Oral candidiasis (also known as Thrush-Moniliasis) is an infection of yeast fungi of the genus Candida on the mucous membranes of the oral cavity and esophagus. It is frequently caused by Candida albicans Although Candida albicans is a type of fungus naturally found in most of the healthy mouths, its overgrowth can cause an outbreak of oral thrush symptoms. The Candida albicans population in the mouth is kept under control as it is competing with the other bacteria and micro-organisms of the mouth.
Symptoms
A common sign of thrush is the presence of creamy white, slightly raised lesions in your mouth—usually on your tongue or inner cheeks—but also sometimes on the roof of your mouth, gums, tonsils, or back of your throat.
The lesions, which may have a “cottage cheese” appearance, can be painful and may bleed slightly when you scrape them or brush your teeth. In severe cases, the lesions may spread into your esophagus, causing:
and Pain or difficulty swallowing-Dysphagia
and A feeling that food gets stuck in the throat –Foreign body sensation
and Fever if the infection spreads beyond the esophagus
Diagnosis
Throat swab for culture (swabbing the back of your throat with sterile cotton and studying the microorganisms under a microscope), performing a flexible endoscopy of esophagus, stomach, and small intestine or taking Barium swallow X-ray of esophagus.
What causes Oral candidiasis (thrush)?
Any condition that changes the natural balance of the microbial ecosystem of the mouth can potentially be the reason for an oral thrush infection.
and Newborn babies. A newborn may acquire the Candida fungus during delivery, if the mother had an active vaginal candidiasis. Symptoms of oral thrush usually follow within 7 to 10 days after birth.
and Diabetics with poorly controlled diabetes. Sugar in saliva encourages the Candida growth
and Elderly with poor immune status
and As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for treatment of asthma and COPD.
and People with an immune deficiency HIV or Cancer patient on Chemotherapy and Radiation treatment).
and Women undergoing hormonal changes, like pregnancy or those on birth control pills.
and Denture users.Xerostomia, Smokers, poor oral hygiene
and Hypothyroid patients
and After organ transplant
Treatment
Oral candidiasis can be treated with topical anti-fungal drugs, such as Mycostatin, Miconazole, Flucanzole or Itraconazole. Topical therapy is given as an oral suspension which is washed around the mouth and then swallowed by the patient.
The most common method of treating oral thrush is to use the antifungal medication in liquid form that should be swished around the mouth slowly, for as long as possible, and then swallowed. Lozenges / pastilles should be dissolved in the mouth slowly and should not be chewed or swallowed whole. The longer the medicine stays in direct contact with the surfaces of the mouth that are affected, the more effective it will be in fighting oral thrush.
Patients who are immuno compromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered anti-fungal medications.
For mild cases, recommended antifungal medications include Mycostatin liquid or lozenges) applied several times daily and Clotrimazole (candid® mouth paint)
For more severe cases, if the infection has spread beyond the mouth or for patients with HIV/AIDS, oral thrush treatment may need higher doses or stronger medications, such as ketoconazole or Fluconazole is a synthetic antifungal agent which can be used for the treatment of a variety of Candida albicans infections.
Flucanazole is a single dose (daily) medicine in the form of tablets that must be chewed and swallowed. