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Are Type 1 Diabetics Immunocompromised

Antibiotic Resistance Rates In Causative Agents Of Infections In Diabetic Patients

Antibiotic Resistance Rates In Causative Agents Of Infections In Diabetic Patients

Hyperglycemia of 11.1 mmol/l (200 mg/dl) in diabetic patients leads to immune suppression of different mechanisms and should be avoided. Due to immune suppression and some diabetic complications, patients with diabetes are prone to many bacterial infections and infection recurrences, such as urinary tract infections, severe periodontitis, pneumonia, skin and soft tissue infections, including diabetic foot infections, osteomyelitis, peritonitis, sepsis and tuberculosis, and uncommon but life-threatening infections; for example, necrotizing soft tissue infections, emphysematous pyelonephritis, emphysematous cholecystitis and malignant otitis, as well as perioperative infections. The vicious cycle is that the infections can worsen the glycemic control of the diabetic patient and vice versa, the poor glycemic control or other factors associated with diabetes mellitus can facilitate the development of the infections. Due to the frequent infections or recurrences, the diabetic patients have more exposure to antibacterial agents. Immunocompromised state and frequent antibiotic use are associated with antibiotic resistance of the causative agents of the infections in these patients, such as Mycobacterium tuberculosis(according to some studies), methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Gram-negative bacteria such as Pseudomonas aeruginosaand Acinetobacter baumannii, bacteria in diabetic foot infections, and involvement of different opportunistic and rare pathogens or multidrug-resistant strains in the infections. Diabetes has been associated with elevated risk for or poor therapy of infections by antibiotic-resistant bacteria such as methicillin-resistant S. aureus, vancomycin-resistant enterococci, extended spectrum -lactamase-producing Gram-negat Continue reading >>

How Diabetes Affects Immune System

How Diabetes Affects Immune System

How Diabetes affects Immune system ? Diabetes is a metabolic disorder that affects how the body uses food for energy due to insulin resistance. Diabetes affects the metabolism as well as the immune system. The disease causes the immune system to destroy insulin producing cells within the pancreas. The immune response is also much lower in people who have diabetes so they are more susceptible to getting infections that could result in the loss of a limb. Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2006, it was the seventh leading cause of death. However, diabetes is likely to be underreported as the under lying cause of death on death certifi cates. In 2004, among people ages 65 years or older, heart disease was noted on 68 percent of diabetes-related death certifi cates; stroke was noted on 16 percent of diabetes-related death certificates for the same age group. Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians—internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include a primary care provider such as an internist, a family practice doctor, or a pediatrician an endocrinologist—a specialist in diabetes care a dietitian, a nurse, and o Continue reading >>

Diabetes Mellitus And Infectious Diseases: Controlling Chronic Hyperglycemia

Diabetes Mellitus And Infectious Diseases: Controlling Chronic Hyperglycemia

As the incidence of diabetes mellitus continues to rise, common focus areas for diabetes control are blood glucose levels, diet, and exercise. Addressing and controlling these factors as well as other factors associated with diabetes are essential for a better quality of life; however, awareness of an increased risk of infections is also warranted in diabetes patients with chronic hyperglycemia. The immune system is comprised of two subcategories: innate immunity and adaptive immunity. Innate immunity, the first line of defense, is activated when a pathogen initially presents itself. This portion of immunity is inherited at birth and is not specific in its mechanism of defense. In addition, it serves the overall immune system by alerting specific cells of pathogen invasion to activate the adaptive immune system. The innate immune system has physical and chemical mechanisms of response. These include but are not limited to sneezing, coughing, sweating, maintenance of normal body temperature, and gram-positive normal flora on the skin. Adaptive immunity is a very specific aspect of a properly functioning immune system that provides protection against previous infections experienced by the host. These responses are mediated by lymphocytes, which consist of natural killer (NK) cells, B cells and T cells. Vaccinations and exposure to pathogens benefit the adaptive immune system by establishing immunologic memory. In the event of another attack by the same foreign organism, the adaptive immune system is able to provide a more efficient response. Complications of Chronic Hyperglycemia Patients with uncontrolled diabetes are considered immunosuppressed due to the negative effects of elevated blood sugars on the immune system. Hyperglycemia impairs overall immunity through diffe Continue reading >>

How Does Type 1 Diabetes Develop?

