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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Severe forefoot infections may lead to limb loss, even if addressed aggressively. Infection or gangrene that compromises the plantar skin flap may preclude a standard transmetatarsal or midfoot amputation, thereby culminating in a below-knee amputation. We report a series of forefoot infections with loss of the distal plantar skin. Open or guillotine amputation at the mid-metatarsal level led to a high rate of healing and a durable stump, provided that the level of infection did not extend beyond the metatarsal heads. Wound closure was obtained by wound contracture alone or by use of partial-thickness skin grafting. Rehabilitation was dependable. The association of diabetes mellitus or gangrene did not adversely affect outcome. Open transmetatarsal amputation is a safe surgical option preferable to midfoot or below-knee amputation for the treatment of severe forefoot infection that does not extend proximally beyond the metatarsal heads.
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PMID:Open transmetatarsal amputation in the treatment of severe foot infections. 275 39

Encephalomyocarditis (EMC) virus induction of diabetes mellitus in mice has proven to be an excellent experimental model for the pathogenesis of viral disease. In SJL and DBA/2 mice, diabetes results exclusively from the infection and damage of beta cells by the virus. In addition, in BALB/cBy mice subclinical beta cell damage caused by the virus is followed by autoimmune beta cell destruction, which results in hyperglycemia. Studies of two closely related plaque variants (EMC-D and EMC-B) selected from the M strain of EMC virus revealed differences in the interferon response associated with viral infection. The EMC-D variant causes diabetes in infected SJL mice by direct beta cell destruction. Infection with EMC-B does not cause diabetes and interferes with the production of diabetes by EMC-D due to the greater ability of EMC-B than of EMC-D to induce interferon in mice. Circulating interferon has a greater effect on inhibition of viral replication because local interferon production is amplified in interferon-primed cells infected with EMC-B. These properties are determined by the interferon-inducing particle (Ifp+) phenotype of EMC-B and the Ifp- phenotype of EMC-D.
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PMID:Encephalomyocarditis virus-induced diabetes mellitus in mice: model of viral pathogenesis. 282 21

Sixty-five lower-extremity amputations were performed as a result of sepsis in diabetic patients during a 3-year period. Chronic plantar ulcer was the most frequent cause of infection. Other causes of infection included ischemic gangrene, trauma, and web space fissures. Advanced ischemia was infrequent; only 21 (32.3%) had ankle-brachial indices (ABI) less than 0.5. Eight (23.5%) deaths and 12 (35.3%) stump failures followed 34 amputations where the stump was closed, compared with no deaths and 4 (12.9%) stump failures when open amputations were done (p less than 0.02). Partial foot amputations with aggressive local debridement resulted in healing in 10 (71.4%) of 14 cases with revision or grafting. Guillotine transmalleolar amputation is advised when foot salvage is not possible, because only 1 (5.9%) of 17 such procedures could not be revised to the below-knee (B-K) level, whereas 8 (33.3%) of 24 definitive, closed B-K amputations were unsuccessful (p less than 0.02). Infections were polymicrobial, with 5.8 bacterial isolates and 2.3 anaerobes recovered per patient. Anaerobic antibiotic coverage, however, failed to alter outcome. Sepsis, often without advanced ischemia, is an important cause of limb loss in patients with diabetes. Open amputations are recommended, with foot salvage possible in many cases.
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PMID:The septic foot in patients with diabetes. 290 97

Thirty-seven clinical isolates of coxsackievirus (CV) serotypes B-1, B-3, B-4, and B-5 were inoculated into male SJL mice. Twelve strains resulted in minor abnormalities of glucose metabolism in one or more of six infected mice (Tables 1 and 2). Sequential infection of male SJL mice with CVB-3, CVB-4, and CVB-5 resulted in abnormal glucose metabolism in 25 percent of the mice (Fig. 1). The glucose index of the abnormal animals was similar to that produced by sequential infection with reovirus and cytomegalovirus but less than that seen with more severe beta cell tropic agents such as streptozotocin or encephalomyocarditis virus. Infection of autoimmune New Zealand (NZB X NZW) F1 male mice with CBV-3, CVB-4, and CVB-5 resulted in transient elevation of the blood glucose concentration associated with acute acinar pancreatitis (Fig. 2). In spite of recent evidence that infection with the coxsackie B viruses can result in human diabetes mellitus, the diabetogenic potential of CVB field strains appears to be limited. Diabetes mellitus may occur as a rare event, limited to genetically susceptible hosts. Autoimmune mechanisms or repeated infection with other CVB serotypes may convert minimal beta-cell destruction into clinically overt disease.
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PMID:Diabetogenic potential of coxsackie B viruses in nature. 299

