Definition of Oral Candidiasis

Candidiasis of the mouth and throat, also known as thrush" or oropharyngeal candidiasis, is a fungal infection that occurs when there is overgrowth of a yeast called Candida. Candida yeasts normally live on the skin or mucous membranes in small amounts. However, if the environment inside the mouth or throat becomes imbalanced, the yeasts can multiply and cause symptoms. Candida overgrowth can also develop in the esophagus, and this is called Candida esophagitis, or esophageal candidiasis.

Symptoms of Oral Candidiasis

Candida infections of the mouth and throat can manifest in a variety of ways. The most common symptom of oral thrush is white patches or plaques on the tongue and other oral mucous membranes. Other symptoms include:

Redness or soreness in the affected areas Difficulty swallowing Cracking at the corners of the mouth (angular cheilitis)

It is important to see your doctor if you have any of these symptoms.

Who Gets Oral Candidiasis?

Candida infections of the mouth and throat are uncommon among adults who are otherwise healthy. Oral thrush occurs most frequently among babies less than one month old, the elderly, and groups of people with weakened immune systems. Other factors associated with oral and esophageal candidiasis include:

HIV/AIDS Cancer treatments Organ transplantation Diabetes Corticosteroid use Dentures Broad-spectrum antibiotic use

How Can I Prevent Oral Candidiasis?

Good oral hygiene practices may help to prevent oral thrush in people with weakened immune systems. Some studies have shown that chlorhexidine (CHX) mouthwash can help to prevent oral candidiasis in people undergoing cancer treatment. People who use inhaled corticosteroids may be able to reduce the risk of developing thrush by washing out the mouth with water or mouthwash after using an inhaler.

Causes of Oral Candidiasis

Candida species are normal inhabitants of the mouth, throat, and the rest of the gastrointestinal tract. Usually, Candida yeasts live in and on the body in small amounts and do not cause any harm. However, the use of certain medications or a weakening of the immune system can cause Candida to multiply, which may cause symptoms of infection.

Oral Candidiasis Statistics

The infection is not very common in the general population. It is estimated that between 5% and 7% of babies less than one month old will develop oral candidiasis. The prevalence of oral candidiasis among AIDS patients is estimated to be between 9% and 31%, and studies have documented clinical evidence of oral candidiasis in nearly 20% of cancer patients.

Diagnosis & Testing of Oral Candidiasis

A healthcare provider diagnoses the infection based on your symptoms, and by taking a scraping of the affected areas to examine under a microscope. A culture may also be performed; however, because Candida organisms are normal inhabitants of the human mouth, a positive culture by itself does not make the diagnosis.

Treatment & Outcomes of Oral Candidiasis

Candida infections of the mouth and throat must be treated with prescription antifungal medication. The type and duration of treatment depends on the severity of the infection and patient-specific factors such as age and immune status. Untreated infections can lead to a more serious form of invasive candidiasis. Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin swish and swallow). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments. Candida esophagitis is typically treated with oral or intravenous fluconazole or oral itraconazole. For severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.
http://www.cdc.gov/fungal/Candidiasis/thrush/

Thrush
Candidiasis - oral; Oral thrush; Fungal infection - mouth; Candida - oral

Last reviewed: October 6, 2012. Thrush is a yeast infection of the mucus membrane lining the mouth and tongue.

Causes, incidence, and risk factors

The body normally hosts a variety of germs ,including bacteria and fungi. Some of these are useful to the body, some produce no harm or benefit, and some can cause harmful infections. Thrush occurs when a fungus called Candida overgrows in your mouth. A small amount of this fungus lives in your mouth most of the time. It is usually kep tin check by your immune system and other germs that also normally live in your mouth. However, when your immune system is weak or when the other normal bacteria die, the fungus can overgrow. The following factors can increase your chances of getting thrush: The following factors can increase your chances of getting thrush:

Being in poor health Being very old or very young Having an HIV infection or AIDS Long-term use or high dose antibiotics Receiving chemotherapy or drugs that weaken the immune system Taking steroid medications

Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a couple of weeks. Candida can also cause yeast infections in the vagina. People who have diabetes and have high blood sugar levels are more likely to get thrush in the mouth (oral thrush), because the extra sugar in your saliva acts like food for Candida. Taking high doses of antibiotics or taking antibiotics for a long time also increases the risk of oral thrush. Antibiotics kill some of the healthy bacteria that help keep Candida from growing too much. People with poorly fitting dentures are also more likely to get thrush.

Symptoms
Thrush appears as whitish, velvety sores in the mouth and on the tongue. Underneath the whitish material, there is red tissue that may bleed easily. The sores can slowly increase in number and size.

Signs and tests

Your doctor or dentist can almost always diagnose thrush by looking at your mouth and tongue. The sores have a distinct appearance. If the diagnosis is not clear, one of the following tests may be performed to look for Candida:

Culture of mouth lesions Microscopic examination of mouth scrapings

Treatment
For thrush in infants, treatment is often NOT needed. It usually gets better on its own within 2 weeks. If you develop a mild case of thrush after taking antibiotics, eating yogurt or taking over-thecounter acidophilus capsules can help. Use a soft toothbrush and rinse your mouth with a diluted 3% hydrogen peroxide solution several times a day. Good control of blood sugar levels in persons with diabetes may clear a thrush infection. Your doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole) to suck on if you have a severe case of thrush or a weakened immune system. These products are usually used for 5 - 10 days. If they don't work, other medication may be prescribed. You may need stronger medications, such as fluconazole (Diflucan) or itraconazole (Sporanox) if:

You have a weakened immune system due to HIV or some medicines The infection is moderate to severe The infection spreads through your body

Expectations (prognosis)
Thrush in infants may be painful, but it is rarely serious. Because of discomfort, it can interfere with eating. If it does not get better on its own within 2 weeks, call your pediatrician.

In adults, thrush that occurs in the mouth can be cured. However, the long-term outlook depends on your immune system and the cause of the immune problem.

Complications
If you have a weakened immune system, Candida can spread throughout your body, causing a widespread (invasive) infection. This might affect your:

Brain (meningitis) Esophagus (esophagitis) Eyes (endophthalmitis) Heart (endocarditis) Joints (arthritis)

Calling your health care provider

Call your doctor if:

Your infant has had thrush-like sores in the mouth for at least 2 weeks. Your infant is eating poorly due to the sores. You are a teen or adult with thrush-like sores. You have pain or difficulty swallowing. You have symptoms of thrush and you are HIV positive, receiving chemotherapy, or you take medications to suppress your immune system.

Prevention
If you get thrush often, your doctor may recommend taking antifungal medication on a regular basis to avoid repeat infections. If an infant with thrush is breastfeeding, talk to your doctor about ways to prevent future infections, such as an antifungal medication. Sterilize or throw out any pacifiers. For bottle-fed babies with thrush, throw out the nipples and buy new ones as the baby's mouth begins to clear. To prevent the spread of HIV infection, follow safe sex practices and use precautions when working with blood products.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001650/ Oral and injected antifungals

Abelcet (amphotericin) AmBisome (amphotericin) Ancotil (flucytosine) Daktarin oral gel (miconazole) Diflucan (fluconazole)

Fungizone (amphotericin) Lamisil tablets (terbinafine) Nizoral tablets (ketoconazole) Nystan oral suspension (nystatin) Sporanox capsules (itraconazole) Sporanox liquid (itraconazole) Vfend (voriconazole)

http://www.netdoctor.co.uk/medicines/treatments-for-fungal-infections.shtml