How Does Type 1 Diabetes Develop?

WHAT DID BOTTAZZO PORTEND? The Bottazzo article (3) was unique in its form of presentation, in that the prose represented the equivalent workings of a legal stenographer recording the debate between two counsels: one for the prosecution (i.e., β-cell homicide) the other representing the defense (i.e., β-cell suicide). More important than the means for its presentation was the evidence noted for each case. Arguments for homicide included, but were not limited to, a theoretic scenario wherein type 1 diabetes was posed to be initiated by an ill-defined environmental attack resulting in the release of β-cell autoantigens (Fig. 1). Subsequently, those self-antigens were thought to be scavenged by macrophages, presented by major histocompatibility complex (MHC) class II molecules (i.e., HLA-DR), leading to the activation of helper T-cells, which would in turn activate B-cells to produce antibodies (e.g., islet cell cytoplasmic autoantibodies and complement-fixing autoantibodies) as well as activate killer cells and cytotoxic T-cells. Interestingly, Bottazzo did note the potential role for “suppressor T-lymphocytes” (i.e., a forerunner of today’s regulatory T-cell), but left them out of the equation because of their ill-defined nature at the time of his writing. Other prosecutorial arguments included seasonality for the disease onset, typical age of onset, and questions related to genetic susceptibility to this disease. FIG. 1. Bottazzo’s “Exhibit 5.” Diagram shows the hypothetical steps leading to activation of the immune system against the β-cell. A: The triggering events: 1) Environmental attack. 2) Release of autoantigens from the β-cell. 3) The macrophage processes them on its surface membrane. D/DR molecules present islet autoantigens to the helper T-cel Continue reading >>

Standards Of Medical Care For Patients With Diabetes Mellitus

Standards Of Medical Care For Patients With Diabetes Mellitus

Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested persons with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Skyler (Ed.): Medical Management of Type 1 Diabetes (1) and Zimmerman (Ed.): Medical Management of Type 2 Diabetes (2). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. CLASSIFICATION, DIAGNOSIS, AND SCREENING Classification In 1997, the ADA issued new diagnostic and classification criteria (3). The classification of diabetes mellitus includes four clinical classes: Type 1 diabetes (results from β Continue reading >>

Immunotherapies And Immune Biomarkers In Type 1 Diabetes: A Partnership For Success

Immunotherapies And Immune Biomarkers In Type 1 Diabetes: A Partnership For Success

Volume 161, Issue 1 , November 2015, Pages 37-43 Immunotherapies and immune biomarkers in Type 1 diabetes: A partnership for success Successful immunotherapies have not translated from mice to human for T1D. Developing immune biomarkers that translate from animal models to humans is required for success. Immune biomarkers in immunotherapy clinical trials are critical for assessing immune efficacy. Best practice standards for biomarker assays should be shared between industry and academia. The standard of care (SoC) for Type 1 diabetes (T1D) today is much the same as it was in the early 1920s, simply with more insulin optionsfast-acting, slow-acting, injectable, and inhalable insulins. However, these well-tolerated treatments only manage the symptoms and complications, but do nothing to halt the underlying immune response. There is an unmet need for better treatment options for T1D that address all aspects of the disease. For decades, we have successfully treated T1D in preclinical animal models with immune-modifying therapies that have not demonstrated comparable efficacy in humans. The path to bringing such options to the clinic will depend on the implementation and standard inclusion of biomarkers of immune and therapeutic efficacy in T1D clinical trials, and dictate if we can create a new SoC that treats the underlying autoimmunity as well as the symptoms it causes. Continue reading >>

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Go to: Diabetes mellitus (DM) is a clinical syndrome associated with deficiency of insulin secretion or action. It is considered one of the largest emerging threats to health in the 21st century. It is estimated that there will be 380 million persons with DM in 2025.[1] Besides the classical complications of the disease, DM has been associated with reduced response of T cells, neutrophil function, and disorders of humoral immunity.[2–4] Consequently, DM increases the susceptibility to infections, both the most common ones as well as those that almost always affect only people with DM (e.g. rhinocerebral mucormycosis).[4] Such infections, in addition to the repercussions associated with its infectivity, may trigger DM complications such as hypoglycemia and ketoacidosis. This article aims to critically review the current knowledge on the mechanisms associated with the greater susceptibility of DM for developing infectious diseases and to describe the main infectious diseases associated with this metabolic disorder. Continue reading >>

