A boy with riboflavin-responsive beta-oxidation deficiency (multiple acyl-CoA dehydrogenation deficiency) was assessed clinically and biochemically after 3 years of continuous riboflavin medication. He was diagnosed at the age of three years after an attack of a Reye's syndrome-like disease. During the 3 years of assessment he has experienced no serious disease; although short episodes of fatigue and loss of appetite have been noted. His mental and physical development has been normal. Biochemically the abnormal excretion of organic acid metabolites, characteristic of the acyl-CoA dehydrogenation deficiency, has been continuously present. Quantitatively there has been a trend to a more simple picture with ethylmalonic acid as the predominant metabolite. However, because of the large within-day variation in the excretion of all the metabolites, changes following diet and riboflavin trials must be interpreted with caution in these patients.
OBJECTIVE: To determine if there is an association between carriage of oral yeasts and malnutrition in infants. DESIGN: A case‐control study within a cross‐sectional study. The dependent variable was carriage of oral yeasts. The exposure variable was malnutrition and con‐founders to be adjusted for were age, sex, and breastfeeding. SETTING: A maternal and child health clinic in Dar‐es‐Salaam, Tanzania that offers routine medical check‐ups to all expectant mothers and children aged between 0 and 5 years in its catchment areas. SUBJECTS AND METHODS: 972 infants aged 6–24 months participated. Smears from the tongue and cheek mucosa were examined for candidal hyphae and blasto‐spores. Malnutrition was categorized according to Tanzanian standards (weight‐for‐age) and World Health Organization (WHO) standards (weight‐for‐height and height‐for‐age). MAIN OUTCOME MEASURE: Carriage of oral yeasts (hyphae and blastospores). RESULTS: Carriage of oral yeasts was significantly higher in the 227 malnourished compared with the 745 wetl nourished adjusted for confounders. Odds ratio for presence of hyphae in smears from the severety malnourished (weight‐for‐age) was 4.5 (90% CI: 2.0–10.0). Odds ratio for presence of hyphae was 2.3 (90% CI: 1.1–4.8) when weight‐for‐height were used to categorize for malnutrition. CONCLUSION: The study tends to confirm the generally hetd view that malnutrition may predispose to carriage of oral yeasts and subsequent oral candidiasis.
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