Open AccessOpportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors
Author(s) -
Lao Minxi,
Li Chen,
Li Jin,
Chen Dubo,
Ding Meilin,
Gong Yingying
Publication year - 2020
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13183
Subject(s) - medicine , odds ratio , diabetes mellitus , gastroenterology , confidence interval , cryptococcosis , type 2 diabetes mellitus , glycated hemoglobin , pneumonia , type 2 diabetes , immunology , endocrinology
Aims/Introduction A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co‐infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram‐negative bacteria. The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non‐survivors than survivors (8.8 ± 2.5 vs 7.7 ± 2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95–6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14–9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07–4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions Invasive fungal disease is a life‐threatening complication in type 2 diabetes mellitus patients. C. a albicans , C. neoformans , and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.