Credits

• Section Writer: Dr. Om J Lakhani
• Section Editor: Dr. Om J Lakhani

Q. What part of the immune system is most affected in diabetes?

• Innate immunity

Q. What are the effects of diabetes on neutrophil function?

• Reduced neutrophil phagocytosis
• Reduces chemotaxis of neutrophils

Q. Summarize the risk factors which make persons living with diabetes more susceptible to infection?

• Primary factors
  • Reduced neutrophil chemotaxis
  • Reduced neutrophil phagocytosis
  • Reduced adherence to vascular endothelium
  • Reduced intracellular bactericidal activity
  • Opsonization defect
  • Cell-mediated immunity defect
• Secondary factors
  • Ischemia and peripheral vascular disease
  • Sensory neuropathy
  • Autonomic neuropathy
  • Urine retention
  • Gastroparesis  and Intestinal dysmotility
  • Glycosuria
  • Increase skin, mucosal and nasal colonization- MRSA in the nose and Candida colonization is common in diabetics

Q. What is the relation between vascular disease and infection?

• Vascular insufficiency  ischemia → increases the growth of anaerobic bacteria

Q. Enlist the diabetes-specific infections, also called "Diabetes defining illness."

• Diabetic foot infection
• Mucormycosis
• Recurrent UTI including fungal UTI
• Candidiasis – balanitis, vulvovaginitis, esophageal candidiasis
• Malignant otitis externa
• Emphysematous pyelonephritis
• Emphysematous cholecystitis
• Pyomyositis
• Necrotizing fascitis

Q. Why is mucormycosis more common in patients having diabetic ketoacidosis?

• Rhizopus grows better in acidic and high glucose environment
• They have __ketone reductase enzyme __which protects them

Q. Why is Candida Albicans more common in people with diabetes?

• Candida produces certain factors which are induced by glucose
• These factors help candida adhere to the mucosa

Q. Which infection has a link with a Glibenclamide?

• Burkholderia pseudomallei, which produce mallediosis, is more common in people with diabetes in endemic area
• They have an increase risk of mortality with Glibenclamide

Q. Why is E. coli infection in the bladder more common in people with diabetes?

• Advanced glycosylated end products increase binding of E. coli with bladder wall