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Fungi associated with delayed healing in diabetic foot ulcers, says study

The presence of fungi within wounds can be associated with longer healing times and poor health outcomes, according to a new study.
People with diabetes often find wounds take longer to heal, and this research highlights the potential significance of the fungi found in diabetic foot ulcers – a diabetic foot ulcer is a complication that one in 10 people with diabetes will develop at some point in their lives.
“Chronic wounds are a silent epidemic,” said senior author Elizabeth Grice, assistant professor of dermatology and microbiology at University of Pennsylvania in Philadelphia. “They usually occur in conjunction with another disorder such as diabetes or obesity, but once a chronic wound occurs, it requires a lot of healthcare and has a devastating effect on a patient’s quality of life.”
Grice’s team analysed 100 patients with diabetic foot ulcers over 26 weeks, or until the wound healed or required amputation. All the wounds were open and located on the bottom of the foot.
Patients were all given the same treatment, and deep wound fluid was sampled every two weeks and sent for genetic sequencing and identification of fungi residing in the wounds.
The researchers observed that 80 per cent of the wounds harboured fungin, with mixed communities of fungi associated with slow healing or complications such as bone infection and amputation.
They also noted that wounds with higher levels of ascomycetes, known as sac fungin, were associated with wounds that took more than two months to heal. The study team hypothesise that doctors could therefore swab wounds to predict how long it might take to heal.
Postdoctoral researcher Lindsay Kalan found that the fungi interacted with the bacteria in wounds, potentially causing biofilms which could explain the longer duration for healing.
Grice added that this interaction is important as it could lead to properly targeted treatment for people with diabetic foot ulcers in the future.
Her team now plan on exploring further the interactions between the fungal and bacterial communities and how the immune system responds.
The findings are published in mBio.

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