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Cha, Son, Lee, and Kang: Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot
Original Article
The Journal of Korean Diabetes Association

The Journal of Korean Diabetes Association 2006; 30(1): 64-72.

Published online: 31 January 2006

DOI: https://doi.org/10.4093/jkda.2006.30.1.64

Prevalence of Fungal Infection on Foot in Diabetic Patients and Correlation between Diabetic Ulcer and Fungal Infection on Foot

Bong Yun Cha, Hyun Shik Son, Jung Min Lee, Sung Koo Kang

Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Received 22 September 2005       Accepted 27 September 2005

Copyright © 2006 Korean Diabetes Association

Abstract

Background

The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection.

Methods

A total of 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed by a dermatologist.

Results

13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease was found in 10,403 patients that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), nonpalpable pulse in 1,051 (4.8%; 7.9%), and foot ulcer was in 425 (2.0%; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer.
A total of 5,486 patients paid visit to the department of dermatology. Of these, 4,519 patient were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population were comprised of 2,272 males and 2,247 females, showing similar prevalences between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 (70%) and onychomycosis was proven mycologically in 3,276 patients. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885 (70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles.

Conclusion

This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.

Keywords: Diabetes Mellitus, Fungal infection, Foot ulcer

Figures and Tables

Fig. 1
Schematic flow chart in this study.
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Fig. 2
Nail problems in the patients with diabetes mellitus referred to dermatology department.
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Fig. 3
Foot problems in the patients with diabetes mellitus referred to dermatology department.
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Fig. 4
Correlation between age and fungal infection in the patients with diabetes mellitus referred to department of dermatology.
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Fig. 5
Predominant types of onychomycosis in the patients with diabetes mellitus. DLSO: distal and lateral subungual onychomycosis, PSO: proximal subungual onychomycosis, WSO: white superficial onychomycosis.
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Fig. 6
Predominant sites of onychomycosis in the patients with diabetes mellitus
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Fig. 7
Predominant sites of tinea pedis in the patients with diabetes mellitus
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Fig. 8
Fungal infections of other sites except for feet in the patients with diabetes mellitus
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Table 1
Age and Sex Distribution of 21,693 Outpatients Diagnosed as Diabetes MeLlitus at The Department of EndocRinology of 35 Hospitals
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M: male, F: female

Table 2
Risk Factors which Influence on the Fungal Infection
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Table 3
Risk Factors which Influence on the Foot Ulcer
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Table 4
Frequency of Deformity and Impalpable Pulse in the Patients with Diabetes Mellitus Referred to Department of Dermatology (Total=5,486)
jkda-30-64-i004

AK: above knee, BK: below knee

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