenesis. Indian J Endocr Metab. 2012;16(Suppl S1):27–36.Google Scholar
  13. 13.
    Gupta S, Koirala J, Khardori R, Khardori N. Infections in diabetes mellitus and hyperglycemia. Infect Dis Clin N Am. 2007;21:617–38.CrossRefGoogle Scholar
  14. 14.
    Jafar N, Edriss H. The effect of short-term hyperglycemia on the innate immune system. Am J Med Sci. 2016;351:201–11.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Nathella PK, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology. 2017;152:13–24.CrossRefGoogle Scholar
  16. 16.
    Kumar NP, Sridhar R, Banurekha VV, Jawahar MS, Fay MP, Nutman TB, et al. Type 2 diabetes mellitus coincident with pulmonary tuberculosis is associated with heightened systemic type 1, type 17, and other proinflammatory cytokines. Ann Am Thorac Soc. 2013;10:441–9.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Serfaty L. Metabolic manifestations of hepatitis C virus. Diabetes mellitus, dyslipidemia. Clin Liver Dis. 2017;21:475–86.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Hadigan C, Kattakuzhy S. Diabetes mellitus type 2 and abnormal glucose metabolism in the setting of human immunodeficiency virus. Endocrinol Metab Clin N Am. 2014;43:685–96.CrossRefGoogle Scholar
  19. 19.
    Nazligul Y, Sabuncu T, Ozbilge H. Is there a predisposition to intestinal parasitosis in diabetic patients? Diabetes Care. 2001;24:1503–4.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    De Ruiter K, Tahapary DL, Sartono E, Soewondo P, Supali T, Smit JWA, et al. Helminths, hygiene hypothesis and type 2 diabetes. Parasite Immunol. 2017;39:e12404.CrossRefGoogle Scholar
  21. 21.
    Mendonca SC, Goncalves-Pires M, Rodrigues RM, Ferreira A Jr, Costa-Cruz JM. Is there an association between positive Strongyloides stercoralis serology and diabetes mellitus? Acta Trop. 2006;99:102–5.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Strachan DP. Hay fever, hygiene, and household size. BMJ. 1989;299:1259–60.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Scudellari M. Cleaning up the hygiene hypothesis. PNAS. 2017;114:1433–6.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Kawai K, Yawn BP. Risk factors for herpes zoster: a systematic review and meta-analysis. Mayo Clin Proc. 2017;92:1806–21.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Anderson E, Fantus RJ, Haddadin RI. Diagnosis and management of herpes zoster ophthalmicus. Disease-a-Month. 2017;63:38–44.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Vrcek I, Choudhury E, Durairaj V. Herpes zoster ophthalmicus: a review for the internists. Am J Med. 2017;130:21–6.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Wollina U. Variations in herpes zoster manifestation. Indian J Med Res. 2017;145:294–8.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Carlton DA, Perez EE, Smouha EE. Malignant external otitis: the shifting treatment paradigm. Am J Otolaringol. 2018;39:41–5.CrossRefGoogle Scholar
  29. 29.
    Mion M, Bovo R, Marchese-Ragona R, Martini A. Outcome predictors of treatment effectiveness for fungal external otitis: a systematic review. Acta Otorhinolaryngol Ital. 2015;35:307–13.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Lee SK, Lee SA, Seon S, Jung JH, Lee JD, Choi JY, Kim BG. Analysis of prognostic factors in malignant external otitis. Clin Exp Otorhinolaryngol. 2017;3:228–35.CrossRefGoogle Scholar
  31. 31.
    Teeuw WJ, Kosho MXF, Poland DCW, Gerdes VEA, Loos BG. Periodontitis as a possible early sign of diabetes mellitus. BMJ Open Diabetes Res Care. 2017;5:e000326.  https://doi.org/10.1136/bmjdrc-2016-000326.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Barca E, Cifcibasi E, Cintan S. Adjunctive use of antibiotics in periodontal therapy. J Istambul Univ Fac Dent. 2015;49:55–62.CrossRefGoogle Scholar
  33. 33.
    Poradzka A, Jasik M, Karnafael W, Fiedor P. Clinical aspects of fungal infections in diabetes. Acta Pol Pharm. 2013;70:587–96.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Farmakoitis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin N Am. 2016;30:143–63.CrossRefGoogle Scholar
  35. 35.