Bacterial Meningitis In Diabetes Patients: A Population-based Prospective Study

Bacterial Meningitis In Diabetes Patients: A Population-based Prospective Study

Diabetes mellitus is associated with increased infection rates. We studied clinical features and outcome of community-acquired bacterial meningitis in diabetes patients. Patients were selected from a nationwide, prospective cohort on community-acquired bacterial meningitis performed from March 2006 to October 2014. Data on patient history, symptoms and signs on admission, treatment, and outcome were prospectively collected. A total of 183 of 1447 episodes (13%) occurred in diabetes patients. The incidence of bacterial meningitis in diabetes patients was 3.15 per 100,000 patients per year and the risk of acquiring bacterial meningitis was 2.2-fold higher for diabetes patients. S. pneumoniae was the causative organism in 139 of 183 episodes (76%) and L. monocytogenes in 11 of 183 episodes (6%). Outcome was unfavourable in 82 of 183 episodes (45%) and in 43 of 183 episodes (23%) the patient died. Diabetes was associated with death with an odds ratio of 1.63 (95% CI 1.12–2.37, P = 0.011), which remained after adjusting for known predictors of death in a multivariable analysis (OR 1.98 [95% CI 1.13–3.48], P = 0.017). In conclusion, diabetes is associated with a 2-fold higher risk of acquiring bacterial meningitis. Diabetes is a strong independent risk factor for death in community-acquired adult bacterial meningitis. Diabetes mellitus type 1 and 2 have been associated with increased infection rates1, particularly bacterial infections2. Diabetes has been associated with a risk ratio of 1.21 for development of infection, and a risk ratio of 2.17 for hospitalization for infection2. Infections in diabetes patients are also more likely to be severe than in the non-diabetes persons3. Diabetes has been stated as risk for bacterial meningitis, in particular listeria meningitis a Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 (insulin-dependent) diabetes occurs worldwide and can appear at any age. The genetic susceptibility is strongly associated with HLA-DQ and DR on chromosome 6, but genetic factors on other chromosomes such as the insulin gene on chromosome 11 and the cytotoxic T-lymphocyte antigen gene on chromosome 2 may modulate disease risk. Numerous studies further support the view that environmental factors are important. Gestational infections may contribute to initiation, whereas later infections may accelerate islet β-cell autoimmunity. The pathogenesis is strongly related to autoimmunity against the islet β cells. Markers of autoimmunity include autoantibodies against glutamic acid decarboxylase, insulin, and islet cell antigen-2, a tyrosine phosphatase-like protein. Molecular techniques are used to establish reproducible and precise autoantibody assays, which have been subject to worldwide standardization. The diagnostic sensitivity (40–80%) and specificity (99%) of all three autoantibodies for type 1 diabetes are high, and double or triple positivity among first-degree relatives predicts disease. Combined genetic and antibody testing improved prediction in the general population despite the transient nature of these autoantibodies. Classification of diabetes has also been improved by autoantibody testing and may be used in type 2 diabetes to predict secondary failure and insulin requirement. Islet autoantibodies do not seem to be related to late complications but rather to metabolic control, perhaps because the presence of islet cell autoantibodies marks different residual β-cell function. Combined genetic and autoantibody screening permit rational approaches to identify subjects for secondary and tertiary intervention trials. Diabetes mellitus is a heterogeneous g Continue reading >>

