From the Guidelines
Thrush, or oral candidiasis, is characterized by white, creamy patches or plaques on the tongue, inner cheeks, roof of the mouth, and throat that cannot be easily wiped away, and is typically diagnosed clinically based on the characteristic appearance of lesions, as noted in the 2016 update by the Infectious Diseases Society of America 1. The clinical findings of thrush may include:
- White, creamy patches or plaques on the tongue, inner cheeks, roof of the mouth, and throat
- Painful lesions that can bleed when scraped
- Cotton-like sensation in the mouth
- Altered taste
- Difficulty swallowing
- Cracking at the corners of the mouth (angular cheilitis)
- Fussiness during feeding and reluctance to eat in infants The diagnosis of thrush is primarily clinical, based on the characteristic appearance of lesions, and the condition occurs when there's an overgrowth of Candida albicans, a naturally occurring yeast in the mouth. Risk factors for thrush include:
- Antibiotic use
- Corticosteroid inhalers
- Diabetes
- Immunocompromised status
- Dentures
- Young or advanced age Treatment typically involves antifungal medications, and good oral hygiene, proper denture care, and addressing underlying conditions are essential for prevention and management, as recommended by the ESCMID guideline for the diagnosis and management of Candida diseases 2012 1. In cases of fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results, in addition to the optimization of HAART when feasible, as noted in the 2012 ESCMID guideline 1. For patients with haematological malignancies, oral azoles, such as fluconazole, are recommended for a rapid response, and physicians should keep in mind that azole-resistant Candida species can be selected during therapy even without prolonged treatment periods, as stated in the ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT) 1.
From the Research
Clinical Findings for Thrush
The clinical findings for thrush, a fungal infection caused by Candida albicans, can be summarized as follows:
- Oral candidiasis is a common manifestation of thrush, and its treatment can be achieved through various antifungal agents 2.
- Fluconazole is a well-established first-line management option for the treatment and prophylaxis of localized and systemic C. albicans infections, including oral candidiasis 3.
- The efficacy of fluconazole in treating oral candidiasis has been compared to other antifungal agents, such as clotrimazole, itraconazole, and amphotericin B, with varying results 2.
- In adults with oral candidiasis, fluconazole has shown a better clinical response rate than clotrimazole, but a similar mycological cure rate 2.
- Itraconazole has been found to be effective in treating oral candidiasis, particularly in immunosuppressed patients, and has a lower relapse rate compared to clotrimazole 2.
- In infants, miconazole and nystatin have shown similar clinical response rates, while miconazole has a superior mycological cure rate 2.
Treatment Options
The treatment options for thrush can be summarized as follows:
- Fluconazole is recommended as a first-line treatment for immunocompetent patients with oral candidiasis 2.
- Itraconazole is recommended for immunosuppressed patients with oral candidiasis, due to its effectiveness and lower relapse rate 2.
- Miconazole is recommended for infants with oral candidiasis, due to its superior mycological cure rate 2.
- Clotrimazole and itraconazole have been found to be effective in treating vaginal candidiasis, with itraconazole showing a higher mycological cure rate 4.