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Why Are Diabetics Immunosuppressed?

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 >>

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 >>

Skin Disorders In Immunocompromised Diabetes Patients

Skin Disorders In Immunocompromised Diabetes Patients

Skin Disorders in Immunocompromised Diabetes Patients Immunity and diabetes is a complicated subject and many skin-related problems may be involved. From the clinicians standpoint, there are five dermatologic conditions related to immunity and diabetes that need special note: the diabetic foot, mucormycosis, necrotizing fasciitis, candidiasis, and recurrent cellulitis of the lower extremities. These illnesses seem uniquely associated with diabetic immune dysregulation. Diabetic footNecrotizing fasciitisMucormycosisCandidiasisCellulitisCandida sepsis This is a preview of subscription content, log in to check access. Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014a;70(1):e118. CrossRef Google Scholar Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers Part II. Management. J Am Acad Dermatol. 2014b;70(1):e214. CrossRef Google Scholar Al-Mutairi N, Sharma AK, Al-Sheltawi M. Cutaneous manifestations of diabetes mellitus. Study from Farwaniya hospital, Kuwait. Med Princ Pract. 2006;15(6):42730. Google Scholar Bristow I. Non-ulcerative skin pathologies of the diabetic foot. Diabetes Metab Res Rev. 2008;24 suppl 1:S849. PubMed CrossRef Google Scholar Hall JC, Hall BJ. Halls manual of skin as a marker of underlying disease. Shelton, CT, USA; 2011. p. 24560. Google Scholar Pavlovi MD, Milenkovi T, Dini M, Misovi M, Dakovi D, Todorovi S, et al. The prevalence of cutaneous manifestations in young patients with type I diabetes. Diabetes Care. 2007;30(8):19647. PubMed CrossRef Google Scholar 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 >>

Immunosuppressioninduced Diabetes Mellitus

Immunosuppressioninduced Diabetes Mellitus

We are concerned that recent reassurances on the low rate of immunosuppressioninduced diabetes mellitus (DM) with calcineurin inhibitorbased regimens are founded on absence of evidence rather than evidence of absence. Recently, Margreiter [ 1 ] published the results of a large multicentre study comparing tacrolimus with cyclosporin microemulsion in renal transplantation. They concluded that the incidence of DM was no higher in the tacrolimustreated group. A serious flaw in this analysis was that DM was defined as the requirement for treatment with insulin for more than 30 days. No data were shown for patients treated with oral hypoglycaemic agents. From our experience, this classification would underestimate the incidence of immunosuppressioninduced DM by 50%. We have reviewed our data for 129 consecutive renal transplants done at St George's Hospital since 1995, with 1year followup, treated with tacrolimus and prednisolone with the addition of azathioprine or mycophenolate mofetil in some cases. Our standard steroid dosing regimen is 500 mg methylprednisolone at the time of surgery, then 20 mg prednisolone per day, reducing by 5 mg every 2 weeks to a maintenance dose of 5 mg daily. Target tacrolimus whole blood 12 h postdose (trough) concentrations were 1520 ng/ml for the first week, 1015 ng/ml for the first 3 months, then 810 ng/ml until the end of the first year. Twenty patients who were diabetic at the time of transplantation were excluded from the analysis. Table 1 shows the numbers of patients who required treatment for DM according to race, a welldefined riskfactor [ 2 ]. Our rate of insulin requirement at any time in Caucasian patients of 6.7% agrees well with the figure of 4.5% reported for a largely Caucasian population [ 1 ] and 8.7% reported in the European 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 >>

Vaccination In Immunosuppressed Cats |

Vaccination In Immunosuppressed Cats |

These guidelines were drafted by Katrin Hartmann et al. Immunosuppression (or immune suppression, synonym immunodepression or immune depression) is a reduction of the activation or efficacy of the immune system. An animal or person who is undergoing immunosuppression or whose immune system is weak for other reasons is classified as to be immunocompromised or having an immunocompromised condition. An immunosuppressant is any agent that weakens the immune system, including infectious agents, immunosuppressive drugs, and toxins. Immunodeficiency (or immune deficiency) is the state resulting from immunosuppression in which the immune systems ability to fight infectious diseases and tumours is compromised or completely absent. Immunosuppression is a common condition in cats, especially due to wide-spread infections with immunosuppressive viruses, such as feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV), but also due to chronic non-infectious diseases leading to immunosuppression, such as tumours, diabetes mellitus, and chronic kidney disease, as well as treatment with immunosuppressive drugs, such as glucocorticoids, cyclosporine, or tumour chemotherapy. Life expectancy in cats has been increasing in the last decades, especially in privately owned cats receiving good preventive, medical, and nutritional care, and with older age, prevalence of chronic diseases raises. Senior cats represent now a large percentage of patients in practice that probably will even increase in the future. In human medicine, specific recommendations exist on vaccination of immunocompromised people, such as the Recommendations of the Advisory Committee on Immunization Practices (ACIP): Use of Vaccines and Immune Globulins in Persons with Altered Immunocompetence of the Centers f 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 >>

