Prevalence of fungal foot infections in patients with diabetes mellitus type 1 - underestimation of moccasin-type tinea.

In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome. However, few data are available on the prevalence of fungal foot infections in patients with diabetes. During a conference attended by patients with long-term diabetes, 95 individuals with type 1 diabetes mellitus (52 men, 43 women, mean disease duration 35.8 years) were examined for fungal infections of the feet. As well as frequency of infection and risk profiles, the level of patient awareness and preventive measures taken were assessed by means of a questionnaire. Clinically, 78 patients (82.1 %) showed probable pedal fungal infections, of which 84.6 % (66/78) were mycologically confirmed by direct microscopy and/or culture. Skin mycoses were found in 9 patients (toe webs 5, soles 4), onychomycosis in 29 patients and simultaneous infection of nails and skin in 28 patients (toe webs 8, soles 20). Thirty-seven (47.4 %) of these patients had positive cultures, particularly for the dermatophyte Trichophyton rubrum (69.2 % of isolates). A significant correlation was found between infection and gender (men more frequently affected) and the age of the patients. The actual frequency of mycoses was underestimated by the patients. This correlated with the assessment of their own knowledge level concerning fungal infections: 83.2 % of patients with skin mycoses and 88.4 % of those with onychomycosis of the feet felt that they needed more information about their disease. Marked mycoses on the soles were often considered to be dry skin by the patients. The high number of infections detected is especially remarkable in that this group of patients were highly motivated. It therefore appears that diabetics require more diagnostic, therapeutic and preventive care in terms of mycotic diseases than has been previously thought.