Mucormycosis in Diabetes

Abstract

Fungal infections are a major health challenge especially in immunocompromised patients. Mucormycosis, a severe, frequently fatal fungal infection, has a unique predisposition to infect patients with diabetes. The infection is caused by organisms belonging to the order Mucorales, among which Rhizopus species are the most common. Uncontrolled diabetes complicated by diabetic ketoacidosis is one of the major risk factors for upsurge in mucormycosis cases. The defense mechanisms, involving macrophages and neutrophils for phagocytosis, are compromised in diabetes. In 2 cases of rhino-orbital-cerebral mucormycosis with underlying diabetes, we observed a marked immune imbalance, with elevated Th17 and diminished T regulatory cells. Recovery of CD4+CD25+ T cells after treatment indicated a favorable phenotype outcome; though high circulating CD4+CD161+ can be detrimental to the patient predisposing to future relapse(s). Mucorale specific T cells contributing to human immune responses against the fungi can be investigated to identify a surrogate diagnostic marker of invasive mucormycosis.