INFECTIONS IN DIABETES

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It is estimated that approximately 7% of the adult population in the United States, or 8 million adults, are affected by diabetes mellitus. Despite the progress in pharmaceutics with many new oral medications available to control diabetes, many diabetics continue to experience serious morbidities related to their disease. Infectious morbidities are common, with diabetics being susceptible to infection for a variety of reasons. Certain types of infections tend to be more common in diabetics than in others, and other infections may be more severe in diabetics than in nondiabetics. In this article, the immune defects leading to increased susceptibility to infections will be reviewed, followed by brief reviews of infections that are common in diabetics (Table 1).

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Innate Cellular Immunity

Several different immune deficits have been described in diabetics. Cell-mediated immunity seems to be most affected, with abnormalities of polymorphonuclear leukocytes (PMNLs), monocytes, and lymphocytes reported. Numerous researchers have studied PMNLs in the past, reporting abnormalities of adherence, chemotaxis, phagocytosis, oxidative burst, and intracellular killing. More recent studies confirm previous findings; Delamaire6 found significantly lower neutrophil chemotaxis among both Type I

Head and Neck Infections

There are two serious head and neck infections to which diabetics are predisposed: rhinocerebral mucormycosis and malignant (or necrotizing) otitis externa. Both infections are rare but potentially life threatening. Diabetics are also predisposed to oral thrush—which is much more common but not serious—and occasionally may develop esophageal candidiasis.

Approximately 50% to 75% of cases of rhinocerebral mucormycosis occur in diabetic patients.34, 49 Ketoacidosis appears to be the most important

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    Address reprint requests to Helene M. Calvet, MD Long Beach DHHS 2525 Grand Avenue Long Beach, CA 90815 e-mail: [email protected]

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