Candidiasis - oral

Alternative names
Oral thrush; Moniliasis - oral

Definition
Oral thrush is a disorder caused by infection of the mouth with the fungus (yeast) Candida albicans.

Causes, incidence, and risk factors

The mouth normally contains many microorganisms. One of these normal microorganisms is the fungus Candida albicans, which is the same fungus associated with vaginal yeast infections or other Candida infections. The growth of Candida is normally kept under control by the presence of normal bacteria.

Uncontrolled overgrowth of Candida in the mouth may be caused by factors that reduce the natural resistance, such as illness, stress, long-term use of corticosteroids or medications that suppress the immune system, and immune disorders such as (AIDS).

It may also be caused by conditions that upset the balance of normal microorganisms in the mouth. This is most commonly associated with use of antibiotics, but it may also occur with uncontrolled diabetes mellitus and with the hormonal changes associated with pregnancy or the use of birth control pills.

Oral thrush is most common in infants and toddlers, in the elderly, and in people who are debilitated or whose immune system has been suppressed by disease or medical treatments.

Thrush in infants is common and is usually not associated with other diseases. Infant thrush that resists treatment or recurs frequently should raise suspicions for an underlying disorder.

In adolescents, young adults, and middle age adults, an oral Candida infection should always be viewed as a possible symptom of an underlying medical problem, such as diabetes or HIV infection, and should be evaluated.

Symptoms

     
  • Ulcer/skin lesion in the mouth (usually on the tongue or inner cheeks)       o Painful       o Slightly raised area       o Creamy white appearance       o May appear curd-like (“cottage cheese” appearance)  
  • Dry mouth

Signs and tests

An examination of the mouth by the health care provider or dentist shows distinctive lesions of the mouth, tongue, or cheeks. Lesions are easily brushed away revealing a reddened, tender area that may bleed slightly.

A microscopic examination of tissue from a lesion can confirm Candida infection, but usually the diagnosis is made by simple physical examination.

Treatment

The goal of treatment is to control the growth of Candida. Antifungal medications (such as nystatin, clotrimazole, and miconazole) are given for 5 to 10 days. They are administered in the mouth (swallowing the medicine after “swishing” it around).

A single-dose oral medicine called Diflucan is available if these treatments do not work. Underlying conditions/disorders should be identified and treated.

Expectations (prognosis)

For infants, oral thrush may be painful, but is rarely serious. It can interfere with eating because of the discomfort. The infection is usually controlled with treatment, but it may recur. Thrush may spread to the palate, tongue, cheeks, or throat. Other spread of the infection is uncommon, but it may occur.

For adolescents and adults, the significance of thrush is dependent on the underlying disorder.

Complications

     
  • Insufficient nutrition  
  • Esophagitis Candida  
  • Spread of Candida to the gastrointestinal tract, lungs, skin, or other area

Calling your health care provider

Infants: If your infant has thrush, a period of watchful waiting may be appropriate, since uncomplicated thrush is frequently self-limiting. If the condition does not resolve in 2 weeks, call for an appointment with your health care provider.

Adolescents and adults: If you think you have oral thrush, call for an appointment with your health care provider. If you are being treated for thrush and symptoms worsen or persist despite treatment, symptoms recur, or new symptoms develop, call your physician.

Prevention

People with recurrent outbreaks of oral thrush, or those who are at very high risk for development of the disorder, may be given prophylactic (preventive) antifungal medications. If an infant who is breast feeding has oral thrush, the mother also should use a topical antifungal medication on her nipples to prevent continuous spread to the infant.

In bottle-fed babies, discard the nipples and buy new ones as the babies mouth begins to clear because the fungus may get into the nipples and can not be easily eradicated.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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