Details
Category: Volume 07 Issue 04 April 2019
Hits: 1180

Title: Bacterial Infections in Unusual Sites in the Setting of Poor Glycaemic Control - Case Reports

Authors: Nkpozi MO, Uche CL

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.52

Abstract

People living with diabetes are prone to bacterial infections; this susceptibility occurs because diabetes mellitus (DM) is associated with atherosclerotic vascular disease, sensory dysfunction and hyperglycaemia. Skin surface over the foot is, particularly, at risk, leading to foot ulcer.

The objective of this report is to draw attention to bacterial infections at unusual sites and their sequelae in persons living with diabetes with poor glycaemic control. Two such cases were seen and managed at different times at Abia State University Teaching Hospital, (ABSUTH), Aba, Nigeria. One who had a huge back abscess was successfully managed while the second person with DKA precipitated by acute fulminant cholecystitis did not make it. A back abscess in a patient with DM is either underreported in Nigeria or rare.

In conclusion, surgical interventions (incision and drainage (I &D), debridement and serial wound dressings or cholecystectomy), antibacterial therapy and optimal glycemic control with insulin are necessary to ensure a favourable outcome.

Keywords: diabetes mellitus, bacterial infections, unusual infection sites, back abscess, fulminant cholecystitis.

References

  1. Brownlee M, Aiello LP, Cooper ME, Vinik AI, Nesto RW, Boulton AJM. Complications of Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, editors,    Williams Textbook of Endocrinology, 11th ed. Philadelphia: Saunders; 2008; 30: 1329 – 1416.
  2. Rheeder P. Type 2 Diabetes: the emerging epidemic. South African Family Practice 2006; 48 (10): 20.
  3. International Diabetes Federation, IDF diabetes atlas. Epidemiology  of diabetes. Available at: http//idf.org/diabetesatlas/5e/the-gllobal-    burden-       United States. Accessed 17 November 2013.
  4. Eugene Sogwi, diabetes in sub saharan Africans and Africans In: Wass JAH, Stewart PM, Amiel SA, Davies MJ, editors, Oxford textbook of Endocrinology and Diabetes. 2nd Oxford: Oxford university press; 2011: 2095 - 2143.
  5. Kitabchi AE, Nyenwe E. Hyperglycaemic crises in adult patients with diabetes mellitus. In: Wass JAH, Stewart PM, Amiel SA, Davies MJ, editors.Oxford textbook of Endocrinology and Diabetes. 2nd ed. Oxford: Oxford university press; 2011: 2095 - 2143.
  6. Uloko AE, Adeniyi AF, Abubakar LY, Yusuf SM, Abdu A, Gezawa ID, Uloko AT. Pattern of diabetes admissions in a Northern Nigerian Tertiary Health Centre.Nigerian Endocrine Practice. 2013;7(1):15 –
  7. Wilson J, Guy R, Elgohari S, Sheridan E, Davies J, et al. Trends in sources of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: data from the national mandatory surveillance of MRSA bacteraemia in England, 2006–2009. J Hosp Infect. 2011; 79: 211–217.
  8. Sreeramoju P, Porbandarwalla NS, Arango J, Latham K, Dent DL, et al. Recurrent skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus requiring operative debridement. Am J Surg. 2011; 201: 216–220.
  9. Bhavan KP, Marshcall J, Olsen MA, Fraser VJ, Wright NM, et al. The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis. 2010; 10: 158.
  10. Aragon-Sanchez J, Quintana-Marrero Y, Lazaro-Martinez JL, Hernández-Herrero MJ, García-Morales E, et al. Necrotizing soft-tissue infections in the feet of patients with diabetes: outcome of surgical treatment and factors associated with limb loss and mortality. Int J Lower Extremity Wounds. 2009; 8: 141–146.
  11. Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004 Feb. 27(2):553-91.
  12. Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med. 1997 Jan. 14(1):29-34.
  13. Shizuma T, Fukui S, Todoroki K. A Case of Back Abscess and Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus. Diabetes Case Rep. 2016; 1:106.
  14. Joshi N, Caputo GM, Weitekamp MR, Kar chmer AW. Infections in patients with diabetes mellitus. N Engl J Med. 1999; 341: 1906-1912.
  15. Takaoka S, Yamane Y, Nishiki M, Kato Y. A case of back abscess followed by ketoacidosis, elevated pancreatic enzyme and sepsis in a patient with type 2 diabetes mellitus. Practice. 2003; 20: 467-470
  16. Sumi D, Kobayashi Y, Yano T, Tanito K, Kamide R. Back abscess.Practical Dermatology. 2007; 30: 881-884.
  17. Rayfield EJ, Ault MJ, Keusch GT, Brothers MJ, Nechemias C, et al. Infection and diabetes: the case for glucose control. Am J Med. 1982; 72: 439-450.
  18. Abengowe CU, McManamon PJ. Acute emphysematous cholecystitis. Canadian Medical Association journal, 1974; 16
  19. Rosenberg AA, Cherry-Bukowiec JR, Li SH, Napolitano LM. Emphysematous cholecystitis. Surgical infections, 2013 Oct [PubMed]
  20. Liao CY, Tsai CC, Kuo WH, Ben RJ, Lin HC, Lee CC, Su KJ, Wang HE, Wang CC, Chen IH, Chien ST,Tsai MK, Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature. BMC nephrology, 2016 Mar 1 [PubMed].

Corresponding Author

Dr MO Nkpozi

Department of Internal Medicine, Abia State University Teaching Hospital (ABSUTH), Aba, Abia State, Nigeria

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., GSM: +2348058525899.