Fungal foot infection, cellulitis and diabetes: a review.

Fungal foot infection, cellulitis and diabetes: a review.
Diabet Med. 2009 May

Bristow IR, Spruce MC.
School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK. ib@soton.ac.uk

AIMS: To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes.

METHODS: A structured review of medline, embase and cinahl databases was undertaken to identify publications investigating fungal foot infection as a risk factor for the development of cellulitis.

RESULTS: Sixteen studies were identified. Eight studies adopted a case-control methodology, with the remainder being cross-sectional surveys. The majority of studies established the presence of tinea infection by clinical rather than established microbiological methods. Although the majority of papers suggested a link, only two case-control studies employed microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis, particularly when infection was located between the toes. There were insufficient data to suggest that fungal foot infection posed an increased risk to patients with diabetes.

CONCLUSION: There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to the diabetic foot. Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals should be encouraged to reduce potential complications.

Wiley InterScience

Acute Bacterial, Nonnecrotizing Cellulitis in Finland: Microbiological Findings

Acute Bacterial, Nonnecrotizing Cellulitis in Finland: Microbiological Findings
Clin Infect Dis. 2008 Feb 8

Siljander T, Karppelin M, Vähäkuopus S, Syrjänen J, Toropainen M, Kere J, Vuento R, Jussila T, Vuopio-Varkila J.
Departments of 1Bacterial and Inflammatory Diseases and 2Vaccines, National Public Health Institute, and 3Department of Medical Genetics, University of Helsinki, Helsinki, and 4Department of Internal Medicine and 5Centre for Laboratory Medicine, Tampere University Hospital, and 6Hatanpää City Hospital, Tampere, Finland; and 7Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.

Background.

Bacterial, nonnecrotizing cellulitis is a localized and often recurrent infection of the skin. The aim of this study was to identify the beta-hemolytic streptococci that cause acute nonnecrotizing cellulitis infection in Finland.

Methods.

A case-control study of 90 patients hospitalized for acute cellulitis and 90 control subjects was conducted during the period of April 2004-March 2005. Bacterial swab samples were obtained from skin lesions or any abrasion or fissured toe web. Blood culture samples were taken for detection of bacteremia.

The patients, their household members, and control subjects were assessed for pharyngeal carrier status. beta-Hemolytic streptococci and Staphylococcus aureus were isolated and identified, and group A and G streptococcal isolates were further analyzed by T serotyping and emm and pulsed-field gel electrophoresis typing.

Results.

Beta-Hemolytic streptococci were isolated from 26 (29%) of 90 patients, 2 isolates of which were blood-culture positive for group G streptococci, and 24 patients had culture-positive skin lesions. Group G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) was found most often and was isolated from 22% of patient samples of either skin lesions or blood, followed by group A Streptococcus, which was found in 7% of patients. Group G streptococci were also carried in the pharynx of 7% of patients and 13% of household members but was missing from control subjects. Several emm and pulsed-field gel electrophoresis types were present among the isolates. Six patients (7%) had recurrent infections during the study. In 2 patients, the group G streptococcal isolates recovered from skin lesions during 2 consecutive episodes had identical emm and pulsed-field gel electrophoresis types.

Conclusions.

Group G streptococci, instead of group A streptococci, predominated in bacterial cellulitis. No clear predominance of a specific emm type was seen. The recurrent nature of cellulitis became evident during this study.

PMID: 18260753 [PubMed - as supplied by publisher]