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Diabetes Immunocompromised Pathophysiology

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 >>

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 >>

The Role Of T-cells In The Pathogenesis Of Type 1 Diabetes: From Cause To Cure

The Role Of T-cells In The Pathogenesis Of Type 1 Diabetes: From Cause To Cure

Type 1 diabetes mellitus results from a T-cell mediated autoimmune destruction of the pancreatic beta cells in genetically predisposed individuals. The knowledge of the immunopathogenesis has increased enormously in the last two decades. The contribution of T-cells in the pathogenesis is beyond doubt. Therapies directed against T-cells have been shown to halt the disease process and prevent recurrent beta-cell destruction after islet transplantation. Less is known about the nature and function of these T-cells, the cause of the loss of tolerance to islet autoantigens, why the immune system apparently fails to suppress autoreactivity, and whether (or which) autoantigen(s) are critically involved in the initiation or progression of the disease. The contribution of dendritic cells in directing the immune response is clear, while the contribution of B-cells and autoantibodies is subject to reconsideration. Autoreactive T-cells have proven to be valuable tools to study pathogenic or diabetes-related processes. Measuring T-cell autoreactivity has also provided critical information to determine the fate of islet allografts transplanted to Type 1 diabetic patients. Cellular autoimmunity is a difficult study subject, but it has been a worthwhile quest to unravel the role of T-cells in the pathogenesis of Type 1 diabetes. The challenge for the future is to determine which factors contribute to the loss of tolerance to beta-cell antigens, and to define what measures T-cells can provide to suppress autoreactivity, since it is becoming increasingly evident that T-cells provide a two-edged sword: some T-cells could be pathogenic, but others can regulate the disease process and thus form new targets for immunointervention. Support for a role of T-cells in the pathogenesis of Type 1 di 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 >>

What Is Cause Of Immunosupression In Diabetes Melitus?

What Is Cause Of Immunosupression In Diabetes Melitus?

The most common infections in diabetes patients involve the skin and urinary tract. Chronic hyperglycemia slows perfusion through blood vessels, causing nerve damage as time progresses. The skin, one of the key barriers in innate immunity, is no longer competent and lost protection against trauma and inflammation.High glucose levels limit and irregulate neutrophil synthesis, Cytosolic calcium in polymorphonuclear leukocytes (PMNs) increases in the presence of hyperglycemia and is inversely proportional to the occurrence of phagocytosis in patients with type II diabetes. High levels of cytosolic calcium inhibit the synthesis of adenosine triphosphate (ATP), which is essential for phagocytosis. The ability of PMN leukocytes to mobilize to the site of infection and stimulate of apoptosis is negatively impacted as well. Hyperglycemia causes other undesirable changes in the function of the immune system such as decreased complement response, leukocyte adherence and bactericidal activity. Chronic hyperglycemia in diabetes patients can lead to acidosis, which limits the activity of the immune system. The effects of these changes are reversible upon treatment of acidosis and hyperglycemia. Continue reading >>

About Diabetes

About Diabetes

Diabetes is a chronic (long-lasting) disease that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. Your pancreas makes a hormone called insulin, which acts like a key to let the blood sugar into your body’s cells for use as energy. If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream, which over time can cause serious health problems, such as heart disease, vision loss, and kidney disease. There isn’t a cure yet for diabetes, but healthy lifestyle habits, taking medicine as needed, getting diabetes self-management education, and keeping appointments with your health care team can greatly reduce its impact on your life. 30.3 million US adults have diabetes, and 1 in 4 of them don’t know they have it. Diabetes is the seventh leading cause of death in the US. Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult-onset blindness. In the last 20 years, the number of adults diagnosed with diabetes has more than tripled as the American population has aged and become more overweight or obese. Types of Diabetes There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant). Type 1 diabetes is caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. About 5% of the people who have diabetes have type 1. Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults. If you have type 1 diabetes, you’ll need t 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 >>

