Bristow, I.R. and Spruce, M.C.
Fungal foot infection, cellulitis and diabetes: a review
Diabetic Medicine, 26, (5), . (doi:10.1111/j.1464-5491.2009.02722.x).
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Aims To review the current evidence for the presence of fungal foot infection (tinea pedis and toenail onychomycosis) as a risk
factor for the development of cellulitis within the lower limb, particularly for those individuals with diabetes.
Methods A structured review of medline, embase and cinahl databases was undertaken to identify publications
investigating fungal foot infection as a risk factor for the development of cellulitis.
Results Sixteen studies were identified. Eight studies adopted a case–control methodology, with the remainder being crosssectional
surveys. The majority of studies established the presence of tinea infection by clinical rather than established
microbiological methods. Although the majority of papers suggested a link, only two case–control studies employed
microbiological diagnosis to demonstrate that fungal foot infection was a risk for the development of lower limb cellulitis,
particularly when infectionwas located between the toes. Therewere insufficient data to suggest that fungal foot infection posed
an increased risk to patients with diabetes.
Conclusion There is some evidence to suggest that fungal infection of the foot is a factor in the development of lower limb
cellulitis, but further robust research is needed to confirm these findings and quantify the risk that fungi pose, particularly to
the diabetic foot.Meanwhile, improved surveillance and treatment of tinea infections on the foot by healthcare professionals
should be encouraged to reduce potential complications.
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