Fungus around the mouth

Oral thrush in adults | NHS inform

Oral thrush is a fungal infection of the mouth. It's not contagious and is usually successfully treated with antifungal medication.

It's also called oral candidosis (or candiasis) because it's caused by a group of yeasts called Candida.

Non-urgent advice: Contact your GP practice if:

You develop symptoms of oral thrush, which can include:

white patches (plaques) in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly
loss of taste or an unpleasant taste in the mouth
redness inside the mouth and throat
cracks at the corners of the mouth
a painful, burning sensation in the mouth

In some cases, the symptoms of oral thrush can make eating and drinking difficult.

If left untreated, the symptoms will often persist and your mouth will continue to feel uncomfortable.

In severe cases that are left untreated, there is also a risk of the infection spreading further into your body, which can be serious.

Your GP will usually be able to diagnose oral thrush simply by examining your mouth. Sometimes they may also recommend blood tests to look for certain conditions associated with oral thrush, such as diabetes and nutritional deficiencies.

What causes oral thrush?

Low numbers of the fungus Candida are naturally found in the mouth and digestive system of most people. They don't usually cause any problems, but can lead to oral thrush if they multiply.

There are a number of reasons why this may happen, including:

taking a course of antibiotics, particularly over a long period or at a high dose
taking inhaled corticosteroid medication for asthma
wearing dentures (false teeth), particularly if they don't fit properly
having poor oral hygiene
having a dry mouth, either because of a medical condition or a medication you are taking
smoking
having chemotherapy or radiotherapy to treat cancer

Babies, young children and elderly people are at a particularly high risk of developing oral thrush, as are people with certain underlying conditions, including diabetes, an iron deficiency or vitamin B12 deficiency, an underactive thyroid (hypothyroidism) and HIV.

As most people already have Candida fungi living in their mouth, oral thrush is not contagious. This means it cannot be passed to others.

Treating oral thrush

Oral thrush can usually be successfully treated with antifungal medicines. These usually come in the form of gels or liquid that you apply directly inside your mouth (topical medication), although tablets or capsules are sometimes used.

Topical medication will usually need to be used several times a day for around 7 to 14 days. Tablet or capsules are usually taken once daily.

These medications don't often have side effects, although some can cause nausea (feeling sick), vomiting, bloating, abdominal (tummy) pain and diarrhoea.

If antibiotics or corticosteroids are thought to be causing your oral thrush, the medicine – or the way it is delivered – may need to be changed or the dosage reduced.

Preventing oral thrush

There are a number of things you can do to reduce your chances of developing oral thrush.

Do

rinse your mouth after meals
brush your teeth twice a day with a toothpaste that contains fluoride
floss regularly
visit your dentist regularly for check-ups, even if you wear dentures or have no natural teeth
remove your dentures every night and clean them with paste or soap and water before soaking them in a solution of water and denture-cleaning tablets
brush your gums, tongue and inside your mouth with a soft brush twice a day if you wear dentures or have no or few natural teeth
visit your dentist if your dentures do not fit properly
stop smoking if you smoke
rinse your mouth with water and spit it out after using a corticosteroid inhaler, and use a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicine
ensure that any underlying condition you have, such as diabetes, is well controlled

If you have a condition or are receiving treatment that could put you at a high risk of developing oral thrush, your doctor may recommend taking a course of antifungal medication to prevent this happening.

Last updated:
13 February 2023

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Candida infections of the mouth, throat, and esophagus | Fungal Diseases

About

Candidiasis is an infection caused by a yeast (a type of fungus) called Candida. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems.¹ Sometimes, Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages fungal growth.

Candidiasis in the mouth and throat is also called thrush or oropharyngeal candidiasis. Candidiasis in the esophagus (the tube that connects the throat to the stomach) is called esophageal candidiasis or Candida esophagitis. Esophageal candidiasis is one of the most common infections in people living with HIV/AIDS.²

Symptoms

Candidiasis in the mouth and throat can have many different symptoms, including:

White patches on the inner cheeks, tongue, roof of the mouth, and throat (photo showing candidiasis in the mouth)
Redness or soreness
Cotton-like feeling in the mouth
Loss of taste
Pain while eating or swallowing
Cracking and redness at the corners of the mouth

Symptoms of candidiasis in the esophagus usually include pain when swallowing and difficulty swallowing.

