Oral Candidiasis - Thrush


Candida albicans accounts for about 90% of human yeast infections.


Epidemiololgy
  1. Candida albicans is a common inhabitant in normal adult gastrointestinal tracts and vaginas. During pregnancy, the colonization rate may be 33%. 
  2. 10% of normal infants are colonized in the GI and respiratory tract at 5 days of age and this rate increases in preterm infants. The skin is usually colonized at 2 weeks of age. 
  3. The neonate acquires the yeast from the mother at the time of delivery.
  4. Thrush usually appears about 1 week of age and diaper dermatitis at 3-4 months. 
  5. Thrush is a disease of infants, and in older children it is associated with the use of antibiotics. 
  6. Recurrent or persistent thrush should raise the suspicion of a possible underlying immunodeficiency syndrome.

Clinical presentation
  1. White curdish like lesions on the buccal mucosa, tongue, palate, and gingiva. The lesions are difficult to scrape off and this differentiates it from milk. After scraping, there is an erythematous base and some bleeding. 
  2. Symptoms- usually asymptomatic and no interference with eating. Rarely, may develop esophagitis in an immunocompetent hosts and feeding may be decreased. 
  3. Esophagitis due to Candida infection may present with chest pain

Treatment
  1. Untreated, will resolve in 3-8 weeks but in most instances antifungal agents are used. Mild cases may be watched without treatment. 
  2. Nystatin suspension. Various reports have reported cure rates between 50-80% on standard 100,000 units per dose 4 times a day. May have to double the dose or apply it directly to the lesions with a cotton swab. Nystatin does not adhere well to the lesions and is swallowed rapidly and this interferes with its efficacy. 
  3. In nursing mothers, the breast may be a reservoir for the yeast so that the application of a topical antifungal between feeds to the breast may help eradicate the infection.
  4. Gentian violet has been shown to be effective but is messy to use. 
  5. Miconazole
  6. Always check for diaper dermatitis because often associated with oral monilia infection
 
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