Diabetes mellitus is a chronic disorder that affects a large segment of the human population and is a major public health problem. In diabetic patients, mycotic infections may increase the risk of developing diabetic foot syndrome.
A total of 60 type 2 diabetic patients with non-healing diabetic foot ulcers (DFU) were recruited for the study. Among them, 72% (43/60) had yeast and mold infections. The pathogenic yeasts were noted in 60% of the patients, of which Candida (C.) species predominated. Molds were isolated from 40% of the infected patients, of which Aspergillus (A.) species preponderated (24%). The association of fungal spores with DFU was recorded with scanning electron microscope (SEM). Assessment of ozone for preventing fungal infection of DFU was performed by recording the inhibition efficacy (IE %) of gaseous ozone.
Spore viability of C. albicans was reduced by over 99.5% at 3 ppm ozone concentration after 180 min’ exposure time. Prevention of mycelial growth in A. flavus was detected with 100% IE at 3 ppm ozone after 210 min.  With increasing duration of ozone exposure, the membrane permeability of A. flavuswas compromised as detected by protein and nucleic acid leakages accompanied with lipid and tryptophan oxidation. The study also determined the efficiency of ozonation in degrading mycotoxins produced by most dominant mycotoxigenic fungal species. The production of aflatoxins and trichothecene toxins was greatly inhibited at 3 ppm ozone after 180 min. The efficacy of ozone-like supportive therapeutic treatment of patients with DFU was compared with target antimycotic therapy and was performed only by measuring the area of lesions.