Indian Journal of Microbiology Research


Fungal isolates from diabetic amputations: Histopathologic spectrum and correlation with culture


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Article Type : Research Article

Author Details: Rajpal Singh Punia,Vikram Jassal,Reetu Kundu*,Jagdish Chander,Ashok Kumar Attri

Volume : 6

Issue : 2

Online ISSN : 2394-5478

Print ISSN : 2394-546X

Article First Page : 131

Article End Page : 134


Abstract

Objectives: Fungal infections of diabetic foot ulcers are often not suspected and when neglected are an important cause of non-traumatic diabetic limb amputations. The present study was undertaken to focus upon the diversity of fungal isolates from diabetic limb amputations.
Materials and Methods: Thirty-one diabetic patients who underwent limb amputation formed the study group. Potassium hydroxide (KOH) wet mount examination was done on bits of gangrenous tissue sent by the surgeon. Culture was also done. Representative sections from the amputation specimens were studied for histomorphology. Periodic acid-Schiff (PAS) and Grocott special staining was done on the sections to facilitate the microscopic detection of fungus.
Result: There were 20 male and 11 female patients. The age bracket was 29 to 90 years (mean: 58±9.32 years). In 13 cases fungus was isolated on KOH/culture. Candida (8), Fusarium (2), Trichosporon (2) and Aspergillus (1) were isolated. On PAS and Grocott staining, fungal profiles were visualized in 15 cases. Fungus was typed on histopathology as Candida (10), Trichosporon (2), Aspergillus (2) and Fusarium (1). Histopathologic sections revealed fungal elements of Candida in 3 culture/KOH negative cases. In 18 cases, one-month of incubation failed to yield any fungus.
Conclusions: Use of special stains facilitates identification of fungal profiles on histopathology. Careful scrutiny of slides for fungus however remains quintessential. Culture allows accurate identification of fungal strain which is necessary for therapeutic decision making thereby greatly improving the treatment outcomes. Prompt medical and surgical intervention in fungal diabetic foot ulcers can help salvaging the limb.

Keywords: Diabetes, Fungus, Histopathology, Amputation, Culture.

Doi :-https://doi.org/10.18231/j.ijmr.2019.028