    Long B, Koyfman A. Mucormycosis: what emergency physicians need to know? Am J Emerg Med. 2015;33:1823–5.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Riley TT, Muzny CA, Swiatlo E, Legendre DP. Breaking the mold: a review of mucormycosis and current pharmacological treatment options. Ann Pharmacother. 2016;50:747–57.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Li H, Cao B. Pandemic and avian influenza A viruses in humans. Epidemiology, virology, clinical characteristics and treatment strategy. Clin Chest Med. 2017;38:59–70.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Ison MG. Antiviral treatments. Clin Chest Med. 2017;38:139–53.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Klekotka RB, Mizgata E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol. 2015;83:401–8.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386:1097–108.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Kaysin A, Viera AJ. Community-acquired pneumonia in adults: diagnosis and management. Am Fam Physician. 2016;94:698–706.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Lee JS, Giesler DL, Gellad WD, Fine MJ. Antibiotic therapy for adults hospitalized with community-acquired pneumonia. A systematic review. JAMA. 2016;315:595–602.Google Scholar
  44. 44.
    Waterer G. Empiric antibiotics for community-acquired pneumonia: a macrolide and a beta-lactam please! Respirology. 2017;  https://doi.org/10.1111/resp.13248.
  45. 45.
    Torres A, Blasi F, Dartois N, Akova M. Which individuals are at increased risk of pneumococcal disease and why? Impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive disease. Thorax. 2015;70:984–9.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    McAlister FA, Majumdar SR, Blitz S, Rowe BH, Romney J, Marrie TJ. The relationship between hyperglycemia and outcomes in 2,471 patients admitted to the hospital with community-acquired pneumonia. Diabetes Care. 2005;28:810–5.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Yende S, van der Poll T, Lee MJ, Huang DT, Newman AB, Kong L, et al. The influence of pre-existing diabetes mellitus on the host immune response and outcome of pneumonia: analysis of two multicentre cohort studies. Thorax. 2018;65:870–7.CrossRefGoogle Scholar
  48. 48.
    Koskela HO, Salonen PH, Romppanen J, Niskanen L. Long-term mortality after community acquired pneumonia-impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study. BMJ Open. 2018;4:e005715.CrossRefGoogle Scholar
  49. 49.
    Hadfield J, Bennett L. Determining best outcomes from community-acquired pneumonia and how to achieve them. Respirology. 2017;23:138.  https://doi.org/10.1111/resp.13218.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Mandell LA. Something new for community-acquired pneumonia? Clin Infect Dis. 2017;63:1681–2.CrossRefGoogle Scholar
  51. 51.
    Peyrani P, Wiemken TL, Metersky ML, Arnold FW, Mattingly WA, Feldman C, et al. The order of administration of macrolides and beta-lactams may impact the outcomes of hospitalized patients with community acquired pneumonia: results from the community-acquired pneumonia organization. Infect Dis. 2018;50:13–20.CrossRefGoogle Scholar
  52. 52.
    Dheda K, Barry CE, Maartens G. Tuberculosis. Lancet. 2015;387:1211–26.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: a systematic review and meta-analysis. PLoS One. 2017;12:e0187967.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Verbeeck RK, Günther G, Kibuule D, Hunter C, Rennie TW. Optimizing treatment outcome of first-line anti-tuberculous drugs: the role of therapeutic drug monitoring. Eur J Clin Pharmacol. 2016;72:905–16.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Riza AL, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vivjer S, Panduru NM, et al. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol. 2014;2:740–53.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Stockamp NW, Thompson GR III. Coccidioidomycosis. Infect Dis Clin N Am. 2016;30:229–46.CrossRefGoogle Scholar
  57. 57.
    Abengowe CU, McManamon PJM. Acute emphysematous cholecystitis. Can Med Assoc J. 1974;111:1112–4.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Garcia-Sancho Tellez L, Rodriguez-Montes JA, Fernandez de Lis S, Garcia-Sancho ML. Acute emphysematous cholecystitis. Report of twenty cases. Hepato-Gastroenterology. 1999;46:2144–8.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Thomsen RW, Jepsen P, Sorensen HT. Diabetes mellitus and pyogenic liver abscess: risk and prognosis. CID. 2007;44:1194–201.CrossRefGoogle Scholar
  60. 60.
    Foo NP, Chen KT, Lin HJ, Guo HR. Characteristics of pyogenic liver abscess patients with and without diabetes mellitus. Am J Gastroenterol. 2010;105:328–35.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Siu LK, Yeh K-M, Lin J-C, Fung C-P, Chang F-Y. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12:881–7.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    van den Berge M, de Marie S, Kuipers T, Jansz AR, Bravenboer B. Psoas abscess: report of a series and review of the literature. Neth J Med. 2005;63:413–61.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Maines E, Franceschi R, Cauvin V, d’Annunzio G, Pini Prato A, Castagnola E, et al. Iliopsoas abscess in adolescents with type 1 diabetes mellitus. Clin Case Rep. 2015;3:638–42.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008;31S:S54–7.CrossRefGoogle Scholar
  65. 65.
    Nicolle LE. Urinary tract infections in special populations. Diabetes, renal transplant, HIV infection, and spinal cord injury. Infect Dis Clin N Am. 2014;28:91–104.CrossRefGoogle Scholar
  66. 66.
