Background <br />The prevalence of type 2 diabetes mellitus (DM) is increasing. Diabetic patients have a higher risk of getting dermatomycosis. Dermatomycoses, although a common health problem amongst DM, is often misdiagnosed and consequently undertreated. Studies on the association between dermatomycosis and type 2 diabetes are lacking, especially in Indonesia. Therefore, the aim of this study was to determine the prevalence, etiology, and association of dermatomycosis with diabetic control of type 2 DM. <br /><br />Methods<br />A cross-sectional study was performed involving 87 subjects with type 2 DM. Demographic and clinical data, including age, sex, and blood glucose level, were collected. If a dermatomycosis lesion was found, a specimen would be taken for identification. Determination of serum glucose level was conducted using Roche c111 analyzer®. Statistical analysis was performed with the chi-square test and Kolmogorov-Smirnov two-independent sample test.<br /><br />Results<br />Seventeen (19.55%) subjects had dermatomycosis. The predominant age group affected was 51 - 60 years (42.4%). The number of clinically apparent dermatomycosis was greater in the uncontrolled than in the controlled blood sugar group, but the difference was statistically not significant (p > 0.05). The lesions were mostly found on the nails (74%) and the most common etiology was candida (50%) followed by dermatophyte (25%) and non-dermatophyte molds (25%). <br /><br />Conclusion<br />Uncontrolled blood sugar tends to increase the risk of dermatomycosis in type 2 DM patients. Fungal skin infections are common in type-2 DM patients, especially in those with poor glycemic control.
Introduction: Overlapping symptoms between dengue and COVID-19 may become diagnostic challenge; moreover, social stigma and fear of being diagnosed with COVID-19 may lead the patients to delayed medical visit. Delayed medical management of dengue may lead to expanded dengue syndrome and fatal outcome. Case Presentation: A 35-year-old female patient with uncontrolled diabetes mellitus and recent COVID-19 infection presented with continuous fever for four days. She delayed seeking medical advice due to traumatized being infected by COVID-19, self-isolation protocol, and COVID-19 protocol in every hospital for every febrile patient. She developed multi organ failure during hospitalization and was diagnosed with expanded dengue syndrome. Clinical Discussion: Diagnosing the etiology of acute febrile illness in the COVID-19 pandemic era is problematic. Most of healthcare facilities warranted COVID-19 evaluation in every acute febrile patient. This protocol may lead to potential delayed diagnosis and serve as a barrier to accessing healthcare facility. False perception, fear and anxiety of being isolated, discrimination in society, and others may lead to stigmatization of COVID-19 and affect the individual decision for COVID-19 testing and seeking medical advices. Our patient had a fatal outcome due to delayed detection and treatment of dengue hemorrhagic fever. Conclusion: Delayed management of expanded dengue syndrome leads to fatal outcome. Stigma may play role as the barrier for seeking medical advice. Having broad differential diagnosis in COVID-19 pandemic era is essential.
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