Contact your healthcare provider if you have symptoms that you think are related to candidiasis in the mouth, throat, or esophagus.

Risk and Prevention

Who gets candidiasis in the mouth or throat?

Candidiasis in the mouth, throat, or esophagus is uncommon in healthy adults. People who are at higher risk for getting candidiasis in the mouth and throat include babies, especially those younger than 1 month of age, and people with at least one of these factors:^3-7

Wear dentures
Have diabetes
Have cancer
Have HIV/AIDS
Take antibiotics or corticosteroids, including inhaled corticosteroids for conditions like asthma
Take medications that cause dry mouth or have medical conditions that cause dry mouth
Smoke

Most people who get candidiasis in the esophagus have weakened immune systems, meaning that their bodies don’t fight infections well. This includes people living with HIV/AIDS and people who have blood cancers such as leukemia and lymphoma. People who get candidiasis in the esophagus often also have candidiasis in the mouth and throat.

How can I prevent candidiasis in the mouth or throat?

Ways to help prevent candidiasis in the mouth and throat include:

Maintain good oral health
Rinse your mouth or brush your teeth after using inhaled corticosteroids

Sources

Candida normally lives in the mouth, throat, and the rest of the digestive tract without causing any problems. Sometimes, Candida can multiply and cause an infection if the environment inside the mouth, throat, or esophagus changes in a way that encourages its growth.

This can happen when:

a person’s immune system becomes weakened,
if antibiotics affect the natural balance of microbes in the body,
or for a variety of other reasons in other groups of people.

Diagnosis and Testing

Healthcare providers can usually diagnose candidiasis in the mouth or throat simply by looking inside.⁸ Sometimes a healthcare provider will take a small sample from the mouth or throat. The sample is sent to a laboratory for testing, usually to be examined under a microscope.

Healthcare providers usually diagnose candidiasis in the esophagus by doing an endoscopy. An endoscopy is a procedure to examine the digestive tract using a tube with a light and a camera. A healthcare provider might prescribe antifungal medicine without doing an endoscopy to see if the patient’s symptoms get better.

Treatment

Candidiasis in the mouth, throat, or esophagus is usually treated with antifungal medicine.⁶ The treatment for mild to moderate infections in the mouth or throat is usually an antifungal medicine applied to the inside of the mouth for 7 to 14 days. These medications include clotrimazole, miconazole, or nystatin. For severe infections, the most common treatment is fluconazole (an antifungal medication) taken by mouth or through a vein. If patient does not get better after taking fluconazole, healthcare providers may prescribe a different antifungal. The treatment for candidiasis in the esophagus is usually fluconazole. Other types of prescription antifungal medicines can also be used for people who can’t take fluconazole or who don’t get better after taking fluconazole.

If you are a healthcare provider, click here to see the Infectious Diseases Society of America’s Clinical Practice Guidelines for the Management of CandidiasisExternalexternal icon.

Statistics

The exact number of cases of candidiasis in the mouth, throat, and esophagus in the United States is difficult to determine. This is because there is no national surveillance for these infections. The risk of these infections varies based on the presence of certain underlying medical conditions. For example, candidiasis in the mouth, throat, or esophagus is uncommon in healthy adults. However, they are some of the most common infections in people living with HIV/AIDS.² In one study, about one-third of patients with advanced HIV infection had candidiasis in the mouth and throat. ⁹

Oral candidiasis (thrush) - symptoms and treatment

Oral candidiasis is an inflammatory disease that develops against the background of damage to the mucous membranes by fungi of the genus Candida. This is usually associated with a deterioration in local and general immunity. According to studies, up to 90% of the adult population is carriers of this fungus, but the disease most often does not develop, since under normal conditions the pathogen does not act aggressively.

Causes of candidiasis

Thrush in the mouth in an adult is a mucosal lesion that may indicate serious health problems. For the reproduction of the fungus, special conditions are necessary. Most often, the disease occurs in patients who neglect oral hygiene. The presence of caries, inflammatory gum disease increases the chances of developing fungal inflammation. This is due to the fact that a large number of pathogenic microorganisms depletes the defense mechanisms.