    Thomas L, Tracy CR. Treatment of fungal urinary tract infection. Urol Clin N Am. 2015;42:473–83.CrossRefGoogle Scholar
  67. 67.
    Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am. 2008;35:1–12.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Wagenlehner FME, Weidner W, Naber KG. Antibiotics in urology – new essentials. Urol Clin N Am. 2008;35:69–79.CrossRefGoogle Scholar
  69. 69.
    Durwood EN. Complicated urinary tract infections. Urol Clin North Am. 2008;35:13–22.CrossRefGoogle Scholar
  70. 70.
    Gardiner RA, Gwynne RA, Roberts SA. Perinephric abscess. BJU Int. 2011;107(Suppl 3):20–3.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Amano M, Shimizu T. Emphysematous cystitis: a review of the literature. Intern Med. 2014;53:79–82.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Hirji I, Andersson SW, Guo Z, Hammar N, Gomez-Caminero A. Incidence of genital infection among patients with type 2 diabetes in the UK General Practice Research Database. J Diabetes Complicat. 2012;26:501–5.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Nyirjesy P, Sobel JD. Genital infections in patients with diabetes. Postgrad Med. 2013;125:33–46.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Goswami R, Dadhwal V, Tejaswi S, Datta K, Paul A, Haricharan RN, et al. Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relationship to their glycaemic status. J Infect. 2000;41:162–16.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Dovnik A, Golle A, Novak D, Arko D, Takac I. Treatment of vulvovaginal candidiasis: a review of the literature. Acta Dermatoveneorol APA. 2015;24:5–7.Google Scholar
  76. 76.
    Matheson A, Mazza D. Recurrent vulvovaginal candidiasis: a review of guideline recommendations. Aust NZJ Obstet Gynaecol. 2017;57:139–45.CrossRefGoogle Scholar
  77. 77.
    Rizzi M, Trevisan R. Genitourinary infections in diabetic patients in the new era of diabetes therapy with sodium-glucose cotransporter-2 inhibitors. Nutr Metab Cardiovasc Dis. 2016;26:963–70.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Kalra S, Chawla A. Diabetes and balanoposthitis. J Pak Med Assoc. 2016;66:1039–41.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol. 2015;7:203–15.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Gill GV, Famuyiwa OO, Rolfe M, Archibald LK. Serious hand sepsis and diabetes mellitus: specific tropical syndrome with Western counterparts. Diabet Med. 1998;15:858–62.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Yeika EV, Tchoumi Tantchou JC, Foryoung JB, Tolefac PN, Efie DT, Choukem SP. Tropical diabetic hand syndrome: a case report. Biomed Central. 2017;10:94.  https://doi.org/10.1186/s13104-017-2405-3.CrossRefGoogle Scholar
  82. 82.
    Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002;66:119–24.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and Management of Lower-Extremity Ulcers. N Engl J Med. 2017;377:1559–67.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Wijesuriya TM, Weerasekera MM, Kottahachchi J, Ranasinghe K, Dissanayake M, Prathapan S, et al. Proportion of lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital in Sri Lanka. Indian J Endocr Metab. 2014;18:63–9.Google Scholar
  85. 85.
    Noor S, Khan RU, Ahmad J. Understanding foot infection and its management. Diabetes Metab Syndr Clin Res Rev. 2017;11:149–56.CrossRefGoogle Scholar
  86. 86.
    Lipski BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S, Lavery L, et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl. 1):45–74.CrossRefGoogle Scholar
  87. 87.
    Muñoz-Quiles C, López-Lacort M, Ampudia-Blasco J, Díez-Domingo J. Risk and impact of herpes zoster on patients with diabetes: a population-based study, 2009-2014. Hum Vaccin Immunother. 2017;13:2606–11.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    O’Connor KM, Paauw DS. Herpes zoster. Med Clin N Am. 2013;97:503–22.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Cathart S, Cantrell W, Elewski BE. Onychomycosis and diabetes. JEADV. 2009;23:1119–22.Google Scholar
  90. 90.
    Zane LT, Chanda S, Coronado D, Del Rosso J. Antifungal agents for onychomycosis: new treatment strategies to improve safety. Dermatol Online J. 2016;22:1–11.Google Scholar
  91. 91.
    Kreijkamp-Kaspers S, Hawke KL, van Driel ML. Oral medications to treat toenail fungal infection. JAMA. 2018;319:397–8.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Atulya Atreja
    • 1
  • Sanjay Kalra
    • 2
  • Joel Rodriguez-Saldana
    • 3
  1. 1.Department of Pulmonary Medicine, MMIMSRMullanaIndia
  2. 2.Department of EndocrinologyBharti HospitalKarnalIndia
  3. 3.Multidisciplinary Center of DiabetesMexico CityMexico

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