Diabetes Mellitus - Sciencedirect

Diabetes Mellitus - Sciencedirect

Volume 24, Issue 4 , JulyAugust 2006, Pages 237-246 Get rights and content Dermatologic problems are common in diabetes, with approximately 30% of patients experiencing some cutaneous involvement during the course of their illness. Skin manifestations generally appear during the course of the disease in patients known to have diabetes, but they may also be the first presenting sign of diabetes or even precede the diagnosis by many years. The skin involvement can be autoimmune in nature, such as acanthosis nigricans, necrobiosis lipoidica, diabetic dermopathy, scleredema, and granuloma annulare, or infectious in the form of erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is tailored according to the underlying pathophysiology, but a tight control of blood glucose is a prerequisite in all management strategies. Continue reading >>

Diabetes And Mucormycosis: A Complex Interplay - Em|consulte

Diabetes And Mucormycosis: A Complex Interplay - Em|consulte

Received:18August2011; accepted:9January2012 Diabetes and mucormycosis: A complex interplay Diabte et mucormycose: une interaction complexe B.Rammaert a , F.Lanternier a , b , S.Poire c , R.Kania d , O.Lortholary a , , b aService des maladies infectieuses et tropicales, centre dinfectiologie Necker-Pasteur, universit Paris Descartes, hpital NeckerEnfants-malades, institut Imagine, APHP, 149, rue des Svres, 75743 Paris cedex 15, France bUnit de mycologie molculaire, Centre national de rfrence mycologie et antifongiques, CNRS URA3012, Institut Pasteur, 75743 Paris cedex 15, France cService de radiologie adulte, hpital NeckerEnfants-malades, APHP, 75743 Paris cedex 15, France dService doto-rhinolaryngologie, hpital Lariboisire, APHP, 75010 Paris, France Corresponding author. Tel.: +33 1 42 19 26 63; fax: +33 1 42 19 26 22. Mucormycosis is a life-threatening invasive fungal infection that arises particularly in diabetic patients with or without other underlying conditions such as haematological malignancies or the need for solid-organ transplantation. Rhino-orbito-cerebral involvement is the primary site of mucormycosis, but the paucity of signs may be a cause of delayed diagnosis. Thus, any case of documented non-bacteriological sinusitis in diabetic patients, even without ketoacidosis, should prompt suspicion of a mucormycosis diagnosis. To optimalize information for clinicians in charge of diabetic patients, this extensive review of the literature was carried out to provide an overview of mucormycosis specificities, epidemiology and pathophysiology in the setting of diabetes. The full text of this article is available in PDF format. Les mucormycoses sont des infections fongiques invasives qui surviennent, entre autres, chez les patients diabtiques avec ou sans immunodpr Continue reading >>

Novel Perspectives On Mucormycosis: Pathophysiology, Presentation, And Management

Novel Perspectives On Mucormycosis: Pathophysiology, Presentation, And Management

Novel Perspectives on Mucormycosis: Pathophysiology, Presentation, and Management 1Department of Medicine, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, California 2David Geffen School of Medicine at UCLA, Los Angeles, California Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. These infections are becoming increasingly common, yet survival remains very poor. A greater understanding of the pathogenesis of the disease may lead to future therapies. For example, it is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These findings raise the possibility that iron chelator therapy may be useful to treat the infection as long as the chelator does not inappropriately supply the fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis. However, several novel therapeutic strategies are available. These options include combination therapy using lipid-based amphotericin with an echinocandin or with an azole (largely itraconazole or posaconazole) or with all three. The underlying principles of therapy for this disease remain rapid diagnosis, reversal of underlying predisposition, and urgent surgical debridement. The zygomycoses are infections caused by fungi of the class Zygomycetes, comprised of the orders Mucorales and Entomophthorales. The Entomophthorales are rare causes of subcutaneous and mucocutaneous infections known as entomophthoromycosis, which largely afflict immunocompetent hosts in developing countries. In contrast, fungi of the order Mucorales are causes of mucormycosis Continue reading >>

