Diabetics have higher risk of potentially dangerous fungal infections

Washington - Older patients with long-standing diabetes and diabetic neuropathy and who have thick, discolored toenails are likely to harbor fungal infections, Reuters Health reports.

The report was based on a presentation given at a recent meeting of the Council of Nail Disorders here.

The presenters - researchers from Rosalind Franklin University of Medicine and Science in North Chicago, Ill. - said clinicians should be alerted to their study’s findings that fungal infections of the toenails are common in patients at high risk for developing diabetic foot ulcerations.

The researchers evaluated 96 male patients with diabetic neuropathy and onychodystrophy presenting for routine care in a diabetes clinic. The patients had a mean age of 71 and mean duration of diabetes of 16 years.

The investigators obtained nail clippings of the most affected nail and debris under the nail. Twenty-five of the patients had nail thickening but no evidence of infection. The other 71 patients had onychomycosis, caused primarily by Trichophyton rubrum, T. mentagrophytes interdigitale and saprophytic mold.

The study notes that while anti-fungal treatment is usually effective, oral agents must be used with caution because of their association with heart failure and hepatic toxicity.

One conclusion to the study is that providers should routinely examine the feet of their diabetic patients for signs of ulcers, which could lead to amputations if left untreated.