Assessment of Systemic Fungal Infections among Diabetic Patients in Enugu, Nigeria

Abstract

Opportunistic invasive fungal infections are emerging health challenges worldwide, especially among immunocompro-mised hosts. This study investigated systemic fungal infections in diabetic patients. The diabetic patients were recruited from the Diabetic Clinics; Enugu State University Teaching Hospital Parklane, Enugu. A structured questionnaire was used to obtain information on the demographic and risk factors from the subjects. Sputum samples were collected from the patients and analyzed mycologically using Sab-ouraud dextrose agar with actidione and brain heart infusion agar fortified with 5% sheep red blood cells. Those with fungal growth were identified using needle mount, Gram stain and sugar fermentation/assimilation tests. Of 120 diabetic patients analyzed, 63 (52.5%) had fungal isolates. The females had higher isolates than the males, 36 (30%) and 27 (22.5%) respectively. The age range above 61-years-olds had more fungal isolates, 27 (22.5%) followed by those of 51-60 years-old with 21 (17.5%). The subjects with primary education had 24 (20%) of fungal isolates while those that were traders, 22 (18.3%) fungal isolates were obtained. The duration of diabetes was statistically significant as those with less than 5 years of diabetes had higher fungal infections of 40 (33.3%). The diabetic patients with FBS levels > 5.8 mmol/l had higher isolates, 51 (42.5%), (P = 0.001) while the subjects on insulin therapy and with persistent elevated fasting blood sugar level had 40 (33.3%) systemic fungal isolates. The frequency of fungal isolates showed that opportunistic and dimorphic fungi were implicated as infectious complications in diabetics. The dimorphic fungal isolates, Blastomyces dermatitidis 10 (8.3%) and Coccidi-oides immitis 6 (5%) are not common in this environment. These systemic fungal infections are of public health challenge due to its high transmission rate.