Pathogenesis Of Mucormycosis

Pathogenesis Of Mucormycosis

Mucormycosis is a life-threatening infection that occurs in patients who are immunocompromised because of diabetic ketoacidosis, neutropenia, organ transplantation, and/or increased serum levels of available iron. Because of the increasing prevalence of diabetes mellitus, cancer, and organ transplantation, the number of patients at risk for this deadly infection is increasing. Despite aggressive therapy, which includes disfiguring surgical debridement and frequently adjunctive toxic antifungal therapy, the overall mortality rate is high. New strategies to prevent and treat mucormycosis are urgently needed. Understanding the pathogenesis of mucormycosis and the host response to invading hyphae ultimately will provide targets for novel therapeutic interventions. In this supplement, we review the current knowledge about the virulence traits used by the most common etiologic agent of mucormycosis, Rhizopus oryzae. Because patients with elevated serum levels of available iron are uniquely susceptible to mucormycosis and these infections are highly angioinvasive, emphasis is placed on the ability of the organism to acquire iron from the host and on its interactions with endothelial cells lining blood vessels. Several promising therapeutic strategies in preclinical stages are identified. Mucormycosis is an infection caused by fungi belonging to the order Mucorales [ 1 ]. Rhizopus oryzae is the most common organism isolated from patients with mucormycosis and is responsible for 70% of all cases of mucormycosis [ 24 ]. The major risk factors for mucormycosis include uncontrolled diabetes mellitus in ketoacidosis, other forms of metabolic acidosis, treatment with corticosteroids, organ or bone marrow transplantation, neutropenia, trauma and burns, malignant hematologic disorders Continue reading >>

Diabetes Mellitus As Hub For Tuberculosis Infection: A Snapshot

Diabetes Mellitus As Hub For Tuberculosis Infection: A Snapshot

Copyright © 2016 Rahul Pal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Tuberculosis (TB) still remains the thorn in the flesh of efficient therapeutics affecting one-third of global population annually. There are several factors that enhance the susceptibility to TB infections including malnutrition, smoking, and immunocompromised conditions such as AIDS. In the recent years, growing body of evidence has gained considerable prominence which suggests that Diabetes Mellitus (DM) is individual risk factor leading to complicated TB infections. In this article the authors have attempted to summarize the link of type 2 DM with TB, the mechanistic action of how DM sensitizes for developing the active TB infection from the latent infection, and problems faced during treatment followed by possible preventive measures. We have tried to give account of the alterations that occurred in DM making a person more prone to develop TB. 1. Introduction Tuberculosis (TB) continues to be a considerable worldwide health issue, provoking millions of new cases and one-third deaths annually. Around 2 billion of the population of the world are considered to be infected with latent TB and out of which approximate 5–10% grows in to active TB [1, 2]. Previously it was thought that TB emerges only in low economic countries but in recent years it is spreading its tentacles to high income countries as well. This shift in the scenario is mainly because of predisposing factors like malnutrition, smoking, and immunocompromised conditions such as AIDS [3–6]. Among various challenging conditions Diabetes Mellitus (DM) 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 >>

What Is Immunosuppression?

What Is Immunosuppression?

Immunosuppression refers to the dampening of the immune response by a normal immune system to antigenic stimulation, either deliberately, or as an adverse effect of a therapeutic agent such as anti-neoplastic chemotherapy. It can also occur when the immune system is impaired such as systemic lupus erythematosus, or diabetes. The causes of immunosuppression may be classified as: Autoimmune disorders such as systemic lupus erythematosus or rheumatoid arthritis Polyclonal immunoglobulins such as antilymphocyte globulin, and monoclonal immunoglobulins such as daclizumab (both monoclonal and polyclonal immunoglobulins target cellular immunity alone by depleting lymphocytes) Calcineurin inhibitors which prevent T cell transcription, such as cyclosporine Rapamycins which block the mTOR kinase in lymphocytes, such as everolimus Mitosis inhibitors which block purine metabolism, such as azathioprine Biological alkylating agents such as cyclophosphamide and chlorambucil Immunosuppression is clinically indicated in three distinct situations: The post-transplant period, to prevent graft rejection and graft-versus-host reactions The presence of an autoimmune or hypersensitivity disorder which causes self-antigens to be identified as foreign targets of immune attack, and leads to tissue and organ damage, and The occurrence of lymphoproliferative disorders. Immunosuppressants are drugs which are used to intentionally suppress the production and activity of immune cells. However, these drugs also suppress the normal immune response to infectious agents, and even to emerging malignant or pre-malignant changes in cells. Chemotherapeutic drugs also diminish the normal immune response. An immune response has two phases, namely, an inductive and a productive phase. In the inductive phase, s Continue reading >>

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