Skin and Soft Tissue Infections Among the Diabetic Patients in Faridpur, Bangladesh

Diabetic is now a day’s most prevalent endocrine disorder; the number of occurrences increases day by day. In our country the new case of diabetic mellitus is remarkably increases in every year. Due to the pathophysiology of this disease, diabetic patient is more susceptible to infection, and they are more porn to develop complicated skin and soft tissue infections. The study was conducted among the diabetic patients in Faridpur Diabetic Association Medical College from April to September 2019. The present study has been done on the skin and soft tissue infections among the diabetic patients in Faridpur district. Among the respondent the highest percentage of the respondent’s sufferings from type- 2 diabetic mellitus about (81.8 %), (14.9 %) sufferings from type-1 diabetic mellitus. Out of 121 respondents, 60 (49.6%) were male and 61 (50.4%) were females. Among the respondent the highest percentage of the respondents are not suffering from skin and soft tissue infection (73.6%), only 26.4 % are sufferings from skin and soft tissue infection. The incidence of skin and soft tissue infection was relatively more frequent among the patients whose blood glucose level was poorly controlled and uncontrolled.

Necrotizing fasciitis: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The speed of spread is directly proportional to the thickness of the subcutaneous layer.
The perineum, trunk, abdomen and upper extremities are most commonly involved in Necrotizing fasciitis [13]. In soft-tissue infections, foot infections are the most common soft tissue infections in patients with diabetes. In DM, fasciitis is characterized by poly-microbial growth, with single anaerobic and multiple aerobic microorganisms [14,15].
Fungal and yeast infections: In diabetic individuals, mycotic infections might elevate the risk of manifesting diabetic foot syndrome [16]. Patients with improperly controlled diabetes disease are more prone to Mucocutaneous Candida infections.
Perleche remains atypical warning of diabetes onset in children [17]. Recent studies have shown a statistically significant relationship between the most common dermatophyte infections like Epidermophyton floccosum and Trichophyton mentagrophytes, Trubrum with diabetes [18].

Viral Infections
Since long time, viruses have been suggested as a potential environmental trigger for DM (typically type-1 diabetes). Viruses belonging to the Enterovirus genus have the capacity to initiate and/or accelerate islet autoimmunity but cannot fully explain the etiology as a sole environmental trigger [19]. In the present investigation, the main objective was a) Dentification of skin diseases including the fungal and bacterial infections among the diabetic patients in DAMCH.
b) Prevalence of skin diseases in different age and sexes groups,

c)
The prevalence of skin and soft tissue infections in earlier diagnosed age group and long-standing diabetic patients and d) Variations of prevalence of skin and soft tissue infections among the different type of diabetic patients. sand muscular.
Justification of this study: Skin and soft-tissue infections (SSTIs) are common reasons to seek medical care in the inpatient and outpatient settings. There were an estimated 869,800 hospital admissions in the hospitals for SSTIs in 2004 [20]. Several investigations have noted that the incidence of SSTIs is increasing in both the inpatient and outpatient settings in the U.S. during the first decade of the 21 st Century, with increases of 29% in the inpatient setting over a 4-year period and 50% in the outpatient setting over an 8-year period [21].

Materials and Methods
The study was conducted at Diabetic Association Medical College Hospital Faridpur. This study period was from April 2017 to September 2019). The study population will be all diabetic patient who admit in this hospital. A pretested semi-structured interview questionnaire with both, open-ended and closed-ended was be used to collect data. The statistical package for social sciences (SPSS) version 22.0 will be used to analyze the data. Obtained data will be evaluated by frequency and percentages ratios, Chi-square (χ2), logistic regression analyses etc.

Data Collection
Face-to-face interview was taken using the questionnaire.
Respondents was provided a detailed explanation of each question in the local language.

Data Processing and Analysis:
At the end of each day of data collection, each questionnaire was checked whether the questionnaire is filled completely and

Results
Out of 121 respondent 60 (49.6) were male respondent and 61 (50.4%) were female respondent ( Table 1). The participation of the female respondents was higher than the male respondent.       (Table 4).
Among the respondent, the highest percentage previously had no skin infection (86.8%) and only 13.2% had skin infection (Table 5). % due to irregular oral medication, and 18.2 % due to uncontrolled diet and 9.9 % due to inadequate physical exercise (Table 6).     The above Table 7 shows that there is no significant relationship between types of diabetic mellitus and skin infection. monthly income of the family and parents wish to send to the school, x2(1, N=121) =3.608, p=.729.      The risk of Group B streptococcal infections was found to be increased with age [24]. Staphylococcus aureus is a major pathogen implicated in diabetic foot infections [9,25]. Staphylococcal folliculitis or skin abscesses are counted as the most common bacterial infections in uncontrolled diabetes (Klingelhoets et al. 2015) [26,27]. Acute and Invasive ("malignant") otitis externa is a quite rare but potentially fatal infection of the external auditory canal and skull. It mainly involves inflammation of the ear canal [28]. Pseudomonas aeruginosa is the causative organism in the vast majority of cases. The acute form is caused primarily by P. aeruginosa and S. aureus. Acute otitis externa manifests with Unrelenting pain and rapid onset of ear canal inflammation, resulting in otalgia, itching, canal edema, canal erythema, and otorrhea.

Conclusion
Diabetes mellitus is one of the chronic deadly diseases worldwide. The complication of this disease is mainly the burden.
Skin and soft tissue infection is most common complication of this disease [34][35][36]. Diabetic patient is more porn to infection by various organisms such as fungus bacteria, virus, parasite etc. The study reveals that, within 121 respondents, most of the diabetic patients had skin and soft tissue infection and the patients who had uncontrolled blood glucose level they were frequently experienced of this complication [37]. The lack of knowledge and also unhealthy practices are also a cause of skin and soft tissue infection among diabetic patients. Skin disease is more frequently occur among the patients whose blood glucose level was chronic and uncontrolled [38]. The prevalence of diabetic mellitus is increasing day by day and is the second cause of death worldwide. Due to its complications, the condition will be more dangerous if we cannot prevent the DM as well as control of blood sugar level of patients. That may cause various types of health complications and threatened our life [39][40][41][42][43].

Ethical Consideration
Formal approval was obtained from concerned authority of Faridpur Diabetic Association Medical College Hospital, Faridpur.