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      Oro-Pharyngeal Candidiasis in Two Dengue Patients

      case-report
      1 , 1 , 1 , , 2
      ,
      Cureus
      Cureus
      mutant era, oral thrush, oral candidiasis, hyperglycemia, dengue hemorrhagic fever (dhf)

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          Abstract

          Dengue, a prevalent arboviral disease, has witnessed a resurgence in India, with outbreaks frequently reported. However, dengue-associated oral (oro-pharyngeal) candidiasis (DAOC) was never reported. We present two severe dengue cases with oral/oro-pharyngeal pseudomembranous candidiasis. Case 1 of a young man without any comorbidities or abuse or immunosuppression presented with fever, headache, altered sensorium, throat pain on recovery, and laboratory reports confirmed dengue with leukopenia, thrombocytopenia, and severe hepatic involvement with oro-pharyngeal candidiasis. Similarly, case 2 of a middle-aged man with a history of smoking and diabetes presented with fever, gum bleeding, and throat pain, later confirmed to be dengue NS1 positive with thrombocytopenia, and mild-moderate hepatic involvement along with oral-oro-pharyngeal candidiasis. Both cases showed improvement with conservative management and oral nystatin suspension. These cases prompt consideration of superadded candida infections in dengue patients, emphasizing the need for further study and clinical vigilance.

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          Impaired glucose metabolism in patients with diabetes, prediabetes and obesity is associated with severe Covid‐19

          ABSTRACT Background Identification of risk factors of severe Covid‐19 is critical for improving therapies and understanding SARS‐CoV‐2 pathogenesis. Methods We analyzed 184 patients hospitalized for Covid‐19 in Livingston, New Jersey for clinical characteristics associated with severe disease. Results The majority of Covid‐19 patients had diabetes mellitus (DM) (62.0%), Pre‐DM (23.9%) with elevated FBG, or a BMI > 30 with normal HbA1C (4.3%). SARS‐CoV‐2 infection was associated with new and persistent hyperglycemia in 29 patients, including several with normal HbA1C levels. Forty‐four patients required intubation, which occurred significantly more often in patients with DM as compared to non‐diabetics. Conclusions Severe Covid‐19 occurs in the presence of impaired glucose metabolism in patients, including those with DM, PreDM and obesity. Covid‐19 is asociated with elevated FBG and several patients presented with new onset DM or in DKA. The association of dysregulated glucose metabolism and severe Covid‐19 suggests that SARS‐CoV‐2 pathogenesis involves a novel interplay with glucose metabolism. Exploration of pathways by which SARS‐CoV‐2 interacts glucose metabolism is critical for understanding disease pathogenesis and developing therapies. This article is protected by copyright. All rights reserved.
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            Oral candidiasis.

            Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options.
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              Current Understanding of the Pathogenesis of Dengue Virus Infection

              The pathogenesis of dengue virus infection is attributed to complex interplay between virus, host genes and host immune response. Host factors such as antibody-dependent enhancement (ADE), memory cross-reactive T cells, anti-DENV NS1 antibodies, autoimmunity as well as genetic factors are major determinants of disease susceptibility. NS1 protein and anti-DENV NS1 antibodies were believed to be responsible for pathogenesis of severe dengue. The cytokine response of cross-reactive CD4+ T cells might be altered by the sequential infection with different DENV serotypes, leading to further elevation of pro-inflammatory cytokines contributing a detrimental immune response. Fcγ receptor-mediated antibody-dependent enhancement (ADE) results in release of cytokines from immune cells leading to vascular endothelial cell dysfunction and increased vascular permeability. Genomic variation of dengue virus and subgenomic flavivirus RNA (sfRNA) suppressing host immune response are viral determinants of disease severity. Dengue infection can lead to the generation of autoantibodies against DENV NS1antigen, DENV prM, and E proteins, which can cross-react with several self-antigens such as plasminogen, integrin, and platelet cells. Apart from viral factors, several host genetic factors and gene polymorphisms also have a role to play in pathogenesis of DENV infection. This review article highlights the various factors responsible for the pathogenesis of dengue and also highlights the recent advances in the field related to biomarkers which can be used in future for predicting severe disease outcome.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                20 January 2024
                January 2024
                : 16
                : 1
                : e52627
                Affiliations
                [1 ] Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
                [2 ] Family Medicine, Midland Health, Midland, USA
                Author notes
                Article
                10.7759/cureus.52627
                10876100
                38374848
                2b5365c0-85ac-4107-a001-dd971074ebf1
                Copyright © 2024, Das et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 January 2024
                Categories
                Family/General Practice
                Emergency Medicine
                Infectious Disease

                mutant era,oral thrush,oral candidiasis,hyperglycemia,dengue hemorrhagic fever (dhf)

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