Oropharyngeal/oesophageal candidiasis (also known as oral thrush)
Candidiasis that involves the oesophagus and mouth is often an infection in those with AIDS. Mucocutaneous candidiasis, also known as chronic mucocutaneous candidiasis (CMC), is a candidiasis infection of the skin, nails and mucous membranes caused by Candida albicans (the fungus that causes most yeast infections).
If candidiasis forms in the throat or mouth it is called oropharyngeal candidiasis or thrush. This is the overgrowth of Candida which normally lives in small amounts. If the environment of the throat or mouth becomes imbalanced for some reason, this may allow for the yeast to multiply which results in various symptoms. The overgrowth of Candida can also occur in the oesophagus, this is known as oesophageal candidiasis or Candida oesophagitis.
When Candida infects the throat and mouth (candidiasis is an infection with Candida) the symptoms can develop in a number of ways. The symptom seen most commonly in oral thrush is plaques or white patches on the oral mucous membranes or the tongue.
Other symptoms may include:
- Soreness or redness in the areas affected
- Difficulty in swallowing
- Painful sores on the sides of the mouth that result in the corners cracking due to the build-up of microorganisms (this is known as angular cheilitis) – these sores often cause a burning sensation in the affected area
- Weight loss
If you are experiencing any of these symptoms, it is advised that you see your doctor for treatment.
Who is at risk of oral candidiasis?
When candidiasis occurs in the throat and mouth, those who have the highest risk are young babies being less than four weeks old, elderly people and people who suffer from a weakened immune system. These infections are uncommon in healthy adults. Thrush in newborns and infants can be common, however, contact your doctor should this thrush last longer than a few weeks.
There are other factors that are associated with oesophageal and oral candidiasis, these include:
- Cancer treatments – These include radiation and chemotherapy as these treatment methods have an adverse impact on the immune system
- HIV/AIDS infection
- Diabetes that is poorly managed
- Poorly fitted dentures
- Organ transplantation
- Broad-spectrum antibiotic use – these are antibiotics that work against a large range of bacteria.
- Corticosteroid use
Can oral candidiasis be prevented?
Practising good oral hygiene helps to prevent oral thrush from occurring in those who have a weakened immune system. The development of oral thrush depends on the strength of one’s immune system.
There have been some studies conducted that note that mouthwash containing chlorhexidine (CHX), is able to aid in preventing oral thrush in those who are undergoing the treatment of cancer. Those who use an inhaler for the administration of corticosteroids (asthma medication), can benefit from washing their mouth out with mouthwash or even water after using their inhaler.
Causes of oral thrush
Candida species are natural residents of the mouth, throat and GI (gastrointestinal) tract. Normally, the Candida yeasts (fungi) reside in the body in small amounts without causing any damage or infection. However, when certain medications are taken or the immune system is weakened, this can result in the Candida multiplying which can cause an infection and lead to the various symptoms associated with oral thrush.
Diagnosis of oral thrush
An oral thrush infection will be diagnosed based on the visible symptoms that the doctor can detect. The doctor will also scrape off some of the affected area in order for it to be examined. This procedure is quick and painless and allows for the doctor to examine the sample of the infected area for fungal infections.
A culture test using a cotton swab can also be performed, however, due to the Candida organisms being natural residents of the mouth, if the culture test is positive, this is not enough evidence to make an accurate diagnosis of infection.
Treatment for oral thrush and outcome
Antifungal medication is typically prescribed for oral thrush. The duration and type of the treatment will be dependent on the infection’s severity, as well as various factors regarding the patient such as their age and immune system status. If infections are left untreated, they can develop into more severe forms of candidiasis, this is known as invasive candidiasis (more on this later).
Topical treatments including nystatin suspension and clotrimazole troches are often used in the treatment of oral thrush. Antifungal medication that is systemic (drugs that act through the entire body), such as itraconazole or fluconazole, are sometimes necessary when oropharyngeal infections do not respond to other medications.
Itraconazole or intravenous fluconazole are common treatments for Candida esophagitis. In more severe cases of oesophageal candidiasis that do not respond to antifungal medications, then a treatment containing amphotericin B is used. This form of treatment will injure the membranes of the fungal cell, making it more permeable for other medications to treat and eliminate.