Abstract
Diabetic foot infection is the leading cause of non-traumatic lower limb amputations worldwide. In addition, diabetes mellitus and sequela of the disease are increasing in prevalence. In 2017, 9.4% of Americans were diagnosed with diabetes mellitus (DM). The growing pervasiveness and financial implications of diabetic foot infection (DFI) indicate an acute need for improved clinical assessment and treatment. Complex pathophysiology and suboptimal specificity of current non-invasive imaging modalities have made diagnosis and treatment response challenging. Current anatomical and molecular clinical imaging strategies have mainly targeted the host’s immune responses rather than the unique metabolism of the invading microorganism. Advances in imaging have the potential to reduce the impact of these problems and improve the assessment of DFI, particularly in distinguishing infection of soft tissue alone from osteomyelitis (OM). This review presents a summary of the known pathophysiology of DFI, the molecular basis of current and emerging diagnostic imaging techniques, and the mechanistic links of these imaging techniques to the pathophysiology of diabetic foot infections.
Highlights
In the past 30 years, diabetic foot infections (DFI) have become increasingly prevalent due to the rising incidence of diabetes mellitus (DM)
Twenty percent of diabetes-related hospital admissions in the U.S are from DFI [2], which is typically introduced by direct inoculation through a traumatic entry site in an insensate foot
Scintigraphy, single-photon emission computed tomography (SPECT), and Positron Emission Tomography (PET) imaging are molecular imaging modalities used for DFI assessment [110]
Summary
In the past 30 years, diabetic foot infections (DFI) have become increasingly prevalent due to the rising incidence of diabetes mellitus (DM). Countries with the highest prevalence of DFU included Belgium (16.6%), Canada (14.8%), and the United States (13.0%) [4] The authors of this meta-analysis chose to exclude any studies that stated ulcer recurrence, suggesting that the overall occurrence of DFU is higher. Several pathological factors place diabetic patients at increased risk for foot infections, including diabetic neuropathy, vascular insufficiency, and immunological dysfunction [12]. Foot deformity (Charcot arthropathy, claw foot, pes cavus, hallux valgus), and gait abnormalities are caused by motor neuropathy resulting from the loss of myelinated fibers [18] These biomechanical changes predispose neuropathic patients to foot ulceration due to increased pressure and shearing. Darrcyhs. kDinry(xsekrions(ixs)erios saiss)igisnaosfiaguntoofnaoumtiocnnoemuirconpeauthroyp. (act)hPy.at(ice)nPtaptireenset nptriensgenwtiinthg CewxhtiatehrncdCosthtfaoorocttohtde efbofooonrtmediietsyfoaarlsmnoditsoyeveanenr.ld(ydion)vgPeamrtliyiedinnftogowmtiutihdlcfaeonro. tiMnufaleccceetrre.adtMeudlacscekerirnwataietrdhousaknbisdncetahsrseooeudnngdtehstehogefretehdaetgeutoslecoeafrntadhnedxuearlocsesinirsuassnutdgragacetssttinihnaugts aturatoctntohmaitcenxeteunrodpsattohyth. e(eb) oPnaetieisntawlsoithseaepno. s(tde)riPoarthieenelt uwlcitehr caonnitnafinecintegdaunleccerrowticitbhaasbesacnedssuonndethrme ignrienagt otofesuarnrdouxnedroinsgis sskuigng. esting autonomic neuropathy. (e) Patient with a posterior heel ulcer containing a necrotic base and undermining of surrounding skin
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