Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: clinical features and associated factors

OBJECTIVES: A retrospective study was performed to investigate the clinical characteristics and associated factors for invasive fungal disease (IFD) in patients with type 2 diabetes mellitus (T2DM). METHODS: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. RESULTS: IFD was diagnosed in 120 patients with T2DM (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%) was the most common. Urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved lung (34/49, 69.4%). Fifteen (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%), and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by gram-negative bacteria. The inpatient mortality rate of IFD was 23.3% (28/120). HbA1c level was higher in non-survivors than survivors (8.8±2.5 vs 7.7±2.1 %, P=0.02). Anemia (adjusted odds ratio (OR) 3.50, 95% confidence interval (CI) 1.95-6.27, P<0.001), hypoalbuminemia (adjusted OR 5.42, 95% CI 3.14-9.36, P<0.001), and elevated serum creatinine (adjusted OR 2.08, 95% CI 1.07-4.04, P=0.03) were associated with IFD in T2DM patients. CONCLUSIONS: IFD is a life-threatening complication in T2DM patients. Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.