Symptoms
Oral thrush is an infection of the mouth and throat with Candida fungi. Different manifestations are distinguished. The actual oral thrush is usually called acute pseudomembranous candidiasis. The leading symptom is the white to yellowish, small-spotted, partially intermingled coating of the mucous membranes in the mouth and throat area. It consists of epithelial cells, fibrin and fungal hyphae and can be wiped off with a tongue depressor, for example. Under the coating, the mucosa is reddened. Other possible symptoms include:
- Bad breath
- Furry feeling
- Lymph node swelling
- Pain causing difficulty swallowing and, in infants, weakness in drinking
- Taste disorders
- Softening of the tissue and erosions with bleeding
- Cracks at the corners of the mouth
In erythematous oral candidiasis, the mucosa is reddened and no coating is found. This form is mainly triggered by dentures. Other oral candidiasis are known (see literature). Candida infections of the mouth and pharynx can spread to the esophagus and the entire gastrointestinal tract.
Causes
Oral thrush is caused by the yeast fungus or other -species. It is an opportunistic infection that occurs primarily in association with local and systemic factors. These include:
- Infancy: oral thrush is common in infants, newborns, and premature infants
- Older people
- Weakened immune system, underlying diseases, e.g. tumor diseases, diabetes mellitus, HIV infection, leukemia, hormonal changes, deficiency states.
- Dentures
- Medications: Antibiotics, cytostatics, inhaled glucocorticoids (cortisone sprays for asthma and bronchitis), immunosuppressants.
- Dry mouth, also due to medication, e.g. antidepressants.
- High carbohydrate diet
- Virulence of the pathogen
Oral thrush can be a trivial disease, but it can also occur secondarily as a consequence of a serious underlying disease.
Transmission
Candida fungi occur naturally in the mouth, throat or digestive tract. Overgrowth is seen as a result of certain triggering factors in the sense of an opportunistic infection (see above). The mother may infect the child during birth (vaginal thrush, neonatal thrush) or later, for example, via the licked nuggi (infant thrush).
Complications
In immunocompromised individuals, the fungi can spread into the bloodstream and cause a severe to life-threatening infection.
Diagnosis
Diagnosis is based on clinical presentation and detection by laboratory methods. Possible differential diagnoses include, for example, diphtheria, measles (Koplik’s spots), oral thrush, syphilis, lichen planus, lichen ruber mucosae, leukoplakia, carcinoma, burns, vitamin B12 deficiency, and map tongue. Milk residue in the mouth of infants is sometimes mistaken for oral thrush. However, they are easily removed and the mucosa is not red.
Prevention and non-drug treatment.
- When using inhaled glucocorticoids (asthma cortisone sprays), the mouth should be rinsed thoroughly with water after use, followed by eating something.
- Treatment of a vaginal fungus in pregnant women shortly before birth to prevent colonization of the newborn with Candida fungi.
- Eliminate and treat risk factors and underlying diseases.
- Good oral hygiene, clean and disinfect dentures regularly. In the literature, this is primarily mentioned chlorhexidine and Dakin solution. Check at the dentist, whether the denture fits well.
- Clean contaminated nuggies, teats and toothbrushes, nipple hygiene.
Medication treatment
Agents effective against fungi (antifungals) are used for drug treatment. Local polyenes and azole antifungals are mainly effective in the mouth and digestive tract and are considered the 1st choice agents for uncomplicated infection. Polyenes act only locally, while miconazole is partially absorbed. The drugs are usually applied four times a day and should be kept in the mouth as long as possible and spread in the oral cavity with the finger and tongue. In infants, the drug is also given on the nuggi in practice.If thrush affects the digestive tract or the anus, the agents are taken additionally. The information in the package insert should be followed.
- Amphotericin B (Ampho-Moronal lozenges, suspension).
- Natamycin (Germany: Pimafucin lozenges).
- Nystatin (Multilind, Mycostatin suspension).
- Miconazole mouth gel (Daktarin mouth gel) – is partially absorbed.
Systemic azole antifungals are usually taken in the form of capsules, tablets or suspension. They are absorbed in the digestive tract and exert their effects from the inside. During treatment, it should be noted that azole antifungals are potent inhibitors of CYP450 and may cause drug-drug interactions. They are potentially less well tolerated than topical agents.
- Fluconazole (Diflucan, generic).
- Itraconazole (Sopranox, generic).
- Ketoconazole (Nizoral, generic).
Some disinfectants are approved for treatment in the form of mouthwashes, lozenges or as sprays. They are available without a doctor’s prescription, unlike antifungals. Disinfectants are applied locally to the mouth and throat and are not usually intended for ingestion.
- Chlorhexidine
- Hexetidine
- Dequalinium chloride
- Povidone-iodine
- Gentian violet (in many countries only as a self-production) is traditionally used, a problem is stains and discoloration caused by the dye.
Analgesics such as paracetamol are used for symptomatic treatment of pain and difficulty swallowing. Local anesthetic drugs and tanning agents may also be suitable for this purpose. Probiotics lozenges provide the mucous membrane of the oral cavity with “good” bacteria, which settle and multiply. The treatment is considered well tolerated.