Immunology Of Type 1 Diabetes

Immunology Of Type 1 Diabetes

The incidence of type 1 diabetes in the UK is 20 per 100 000 and increasing, particularly in the under-5-years age group. 1 It comes with the burden of daily insulin injection and blood testing, as well as both short- and long-term complications, and this can include premature death. The standardized mortality ratio for type 1 diabetes has been estimated as 4-fold for females and 2.7-fold for males in the UK. 2 Even with tight glucose control, there is a significant risk of neuropathy, retinopathy and nephropathy, as well as a 3-fold increase in the risk of severe hypoglycaemia. 3 Understanding the pathology of type 1 diabetes may help improve management. Type 1 diabetes is characterized by an absolute loss of insulin secretion, and results from an autoimmune process that destroys insulin-producing cells within the pancreatic islet. This review will focus on the immunology of type 1 diabetes, and how this understanding may influence the clinical management, and development of new treatments for this disease. There are over one million islets in a healthy adult pancreas. They make up 1% of the total pancreatic volume, weigh about 1 g, and contain about 1 mg of insulin. 4 Histological analysis of the pancreas from patients with type 1 diabetes shows immunological activity not present in a healthy or a type 2 diabetic pancreas. 5 This activity is limited to insulin-containing islets, includes infiltration by activated lymphocytes, antibodies and components of the complement system. These histological findings are consistent with type 1 diabetes being an immune-mediated disease ( Figure 1 ). Insulitis. A pancreatic islet (insulin in red) being invaded by T lymphocytes (green), the currently irreversible process that leads to type 1 diabetes. Courtesy of Anne Cooke, Univers Continue reading >>

Are Diabetics Immunocompromised? - Usmle Forums

Are Diabetics Immunocompromised? - Usmle Forums

Both of them are IC, one the reasons is high glucose levels of the blood that alot of organisms like (ofcourse if it's poorly controlled DM), DM1 associated with mucor that's right usually the ketoacidotic patients because of the very high glucose levels. the other reason might be the angiopathy which damages the blood supply and heance the white blood cell supply to different tissues in our body hence reducing the ability to fight different infections, a big thing to remember that the integrins on endothelial cells are downregulated in diabetes which also damages the migration of neutrophils to site of infection. Another thing is the increased oxidative stress on cells in diabetes damages membranes some of this membranes are of white blood cells which become less functional. As you see there are alot of reasons - what USMLE can specifically ask you is the lack of adhesion which can be similar to Leukocyte adhesion deficiency, i also add that alcoholic patients also show the same problem with adhesion. Continue reading >>

Bacterial Infections In Patients With Type 1 Diabetes: A 14-year Follow-up Study

Bacterial Infections In Patients With Type 1 Diabetes: A 14-year Follow-up Study

Abstract Objective This study explored the annual occurrence/incidence of bacterial infections, and their association with chronic hyperglycemia and diabetic nephropathy, in patients with type 1 diabetes. Design In a register-based follow-up study, we investigated the frequency of bacterial infections in patients with type 1 diabetes (n=4748) and age-matched and sex-matched non-diabetic control (NDC) subjects (n=12 954) using nationwide register data on antibiotic drug prescription purchases and hospital discharge diagnoses, collected between 1996 and 2009. Diabetic nephropathy was classified based on the urinary albumin excretion rate (AER). Results The hospitalization rate due to bacterial infections was higher in patients with diabetes compared with NDCs (rate ratio (RR) 2.30 (95% CI 2.11 to 2.51)). The rate correlated with the severity of diabetic nephropathy: RR for microalbuminuria was 1.23 (0.94 to 1.60), 1.97 (1.49 to 2.61) for macroalbuminuria, 11.2 (8.1 to 15.5) for dialysis, and 6.72 (4.92 to 9.18) for kidney transplant as compared to patients with diabetes and normal AER. The annual number of antibiotic purchases was higher in patients with diabetes (1.00 (1.00 to 1.01)) as compared with NDCs (0.47 (0.46 to 0.47)), RR=1.71 (1.65 to 1.77). Annual antibiotic purchases were 1.18-fold more frequent in patients with microalbuminuria, 1.29-fold with macroalbuminuria, 2.43-fold with dialysis, and 2.74-fold with kidney transplant as compared to patients with normal AER. Each unit of increase in glycated hemoglobin was associated with a 6–10% increase in the number of annual antibiotic purchases. Conclusions The incidence of bacterial infections was significantly higher in patients with type 1 diabetes compared with age-matched and sex-matched NDC subjects, and cor Continue reading >>

Are Children With Type 1 Diabetes Immunocompromised?

Are Children With Type 1 Diabetes Immunocompromised?

