Thrush (Oral Candidiasis) Pathophysiology Thrush represents an overgrowth of yeast when either normal host immunity or normal host flora has been disrupted. Yeast overgrowth on the oral mucosa causes the epithelial cells to desquamate. Bacteria, keratin, and necrotic tissue accumulate and form a pseudomembrane. Oral candidiasis is common in infants. Neonates with thrush have usually been colonized when they passed through the birth canal, but other sources of transmission may include colonized breasts, hands, or bottle nipples. Clinical presentation 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. Infants with thrush may present with pain, poor feeding, or fussiness, but patients are more often asymptomatic and thrush presents no interference with eating. Oral candidiasis may be associated with diaper candidiasis, so it is always important to check for diaper rash when thrush is present. Causes Premature infants are especially predisposed to thrush due to their immature immune system. In older patients who are immunocompetent, predisposing factors are often present, such as a recent course of antibiotic therapy that disrupts the normal flora, or steroid use. Immunosuppressed patients are more susceptible to oral candidiasis, as well as cutaneous and systemic infections. Treatment Nystatin oral suspension is the drug of choice for oral candidiasis. 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. Gentian violet has been shown to be effective as a second-line agent for oral candidiasis resistant to nystatin, but is messy to use and should not be swallowed. These oral antifungals have little to no systemic absorption, so there are minimal adverse effects. 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. Always continue to check for diaper dermatitis because often associated with oral monilia infection
Posted on: Mon, 08 Sep 2014 09:27:30 +0000
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