The second group of reasons is the weakening of the immune system due to a number of diseases and conditions:

HIV, diabetes mellitus;
oncological diseases;
dystrophy, deficiency of vitamins, minerals;
surgeries, severe infections, etc.

There are also specific reasons for the development of thrush. It may appear after prolonged and powerful antibiotic therapy. The use of antibiotics leads to the destruction of beneficial flora and imbalance. This causes the active reproduction of Candida.

Oral candidiasis also develops against the background of inhaled corticosteroids. Usually the lesion has the appearance of erythema and appears in areas where the drug has come into contact with the mucosa: in the palate, tongue.

Features of the diet affect the likelihood of developing candidiasis. So, the predominance of carbohydrates predisposes to the activity of the fungus. The growth of Candida and its attachment to the mucosa are enhanced in the presence of sugars.

Bad habits increase the chances of developing leukoplakia, lichen planus and other diseases. Especially when it comes to smoking. Candidiasis often develops in patients with tongue piercings.

The presence of removable dentures is also a risk factor if the patient does not follow the rules of hygiene. In the absence of high-quality cleansing, the prosthesis is covered with a biofilm, which contains a lot of fungi. Disinfection is the main measure for the prevention of the disease and part of the complex treatment for progressive oral candidiasis. If the patient does not remove the structure at night, this also increases the likelihood of developing the disease. The mucous membrane remains without oxygen for a long time, is not washed by saliva - these conditions are suitable for the development of fungi and anaerobic microorganisms. The prosthesis can injure the mucous membranes if it does not fit. Microtraumas weaken local defenses and contribute to the onset of the development of a fungal infection. Injuries can also be associated with sharp chipped teeth and fillings, chemical and thermal burns.

Dryness of the oral cavity due to decreased salivation, changes in the viscosity of saliva, its composition is one of the causes of candidiasis. This may be due to other diseases, so it is important to find out the causes of dryness in order to effectively deal with the consequences.

Oral candidiasis is more common in children. The immaturity of the immune system, the colonization of the oral cavity by Candida from the vaginal canal of the mother during natural childbirth lead to the fact that the disease develops in early infancy. However, older children can also suffer from an illness, which is associated with a weakening of the immune forces.

Types of oral candidiasis and symptoms

Manifestations of oral candidiasis may vary from patient to patient. This is due to the degree of damage to the mucous membranes, as well as the specific type of disease. There are four forms:

acute pseudomembranous;
acute atrophic;
chronic atrophic;
chronic hyperplastic.

Although the treatment regimen for all forms is almost the same, the symptoms can vary significantly. Let's consider them in more detail.

Acute pseudomembranous candidiasis

This form of oral candidiasis may be asymptomatic. There is slight discomfort due to a white film or small plaques rising above the mucosa. With a mild course, one or more plaques appear, they are easily removed by scraping, and the mucosal area under them has a bright red color. In severe cases, large plaques appear in large numbers. They can merge, forming large areas of damage. Sometimes the symptoms cover the entire mucous membrane. When the plaques thicken, their removal becomes problematic. A severe course is more typical for infants, as well as in adult patients after antibiotic therapy, corticosteroids, immunosuppressants.

Acute and chronic atrophic candidiasis

Acute atrophic candidiasis is accompanied by severe burning. There may be no white plaque, and the mucous membrane becomes bright red. Many patients report a metallic, sour, salty, or bitter taste in their mouths. A characteristic manifestation of the disease is dry mouth. This form of the disease is often associated with drug therapy.

In chronic atrophic candidiasis, redness and burning are less pronounced. Usually the disease develops against the background of the installation and wearing of prostheses.

Chronic hyperplastic candidiasis

This form of the disease is typical for adults. Oral thrush can spread to the mucous membranes of the cheeks, the corners of the mouth and lips, the back of the tongue, and the soft palate. One of the symptoms is the appearance of white plaques that tend to merge with each other. As the disease progresses, their surface becomes rough, rough. Over time, the elements may turn yellow. Formations merge with mucous membranes and it is impossible to remove them.

Diagnostic methods

Treatment by a general dentist. Diagnosis begins with an examination and a detailed survey: the doctor will find out what drugs you have taken recently, whether there are chronic and infectious diseases. A cytological examination of plaque taken from the mucosa is mandatory. This is important because the accumulation of non-fungal flora can be easily confused with a fungal infection.