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 >>

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 >>

Infections In The Immunocompromised Host

Infections In The Immunocompromised Host

Infections in the Immunocompromised Host Author: Rebecca Schreier, DO; Chief Editor: Russell W Steele, MD more... An immunocompromised host is a patient who does not have the ability to respond normally to an infection due to an impaired or weakened immune system. This inability to fight infection can be caused by a number of conditions including illness and disease (eg, diabetes, HIV), malnutrition, and drugs. Guidelines from the IDSA recommend vaccination for immunocompromised patients According to new guidelines from the Infectious Diseases Society of America (IDSA), most immunocompromised patients should be vaccinated. The new guidelines are designed for health care professionals caring for patients with compromised immune systems due to HIV infection or AIDS, cancer, solid organ transplantation, stem cell transplantation, sickle cell disease or asplenia, congenital immune deficiencies, chronic inflammatory conditions, cochlear implants, or cerebrospinal fluid leaks. [ 1 , 2 ] Specific recommendations include the following: When possible, vaccines should be administered before planned immunosuppression. Live vaccines should be administered at least 4 weeks before immunosuppression and should be avoided within 2 weeks of beginning immunosuppression. Inactivated vaccines should be administered at least 2 weeks before immunosuppression is initiated. Most immunocompromised patients 6 months of age or older should receive annual influenza vaccination as an injection; these patients should not receive live attenuated influenza vaccine administered as a nasal spray. Influenza vaccine is unlikely to be of benefit in individuals who are receiving intensive chemotherapy or who have received anti-B-cell antibodies in the preceding 6 months. Immunocompetent persons living with Continue reading >>

Diabetes Exacerbates Infection Via Hyperinflammation By Signaling Through Tlr4 And Rage

Diabetes Exacerbates Infection Via Hyperinflammation By Signaling Through Tlr4 And Rage

ABSTRACT For more than a century, diabetic patients have been considered immunosuppressed due to defects in phagocytosis and microbial killing. We confirmed that diabetic mice were hypersusceptible to bacteremia caused by Gram-negative bacteria (GNB), dying at inocula nonlethal to nondiabetic mice. Contrary to the pervasive paradigm that diabetes impedes phagocytic function, the bacterial burden was no greater in diabetic mice despite excess mortality. However, diabetic mice did exhibit dramatically increased levels of proinflammatory cytokines in response to GNB infections, and immunosuppressing these cytokines with dexamethasone restored their resistance to infection, both of which are consistent with excess inflammation. Furthermore, disruption of the receptor for advanced glycation end products (RAGE), which is stimulated by heightened levels of AGEs in diabetic hosts, protected diabetic but not nondiabetic mice from GNB infection. Thus, rather than immunosuppression, diabetes drives lethal hyperinflammation in response to GNB by signaling through RAGE. As such, interventions to improve the outcomes from GNB infections should seek to suppress the immune response in diabetic hosts. IMPORTANCE Physicians and scientists have subscribed to the dogma that diabetes predisposes the host to worse outcomes from infections because it suppresses the immune system. This understanding was based largely on ex vivo studies of blood from patients and animals with diabetes. However, we have found that the opposite is true and worse outcomes from infection are caused by overstimulation of the immune system in response to bacteria. This overreaction occurs by simultaneous ligation of two host receptors: TLR4 and RAGE. Both signal via a common downstream messenger, MyD88, triggering hy 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 >>

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 >>

Diabetes Mellitus Type 1

Diabetes Mellitus Type 1

Diabetes mellitus type 1 (also known as type 1 diabetes) is a form of diabetes mellitus in which not enough insulin is produced.[4] This results in high blood sugar levels in the body.[1] The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss.[4] Additional symptoms may include blurry vision, feeling tired, and poor healing.[2] Symptoms typically develop over a short period of time.[1] The cause of type 1 diabetes is unknown.[4] However, it is believed to involve a combination of genetic and environmental factors.[1] Risk factors include having a family member with the condition.[5] The underlying mechanism involves an autoimmune destruction of the insulin-producing beta cells in the pancreas.[2] Diabetes is diagnosed by testing the level of sugar or A1C in the blood.[5][7] Type 1 diabetes can be distinguished from type 2 by testing for the presence of autoantibodies.[5] There is no known way to prevent type 1 diabetes.[4] Treatment with insulin is required for survival.[1] Insulin therapy is usually given by injection just under the skin but can also be delivered by an insulin pump.[9] A diabetic diet and exercise are an important part of management.[2] Untreated, diabetes can cause many complications.[4] Complications of relatively rapid onset include diabetic ketoacidosis and nonketotic hyperosmolar coma.[5] Long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.[4] Furthermore, complications may arise from low blood sugar caused by excessive dosing of insulin.[5] Type 1 diabetes makes up an estimated 5–10% of all diabetes cases.[8] The number of people affected globally is unknown, although it is estimated that about 80,000 children develop the disease each year.[5] With Continue reading >>

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