[Prevention and treatment of infectious diseases in diabetic patients]

Multicausal analysis of mortality due to diabetes mellitus in Spain, 2016-2018

OBJECTIVES

This study aimed to assess multicausal mortality due to diabetes from 2016-2018 in Spain. Specific objectives were to quantify the occurrence of diabetes as an underlying cause or as any registered cause on the death certificate.

MATERIALS AND METHODS

A cross-sectional descriptive study taking a multicausal approach.

RESULTS

Diabetes appears as an underlying cause of 2.3% of total deaths in Spain, and as any cause in 6.2%. In patients in whom Diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases in men(prevalence ratio 1,59)and women (PR1,31). In men, the causes associated with diabetes as any cause were skin diseases(prevalence ratio 1.33), followed by endocrine diseases(prevalence ratio 1.26)and genitourinary diseases (prevalence ratio1.14). In women, the causes associated with the presence of diabetes as any cause were endocrine (prevalence ratio 1.13)and genitourinary (prevalence ratio 1.04)diseases.

CONCLUSIONS

In patients in whom diabetes appears as an underlying cause on the death certificates, the 15 most frequent immediate causes are cardiovascular diseases. In men, the causes associated with the presence of diabetes as any cause of death are skin, endocrine and genitourinary diseases. In women, the causes associated with diabetes as any cause are endocrine and genitourinary.

Management of Fourniers gangrene secondary to perineal invasion by rectal cancer

INTRODUCTION AND IMPORTANCE

Fournier's gangrene is a known disease process resulting in a severe necrotizing soft tissue infection involving the perineum and scrotum. Although most cases are known to be associated with diabetes (Go et al., 2010 [1]), it is rare to develop this extensive infection secondary to tumor invasion from the rectum. Treatment typically requires several debridements until infection is fully controlled.

CASE PRESENTATION

A 65 year old man with a history of locally invasive and unresectable rectal cancer presents to our emergency department with severe perineal and scrotal pain and was found to be in septic shock. He had previously undergone a diverting colostomy as well as radiation to the pelvis. He underwent several surgical debridements until the infection was controlled. He then required procedures to close the large defects created until complete wound healing was achieved within 3 months of presentation.

CLINICAL DISCUSSION

This condition is associated with a high morbidity and mortality, and its management can be split in to two stages. The early phase includes resuscitation, initial debridements and likely several sequential debridements as well as fecal diversion. The late phase then involves the healing process with reconstruction efforts. A multi-disciplinary team is required for appropriate management under the direction of the general surgeon, which also include urologists, plastic surgeons and wound care nurses.

CONCLUSION

Fournier's gangrene secondary to tumor invasion should be recognized as a potential cause other than the typical culprits. Resuscitation, antibiotics, debridements and a team approach is needed to recover from such a debilitating disease.

Fournier's Gangrene Mimicking Acute Epididymo-Orchitis in an Undiagnosed Diabetic Patient

Fournier's gangrene (FG) is an infectious disease characterized by necrotizing fasciitis of the perineal, perianal, or genital area associated with aging, male gender, diabetes mellitus (DM), alcoholism, trauma, and immunosuppression states. It can rapidly evolve into sepsis, septic shock, and multiorgan failure with a high mortality rate. We present the case of a 55-year-old man who developed a severe FG, initially assumed as an epididymo-orchitis with new-onset DM. The early identification and treatment resulted in a favorable outcome, being discharged from the hospital after 21 days. Diabetic patients are more susceptible to having severe infections such as FG, hence the importance of adequate metabolic control and increased suspicion to prevent fatal complications.

Modification of physico-chemical surface properties and growth of Staphylococcus aureus under hyperglycemia and ketoacidosis conditions

Diabetes is a widely spread disease affecting the quality of life of millions of people around the world and is associated to a higher risk of developing infections in different parts of the body. The reasons why diabetes enhances infection episodes are not entirely clear; in this study our aim was to explore the changes that one of the most frequently pathogenic bacteria undergoes when exposed to hyperglycemia and ketoacidosis conditions. Physical surface properties such as hydrophobicity and surface electrical charge are related to bacterial growth behavior and the ability of Staphylococcus aureus to form biofilms. The addition of glucose made bacteria more negatively charged and with moderate-intermediate hydrophobicity. Ketone bodies increased hydrophobicity to approximately 75% and pathological concentrations hindered some of the bacterial surface charge by decreasing the negative zeta potential of cells. When both components were present, the bacterial physical surface changes were more similar to those observed in ketone bodies, suggesting a preferential adsorption of ketone bodies over glucose because of the more favorable solubility of glucose in water. Glucose diabetic concentrations gave the highest number of bacteria in the stationary phase of growth and provoked an increase in the biofilm slime index of around 400% in relation to the control state. Also, this situation is related with an increase of bacterial coverage. The combination of a high concentration of glucose and ketone bodies, which corresponds to a poorly controlled diabetic situation, appears associated with an early infection phase; increased hydrophobic attractive force and reduced electrostatic repulsion between cells results in better packing of cells within the biofilm and more efficient retention to the host surface. Knowledge of bacterial response in high amount of glucose and ketoacidosis environments can serve as a basis for designing strategies to prevent bacterial adhesion, biofilm formation and, consequently, the development of infections.