Muhammad Khalid, Muhammad Sabir, Raziuddin Ahmed, Shahida Bashir, Muhammad Arif Memon, Mukesh Kumar, Behram Khan Khoso.
Tinea pedis in diabetic foot ulcer cases reporting in diabetic clinic at Jinnah Post-graduate Medical Center (JPMC), Karachi - a cross-sectional study.
Pak J Surg Jan ;37(4):259-64.

Objective: Diabetes mellitis, when chronic and uncontrolled, is undeniably associated with myriad health complications, most importantly immune dysfunction and healing abnormalities. The ensuing tissue injury and the ineffective healing, particularly in the foot, is often compounded by bacterial and fungal infections, which predispose to the development of infected diabetic foot ulcer (DFU) - a grave complication ending up in foot amputation in significant number of patients. This study assesses the prevalence and pattern of dermatophytes in diabetic foot ulcer. Material and Methods: In this study we included a total of 298 diabetic patients with diabetic foot ulcers who presented to JPMC from June 2019 till June 2020. We recorded their demographic features and blood glucose level at the time of sample taking. The foot ulcers were graded according to Wagner/ Meggit ulcer grading scale. Taking aseptic measures, samples were taken from the ulcers and skin at the ulcers edge and, processed and interpreted according to standard guidelines. Results: Fungal positivity was more in men (61%) than women (39%). Overall mean age (+- SD) was 50.0(+- 8.1) years. On fungal culture, total fungus positive cases were 92 (30.9%) out of which 49 (53%) were dermatophytes (p<0.01). Prevalence of dermatophytes in the DFU (tinea pedis) of population studied was found to be 16.44%. The most frequently isolated species was Tinea rubrum (43%) followed by Tinea mentagrophytes (29%). Conclusion: This study showed that dermatophytes are associated with Diabetic Foot Ulcer in significant number of cases. Specific antifungals must be prescribed to treat dermatophyte infection (tinea pedis) and prevent its most horrendous complication, foot amputation. This is only possible when a high clinical suspicion is supported by timely and appropriate screening for fungi, such as dermatophytes, especially, when lesions are refractory to repeated anti-bacterial therapy.

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