Are children with type 1 diabetes immunocompromised? PGY-1;* Assistant Professor; Professor, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man. Copyright 2005 CMA Media Inc. or its licensors This article has been cited by other articles in PMC. In their clinical report of a 4-year-old child with leukemia and an enlarging arm lesion that proved to have been caused by an opportunistic fungus, Ahmed Mater and associates 1 state that [these i]nfections generally occur in immunocompromised patients with conditions such as neutropenia, diabetes or hematologic malignant disease. 1 This statement implies that all patients with type 1 or type 2 diabetes mellitus are immunocompromised. Our interest is children (up to 18 years of age) with type 1 diabetes, and we challenge the accuracy of the statement in this context. Mater and associates 1 cite 2 papers 2 , 3 that listed diabetes, specifically diabetes complicated by ketoacidosis, as a risk factor for opportunistic infections. However, those articles did not provide evidence to support this claim in children with type 1 diabetes. Is there any evidence to show increased rates of infection or prolonged recovery from infection in children with type 1 diabetes? In-vitro data have demonstrated impaired immune function due to hyperglycemia and/or hypoinsulinemia in association with type 1 diabetes. 4 , 5 However, those studies did not show that the differences in cell-mediated and humoral immune function translate into significant morbidity or mortality in the clinical setting. In fact, the humoral response to influenza vaccine in patients with type 1 diabetes is no different from that of controls with respect to protection rates. 6 The incidence of candidal infection is greater among patients with type Continue reading >>

What Infections Are You At Risk For With Diabetes?

What Infections Are You At Risk For With Diabetes?

What Infections Are You at Risk for With Diabetes? By Heather M. Ross | Reviewed by Richard N. Fogoros, MD People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection. What Kinds of Infections Are Most Likely If You Have Diabetes? When you have diabetes, you are especially prone to foot infections , yeast infections , urinary tract infections , and surgical site infections . In addition, yeast cells (Candida albicans) are more likely to colonize the mucous membranes (e.g., mouth, vagina, nose) in people with diabetes. These Candida cells then interfere with the normal infection-fighting action of white blood cells. With white blood cells impaired, Candida can replicate unchecked, causing yeast infections. High blood sugar levels contribute to this process. Other Sources of Diabetes-Related Infection Diabetic neuropathy ( nerve damage ) causes problems with sensation, particularly in the feet. This lack of sensation sometimes means foot injuries go unnoticed. Untreated injuries can lead to infection. Some types of neuropathy can also lead to dry, cracked skin, which allows a convenient entry point for infection into the body. People with diabetes often have low blood flow to the extremities. With less blood flow, the body is less able to mobilize normal immune defenses and nutrients that promote the body's ability to fight infection and promote healing. We know healthy eating is key to help manage diabetes, but that doesn't make it easy. Our free nutrition guide is here to help. Sign up and receive your free copy! Why Are Infecti Continue reading >>

Are Diabetics Considered Immunocompromised?

Are Diabetics Considered Immunocompromised?

This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Are diabetics considered immunocompromised? There is a really nasty round of the flu in our town right now. It starts with a sudden bad headache and ends with vomiting and extreme tiredness that lasts a few days. Lots of teachers and kids have been out the last week and a half with it. I was talking to someone about it at school and they asked me if I had considered keeping Kylee at home since she was immunocompromised. I told them no, she has had a flu shot(I know that doesnt protect them 100%), and that I didnt really consider her to be immunocompromised. Not to mention with her brothers and I still at the schools, I didnt think keeping her home would offer her that much more protection. But it got me thinking, are diabetics considered to be immunocompromised? I know diabetes is an autoimmune disorder, but their immune systems still work. I have always considered people who were immunocompromised to have immune systems that didnt work. There is a really nasty round of the flu in our town right now. It starts with a sudden bad headache and ends with vomiting and extreme tiredness that lasts a few days. Lots of teachers and kids have been out the last week and a half with it. I was talking to someone about it at school and they asked me if I had considered keeping Kylee at home since she was immunocompromised. I told them no, she has had a flu shot(I know that doesnt protect them 100%), and that I didnt really consider her to be immunocompromised. Not to mention with her brothers and I still at the schools, I didnt think keeping her home would offer her that much more protection. But it got me thinking, are diabetics considered to be immunocompromised? I know dia Continue reading >>

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