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Oropharyngeal / Esophageal Candidiasis ("Thrush")

Candidiasis that develops in the mouth or throat is called "thrush" or oropharyngeal candidiasis. The most common symptom of oral thrush is white patches or plaques on the tongue and other oral mucous membranes. This infection is uncommon among healthy adults.

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Definition

Candidiasis of the mouth and throat, also known as “thrush" or oropharyngeal candidiasis, is a fungal infection that occurs when there is overgrowth of a yeast called Candida. Candida yeasts normally live on the skin or mucous membranes in small amounts. However, if the environment inside the mouth or throat becomes imbalanced, the yeasts can multiply and cause symptoms. Candida overgrowth can also develop in the esophagus, and this is called Candida esophagitis, or esophageal candidiasis.

Symptoms

Candida infections of the mouth and throat can manifest in a variety of ways. The most common symptom of oral thrush is white patches or plaques on the tongue and other oral mucous membranes. Other symptoms include:

  • Redness or soreness in the affected areas
  • Difficulty swallowing
  • Cracking at the corners of the mouth (angular cheilitis)

It is important to see your doctor if you have any of these symptoms.

Risk & Prevention

Who Gets Oral Candidiasis?

Candida infections of the mouth and throat are uncommon among adults who are otherwise healthy. Oral thrush occurs most frequently among babies less than one month old, the elderly, and groups of people with weakened immune systems. Other factors associated with oral and esophageal candidiasis include:

  • HIV/AIDS
  • Cancer treatments
  • Organ transplantation
  • Diabetes
  • Corticosteroid use
  • Dentures
  • Broad-spectrum antibiotic use
How Can I Prevent Oral Candidiasis?

Good oral hygiene practices may help to prevent oral thrush in people with weakened immune systems. Some studies have shown that chlorhexidine (CHX) mouthwash can help to prevent oral candidiasis in people undergoing cancer treatment. People who use inhaled corticosteroids may be able to reduce the risk of developing thrush by washing out the mouth with water or mouthwash after using an inhaler.

Sources

Candida species are normal inhabitants of the mouth, throat, and the rest of the gastrointestinal tract. Usually, Candida yeasts live in and on the body in small amounts and do not cause any harm. However, the use of certain medications or a weakening of the immune system can cause Candida to multiply, which may cause symptoms of infection.

Diagnosis and Testing

A healthcare provider diagnoses the infection based on your symptoms, and by taking a scraping of the affected areas to examine under a microscope. A culture may also be performed; however, because Candida organisms are normal inhabitants of the human mouth, a positive culture by itself does not make the diagnosis.

Treatment and Outcomes

Candida infections of the mouth and throat must be treated with prescription antifungal medication. The type and duration of treatment depends on the severity of the infection and patient-specific factors such as age and immune status. Untreated infections can lead to a more serious form of invasive candidiasis.

Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin “swish and swallow”). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments.

Candida esophagitis is typically treated with oral or intravenous fluconazole or oral itraconazole.  For severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.

For healthcare providers: the most up-to-date clinical practice guidelines for the treatment of oropharyngeal / esophageal candidiasis are available at the Infectious Diseases Society of America.

Statistics

The infection is not very common in the general population. It is estimated that between 5% and 7% of babies less than one month old will develop oral candidiasis.  The prevalence of oral candidiasis among AIDS patients is estimated to be between 9% and 31%, and studies have documented clinical evidence of oral candidiasis in nearly 20% of cancer patients.

Additional Information

Publications

Cannon, R. D., A. R. Holmes, et al. (1995). "Oral Candida: clearance, colonization, or candidiasis?" J Dent Res 74(5): 1152-1161.

Ellepola, A. N. and L. P. Samaranayake (2001). "Inhalational and topical steroids, and oral candidosis: a mini review." Oral Dis 7(4): 211-216.

Ferretti, G. A., R. C. Ash, et al. (1988). "Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse." Bone Marrow Transplant 3(5): 483-493.

Ravera, M., A. Reggiori, et al. (1999). "Evaluating diagnosis and treatment of oral and esophageal candidiasis in Ugandan AIDS patients." Emerg Infect Dis 5(2): 274-277.

Schelenz, S., S. Abdallah, et al. (2011). "Epidemiology of oral yeast colonization and infection in patients with hematological malignancies, head neck and solid tumors." J Oral Pathol Med 40(1): 83-89.

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