Scraping is performed in the morning, on an empty stomach, it is not necessary to brush your teeth before the procedure. On the eve, it is important to refuse to eat foods rich in carbohydrates so as not to provoke the growth of pathogenic flora. Studies allow not only to accurately determine the pathogen and type of Candida fungus, but also to find out the sensitivity of fungi to the main antifungal drugs. Based on the results of the tests, the doctor will determine the fungus in the oral cavity and prescribe medication.

Features of treatment

The basis of treatment is systemic and local antifungal drugs. Today they are widely represented on the pharmaceutical market, but it is important to know that the level of Candida fungus resistance to fixed assets is growing every year. For example, resistance to drugs such as Fluconazole is almost complete. Previously, this remedy was used in almost all cases of the disease, but today doctors are forced to revise standard treatment regimens.

Treatment of thrush in the mouth in adults is selected individually. The choice of a systemic antifungal agent is based on the type of pathogen, the patient's condition and the individual characteristics of his health. There are agents to which the infection has minimal resistance. The doctor may prescribe drugs based on nystatin, imidazole derivatives, etc.

In addition, local funds must be used:

mouth rinses;
gels and suspensions for application to affected areas;
topical lozenges and lozenges;
irrigation solutions and aerosols;
ointments for laying in the oral cavity on a cotton-gauze swab, etc.

Your healthcare provider may prescribe an over-the-counter antiseptic or mild saline rinse. Usually, solutions based on iodine, chlorhexidine, potassium permanganate, gentian violet, sodium tetraborate in glycerin are used. Some pills the doctor may recommend laying on the cheek.

Conditions for effective treatment

Effective treatment of oral thrush involves addressing the underlying cause. It is very important to sanitize the oral cavity: to cure teeth destroyed by caries, to remove non-viable teeth and roots that can no longer be restored. These are chronic foci of inflammation, so simultaneous sanitation will shorten the treatment time. Tartar and plaque should also be removed. This is especially true in cases of candidal stomatitis associated with trauma to the gums with sharp edges of hard dental deposits.

Patients with removable dentures should be retrained in hygiene and disinfection of prosthetic structures. If the time of using the prosthesis comes to an end, it is important to replace it in a timely manner. Treatment of candidiasis will be useless if a person uses the prosthesis incorrectly and again creates conditions for the reproduction of fungi in the oral cavity.

Unsuitable crowns, bridges and other structures are also subject to replacement. It is also important to eliminate enamel chips, which become a source of injury to the gums, mucous membranes of the cheeks and tongue.

Smokers should, if possible, reduce their smoking episodes or give up smoking habits. If the disease developed while taking corticosteroids, it is important to explain the rules of treatment: you should rinse your mouth with plenty of warm water after spraying the drug.

In the treatment of oral candidiasis that has developed against the background of antibiotic therapy, measures should be taken to restore the normal microflora of the intestine and oral cavity. It may be necessary to consult another narrow specialist or therapist: you will need to take probiotics and prebiotics.

For all patients treated for candidiasis, a few general guidelines apply:

maintaining oral hygiene;
refusal of food rich in carbohydrates;
Refusal of sugary drinks.

It is necessary to exclude from the diet food that can irritate the mucous membranes: dishes cooked with vinegar, marinades, spicy, peppery foods, smoked meats, sour fruits and berries. Also, you can not eat confectionery, pastries with yeast, sugar. It is better to give preference to warm dishes. It is necessary to observe such a diet for another 1.5-2 months after recovery.

In some cases, it is advisable to use toothpastes with glucose oxidase, lysozyme, lactoferrin. They improve the protective forces of the oral mucosa and can be part of a comprehensive prevention of inflammation. The choice of toothpaste must be agreed with the doctor, he will recommend the best remedy, and also tell you which brush is suitable.

Possible complications

If treatment is started late or incorrectly selected, acute oral candidiasis can be transformed into chronic or complicated by the transition to an invasive process that is difficult to treat.

