Thrush

Thrush is the most common and characteristic expression of oral candidiasis, an infectious disease of the buccal mucosa sustained by yeasts belonging to the genus Candida. Among these, the most common causative agent in man is the Candida albicans, the same responsible for vaginal candidiasis.

Causes

Thrush mainly affects newborns, but it also prefers the elderly and immunocompromised adults, so much so that the finding of oral candidiasis in a young adult not suffering from neoplasms, nor being treated with cortisone, must always lead to suspect an underlying HIV infection.

Candida is an integral part of the flora present in the oral cavity of many people; only when the host's immune defenses precipitate, this microorganism can proliferate almost undisturbed inside the mouth, causing the infection known as oral candidiasis, of which thrush (or acute pseudomembranous candidiasis) is the most characteristic manifestation.

As for the neonatal period, thrush mainly affects newborns born to mothers affected by vaginal candidiasis, especially if they are premature; also in this case the infection is more common in dystrophic infants.

Risk factors

Prolonged antibiotic treatments can cause thrush, as they tend to reduce the symbiotic (beneficial) and saprophytic bacterial flora that controls the growth of Candida albicans.

Diabetes, smoking, the presence of conditions that induce xerostomia (dry mouth), and the use of dental prostheses complete the picture of risk factors for this annoying and generally not serious infection.

Symptoms

Thrush is characterized by the appearance of whitish, milky (they have the appearance of stale milk), punctate, lenticular or confluent plaques; the sites commonly affected are the back of the tongue and less often the palate, while the extension in the back mouth, in the "esophagus and larynx is the indicator of a" major depression of the immune system (AIDS, lymphomas, neoplasms, drug addiction, prolonged therapy with corticosteroids and chemotherapy)

The lily of the valley can cause an intense burning, for which it is difficult to eat and the flavors are not perceived; when the infection has spread to the throat and esophagus, the patient complains of difficulty in swallowing and may be feverish.

The infant tends to manifest the discomfort induced by thrush through crying and nervousness crises, while when the infection is transmitted from the baby's mouth to the mother's breast, the latter complains of symptoms such as red, particularly sensitive or painful nipples.

The greyish-white islets present in the oral mucosa of people with thrush are essentially made up of epithelial cells, leukocytes and agglomerates of the fungus; once detached, they reveal an erythematous, abraded and easily bleeding surface underneath.

Pictures Lily of the valley

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Treatment

Treatment of thrush obviously depends on the extent of the infection and its manifestations; in the milder forms, special mouthwashes or rinses with alkaline solutions (sodium bicarbonate, sodium borate) or hydrogen peroxide (hydrogen peroxide) at 3% can be used.

If thrush affects a breastfed baby, applications must also be extended to the mother's nipple and areola; in similar situations (for which the use of antifungals is not normally indicated, unless the infection resolves itself in the two weeks), it is equally important to sterilize teats and pacifiers before use.

Medicines

If oral candidiasis arises after the use of antibiotics, the doctor may recommend the use of unsweetened yogurt or better still probiotic preparations. In the most common forms, however, the treatment of thrush involves the use of drugs active on candida, such as nystatin, miconazole and clotrimazole.

In the event that the infection has spread to other sites of the body (esophagus, heart, brain, eyes, genital areas, joints), and in immunocompromised patients, more powerful drugs can be used, such as fluconazole, ketoconazole and "amphotericin B.

To learn more, read: Medicines for the Treatment of Thrush "

Prevention

The most important prophylactic measure consists in not modifying the balance of the local bacterial flora (a valid advice especially in the prevention of vaginal candidiasis) and in following a healthy lifestyle that keeps the humoral (immune) defenses of the host very efficient.

The prevention of type II diabetes - through a healthy diet, weight control and regular physical activity - also translates into an "effective prophylactic action against thrush. The growth of oral candida is in fact favored by the presence of abundant amount of sugar in saliva, which contains glucose in concentrations similar to those in blood.

To learn more, read: Diet and Candida and Strengthening the immune defenses "