Sepsis in the burned individual can arise from multiple causes. However, the unique source is the burn wound itself. It is clear that health is association with maintenance of a bacterial equilibrium in the wound and that infection is a result of an imbalance in favor of the bacteria. The primary host defense mechanism, an intact epithelial barrier, has been lost at the time of burning. A portal of entry has been created, and the bactericidal defenses have been neutralized. All of the host defense mechanisms associated with inflammation are evoked but may be limited by the avascular isolation of much of the wound. In addition to alteration in vascular response associated with the burns, there are adverse changes in the neutrophils themselves. The alterations in nutrition that may follow burn injury further reduce systemic host resistance. Associated diseases, such as diabetes, may present a further hazard. All of the local factors influencing host resistance are adversely affected in the burn wound. There is necrotic tissue, decreased local tissue perfusion, and loss of the mechanical barrier. Quantitative techniques have demonstrated that bacteria are present in the depths of the wound from the time of injury. Infection and burn wound sepsis are clearly represented by the quantitative increase in bacteria to numbers exceeding 10(5) per gram of tissue. In no other instance has the importance of the "amphibiont" organisms been more clearly demonstrated than in the burn wound. Today's nonpathogen has all too often become tomorrow's killer. As therapeutic control becomes effective against the current organism, the ecologic void is filled by another, which, by definition, is resistant to the treatment being employed.
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PMID:Burn sepsis. 304 88

Cunninghamella bertholletiae, an uncommon cause of human infection, has been reported with increasing frequency in recent years. C. bertholletiae belongs to the order Mucorales and produces infections similar to those produced by the other agents of mucormycosis. Infections with this group of organisms have typically been seen either in patients with diabetes mellitus or in those receiving chemotherapy. Recent reports of mucormycosis in dialysis patients receiving deferoxamine for iron or aluminum overload have raised the possibility that deferoxamine therapy is a risk factor for mucormycosis. A case of C. bertholletiae infection in a patient receiving deferoxamine for iron overload unrelated to hemodialysis was investigated in detail, and possible explanations for this patient's infection were assessed.
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PMID:Cunninghamella bertholletiae infection associated with deferoxamine therapy. 306 Sep 47

Phialophora richardsiae infection in humans is rare. The first human isolate was recovered from a patient with a phaeomycotic cyst in 1968. Since 1975 seven other cases have appeared in the world literature, and an additional case is reported here. The mean age of these nine patients was 61.4 years. Two patients had diabetes mellitus, one had diabetes mellitus and disseminated adrenocortical carcinoma, and one had a myeloproliferative disorder. The mode of acquisition was presumed to be inoculation with contaminated plant material, but a history consistent with an inoculation injury was obtained in only four patients and a retained splinter was found in the lesion of only one patient. Infection with P. richardsiae was not associated with systemic symptoms or signs. Six patients presented with a single subcutaneous cystic granulomatous lesion. One patient had chronic dacryocystitis. More extensive or invasive disease occurred in two patients, both with an ultimately fatal underlying neoplastic process. A specific etiologic diagnosis was made by culture of purulent material obtained by excisional biopsy in six patients, incision and drainage in one patient, aspiration in one, and spontaneous drainage in one. Subcutaneous nodules were cured with surgical excision. There is insufficient information concerning antifungal therapy to recommend its use.
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PMID:Phialophora richardsiae infection in humans. 306 Sep 48

Group B streptococcal infection may result in significant morbidity and mortality in both infants and adults. The experience with group B streptococcal disease was analyzed at one medical center over a ten-year period from 1975 to 1984. Streptococcus agalactiae bacteremia was observed in 29 adults and 26 infants, with an attack rate of 0.2 cases per 1000 adult admissions and 3.2 cases per 1000 live births, respectively. The majority of adult infections apparently occurred as a result of nosocomial acquisition and was associated with a high mortality rate of 38%. Risk factors for group B streptococcal sepsis in adults include diabetes mellitus, malignancy, and hepatic failure. The majority (73%) of neonatal cases occurred within seven days of birth and occurred in a setting of maternal fever, prolonged rupture of membranes, or prematurity. The mortality rate in infants was remarkably low at only 15%. Fatalities occurred in both adults and infants, despite appropriate antimicrobial therapy. Infection control strategies against group B streptococcus must address potential nosocomial dissemination in adults as well as vertical transmission in infants.
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PMID:Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. 327 72

Infections of diabetic foot ulcers are a common, longstanding complication of poorly controlled diabetes. They result from the interplay of peripheral neuropathy and peripheral vascular disease. In most cases, diabetic foot infections are polymicrobial, and deep tissue culture after debridement is essential for identifying the true pathogens. Treatment includes bed rest, empiric and specific antibiotic therapy, and good control of diabetes.
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PMID:Infected diabetic foot ulcers. 327 69

The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all - diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients - mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.
Infection
PMID:Streptococcus agalactiae (group B) endocarditis--a description of twelve cases and review of the literature. 330 82


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