Prevention of candidiasis

Specific prophylaxis of candidiasis in the oral cavity is carried out only in the presence of HIV infection, the patient undergoing radiation therapy, immunosuppressive or antibiotic therapy. In the absence of these risk factors, the doctor will make recommendations for a specific case.

Prevention of fungal diseases in patients with diabetes mellitus, bronchial asthma, chronic systemic diseases involves control of the underlying pathology. It is important to regularly see a doctor of your profile, take the prescribed funds.

If antibiotic therapy is necessary, the following rules must be followed:

take antibiotics only as directed by your doctor;
observe a sufficient duration of the course of treatment - do not cancel self-prescribed drugs when relief occurs;
if a long course of treatment is needed or if repeated antibiotic therapy is required, take the prescribed antifungal agents for prophylaxis.

When treating asthma, ask your doctor about using nebulizers. After inhalation, it is important to rinse the mouth in order to prevent the negative effects of the drug components on the mucous membranes.

If oral candidiasis often recurs, it is better to undergo a comprehensive examination: a standard medical examination or use specific diagnostic methods that the doctor will select. Fungal infections of the mucous membranes can be a manifestation of an underlying disease that you do not know about. Consult a therapist to find out the exact causes and take action in time.

Candidiasis - causes, symptoms, diagnosis and treatment - St. Petersburg State Budgetary Institution of Health "Dermatovenerological Dispensary No. 4"

Candidiasis is an infectious disease affecting the skin, mucous membranes and / or internal organs, caused by yeast-like fungi of the genus Candida. The term "candidiasis" implies a pathological process, which is based on the overgrowth of Candida, primarily in the gastrointestinal tract and secondarily in other areas (on the mucous membrane of the genitals, bronchi, in parenchymal organs).

Causes

Candidiasis (thrush) affects not only external but also internal organs. The cause of the disease are yeast-like fungi that live in the body of every person.

Many factors can provoke intensive reproduction of the fungus. For example, hypothermia, illness, stress, hormonal changes (during pregnancy or taking hormonal drugs).
When taking antibiotics, along with pathogenic bacteria, the beneficial microflora of the intestine and vagina, which controls the growth and development of Candida fungi, also dies. The presence of a chronic disease that reduces the activity of the immune system (HIV, sexually transmitted diseases, infections) very often causes candidiasis.
Candidiasis may be accompanied by endocrine diseases (diabetes, obesity, thyroid dysfunction).
Finally, hot climates or wearing uncomfortable, tight or synthetic underwear can be causes of candidiasis.

The source of candidiasis infection is usually the body's own flora (autoinfection), but infection from outside can occur. Causing a disease, the fungus does not change its properties - the body changes its properties (local protection decreases). Attaching to the cells of the epithelium, the pathogenic fungus begins to parasitize in them, penetrating deep into the tissues.

In the body's struggle with candidiasis, a dynamic balance often occurs when the fungus seeks to penetrate deeper into the tissues, but cannot, and the body tries to reject it and also cannot. In this case, the process can last for years, a shift in the balance in one direction or another will either lead to recovery or exacerbate the process.

Candidiasis occurs in several forms, depending on certain features.

The person is a carrier of the disease. Symptoms of candidiasis are absent, there is no need to treat.
Sharp. Accompanied by itching, rashes, discharge. It is necessary to treat comprehensively and qualitatively. Most often, young children are susceptible to infection.
Chronic. Characterized by remission and manifestation of symptoms, relapses are possible. It develops if it is incorrect to treat with antibiotics for a long time, use hormonal contraceptives.

This disease has several varieties, since it does not have an exact localization in the body:

Urogenital candidiasis
- female.
- male.
Oral candidiasis
- Lip thrush
- Thrush of the tongue
- Stomatitis, as well as oropharyngeal candidiasis - thrush of the oral mucosa, tonsils, gums.
Skin and nail candidiasis
- On the folds of the skin (armpits, area between the buttocks, inguinal folds).
- Candidiasis of exposed (or smooth) parts of the skin. Occurs rarely.
- Candidiasis on the palms.
- Candidiasis on the nail plates.
- Candidiasis of the feet.
Candidiasis of internal organs
- GIT (stomach, esophagus, intestines, anus).
- Lungs and bronchi.
- Hearts.
- Meninges.
- Eyes and ears.
Neonatal candidiasis (e.g. pseudomembranous)

Symptoms of candidiasis

The disease is ubiquitous. The causative agents of candidiasis are found in the air, soil, vegetables, fruits, confectionery products. Yeast-like fungi are found as saprophytes on healthy skin and mucous membranes.

