Background. Patients with diabetes represent 50 to 70 % of patients who undergo nontraumatic foot or leg
amputation, caused mostly by infection and necrosis of soft tissues accompanied with osteomyelitis. Signs and
symptoms of infections may often be absent in patients with infected foot ulcers – the syndrome of „diabetic foot“
(DF). The course and consequences of the infection may be influenced by the immune system dysfunction. The aim
of our study was to assess presence of the chronic inflammation and specific immune responses, both humoral and
cellular in patients with diabetic foot infection.
Methods and Results. 34 patients treated over one month for an infected DF in our foot clinic (mean age 54±8
years, mean duration of diabetes 20±9 years, mean HbAlc 8.8±1.5 %), were matched with 27 healthy subjects. All
patients were without clinical signs of acute deep foot infection and without critical leg ischemia. The inflammatory
response was assessed by white blood cells count and C-reactive protein (CRP), humoral immune response was
assessed by immunoglobulins (Ig) and cellular immunity was evaluated by T lymphocytes subpopulations. Patients
with DF compared with healthy controls exhibited the laboratory signs of infection – significantly increased white
blood cells count (7.6±2.1 vs. 6.4±1.3.109/l, p<0.01) and neutrophil count (4.6±1.8 vs. 3.8±0.9.109/l, p<0.05) and
significantly increased CRP (7±12 vs. 2±6 mg/l, p<0.01). Patients with DF had also significantly higher IgA levels
(3.5±1.6 vs. 2.7±1.1 g/l, p<0.05) and significantly more CD3+ T cells (76±8 vs. 71±10 %, p<0.05) and suppressor/
cytotoxic CD8+ T cells (32±11 vs. 26±10%, p<0.05). Other followed parameters, IgG, IgMand serum monocyte
and lymphocyte counts, CD4+ helper T cells and CD4+/CD8+ T-cell ratio did not differ between patients with DF
and healthy controls.
Conclusions. We did not anticipate a severe secondary immunodeficiency in followed cellular and humoral
immune parameters in patients with chronic bacterial foot infection. It is necessary to assess the sufficiency of
immune system activation with respect to chronic inflammation in next research.
diabetic foot, infection, immunity.