Thrush (infection)
Thrush is a fungal infection primarily affecting the mouth, caused by an overgrowth of the yeast organism Candida albicans. This condition often starts on the tongue and inside the cheeks, potentially spreading to other areas such as the gums, throat, and even the larynx and digestive tract in severe cases. Various factors can disrupt the natural balance of microorganisms in the mouth, leading to thrush, including age, weakened immune systems, certain medications (like antibiotics and corticosteroids), and underlying health conditions like diabetes.
Symptoms typically include white or red patches in the mouth, a thick coating, dry mouth, and in more advanced cases, difficulties with swallowing. Diagnosis usually involves a medical history review and a physical examination, sometimes accompanied by a microscopic analysis of samples taken from the affected area. Treatment focuses on restoring the normal balance of oral flora, often employing antifungal medications and improved oral hygiene practices. Preventive measures can also be effective, such as avoiding unnecessary antibiotics and maintaining proper dental care. Understanding thrush is crucial, as it can significantly impact comfort and quality of life, particularly for those with compromised immune systems.
Thrush (infection)
- ANATOMY OR SYSTEM AFFECTED: Larynx, mouth, respiratory system, skin, throat, tongue
- ALSO KNOWN AS: Oropharyngeal candidiasis
Definition
Thrush is a fungal infection of the mouth caused by an overgrowth of the yeast organism Candida albicans. Thrush usually begins on the tongue and inside the cheeks and may spread to the palate, gums, tonsils, and throat. In severe cases, the infection may spread to the larynx (voice box), digestive tract, respiratory system, and skin.
Causes
Many microorganisms, including yeast and bacteria, live in the mouth. Thrush occurs when the normal balance of these organisms is upset, allowing an overgrowth of Candida.
Risk Factors
Risk factors for developing thrush include age (infants, toddlers, and the elderly); a weakened immune system from human immunodeficiency (HIV) virus infection, acquired immunodeficiency syndrome (AIDS), medications associated with organ transplantation, cancer, or medical treatments for cancer, such as chemotherapy; stress; prolonged illness; use of antibiotics; use of oral or inhaled corticosteroids; diabetes; hormonal changes, such as those associated with pregnancy or the use of birth control pills; wearing dentures; conditions that cause a dry mouth; and smoking. Additional factors that increase the risk of thrush may also include poor oral hygiene and specific vitamin deficiencies.
Symptoms
The symptoms of thrush, which occur in the mouth, include white, raised patches; red, slightly raised patches; discharge with a curdlike appearance (like cottage cheese); thick, dark brownish coating in the mouth; dry mouth; and fissures or cracks in the mouth. If the infection spreads into the esophagus, one may also experience difficulty or pain with swallowing or a sensation of something “stuck” in the throat. If thrush spreads systemically, one may develop a fever.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and examine the patient’s mouth. A sample of cells from the affected area may be scraped off and examined under a microscope.
Treatment and Therapy
The goal of treatment is to restore the normal balance of bacteria and yeast in the mouth. Treatments may include antifungal medications such as lozenges, troches (a type of lozenge that dissolves in the mouth), tablets, or oral rinses; medications that are active against yeast, such as nystatin (Bio-Statin and Nilstat), clotrimazole (Lotrimin and Mycelex), miconazole, and gentian violet; and, for breastfeeding mothers of infants with thrush, a topical antifungal medication placed on the woman’s nipples to reduce the infant’s infection.
Oral hygiene practices that may aid healing include rinsing one’s mouth with warm salt water and gently scraping off patches with a toothbrush. Finally, underlying conditions contributing to thrush can be identified and treated.
Additional treatments for thrush include fluconazole, amphotericin B, and itraconazole. These oral antifungal medications may be prescribed for more severe cases.
Prevention and Outcomes
Preventive measures can be taken to reduce the risk of thrush. Thrush in adults is often associated with AIDS, so persons with thrush should obtain a blood test for HIV and follow recommended prevention guidelines, such as using condoms and other protection and avoiding needles except under sterile conditions.
Persons who are at high risk for or who are prone to thrush may be given antifungal medication as a preventive measure. If prone to thrush, one should avoid overusing mouthwashes and mouth sprays, which can upset the normal balance of yeast and bacteria in the mouth. If a baby is prone to thrush and drinks from a bottle, the baby should drink from the bottle with disposable nipples.
One should avoid unnecessary antibiotic use. If avoiding antibiotics is not an option, one should consider eating yogurt or using acidophilus tablets (probiotics) during antibiotic treatment and several weeks afterward. One should decrease their intake of sugar- and yeast-containing foods and beverages, such as bread, wine, and beer, and, if using a cortisone inhaler, rinse the mouth thoroughly after each use.
Bibliography
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