Manifestations of candidiasis, and therefore symptoms and signs, depend on the localization of the focus of the disease.

Candidiasis of the oral mucosa (oral candidiasis, childhood thrush) occurs most often in children, as a rule, they become infected from the mother through the birth canal. Symptoms:

buccal mucosa, pharynx, tongue and gums become red,
puffiness appears,
then foci of white cheesy plaque appear on the oral mucosa.

With candidiasis of the skin and its appendages, most often the foci are located in large folds:

inguinal-femoral,
intergluteal,
armpits,
under the mammary glands.

The skin in the interdigital folds may be affected, more often in children and adults suffering from serious diseases - on the skin of the palms, feet, smooth skin of the trunk and extremities. Foci in large folds look like small 1-2 mm bubbles, which soon open with the formation of erosion. Erosions increase in size, merge, forming large areas of damage.

The foci of candidiasis have an irregular shape, dark red color, around the foci there is a strip of exfoliating epidermis. Outside the folds, the lesions look like red spots with peeling in the center; occasionally, small bubbles may appear around the focus.

Vaginal candidiasis (candidiasis, thrush) is an infectious disease of the vaginal mucosa that often spreads to the cervix and vulva. Almost every woman has experienced such a disease, and some signs of candidiasis are constantly disturbing. Most common in women of reproductive age, but can occur in girls

Intestinal candidiasis (dysbacteriosis) often accompanies vaginal candidiasis or develops in isolation. Usually intestinal candidiasis appears after taking antibiotics or past intestinal infections. Fungi of the genus Candida live in the small intestine. Symptoms characteristic of this type of candidiasis: in the stool of a patient suffering from intestinal candidiasis, white cheesy flakes are often found.

Esophageal candidiasis is a disease that is very difficult to define among all those available in the field of gastroenterology. The disease is characterized by a discrepancy between the severity of the disease, the level of damage and the condition of the patient himself.

Complication

With timely treatment, candidiasis does not cause any particular harm to health. But the symptoms of candidiasis can cause a lot of discomfort. Long-term, it can lead to damage to other organs, most often the urethra, bladder and kidneys. In severe cases, the progressive disease can affect the reproductive organs, leading to infertility in both men and women. But the greatest danger of candidiasis is for pregnant women, because. very high risk of fetal harm.

How the disease is diagnosed

Visual methods for diagnosing candidiasis. On examination, inflammation of the skin areas is revealed, limited by the border of exfoliating, macerated epidermis, whitish plaque on the mucous membranes.

Laboratory diagnostics. Contrary to popular belief, the main method for diagnosing candidiasis is still smear microscopy from the affected areas of the mucosa. PCR (DNA - diagnostics), popular recently, as a rule, is poorly suited for the diagnosis of candidiasis.

Laboratory diagnosis of the disease includes:

smear microscopy of secretions
cultural diagnosis (inoculation)
enzyme immunoassay (ELISA)
polymerase chain reaction (PCR).

Treatment of candidiasis

Treatment of candidiasis is aimed at eliminating the factors that contribute to the development of candidiasis. In case of skin lesions, local treatment is carried out in an open way with the use of antifungal ointments.

The attending physician prescribes systemic and local medications for this ailment. Local agents are not absorbed into the blood - they act only on the mucous membrane affected by the Candida fungus. They stop the reproduction and growth of fungi, relieve discomfort and restore affected tissues.

Prevention

Since candidiasis is a relapsing infection that occurs very often, there are some methods of prevention that reduce the frequency of recurrence of the disease, and also prevent primary infection.

Of the generally accepted means of preventing candidiasis, the following should be noted:

hardening of the body,
intake of vitamins and microelements in spring and autumn,
regular standard hygiene practices;
particular importance should be given to the type of clothing and underwear. It is recommended to wear cotton underwear, breathable and loose casual clothing.

With timely treatment, the prognosis is favorable, the cure usually occurs within a week. With complicated forms and lesions of internal organs, the treatment of candidiasis is difficult.

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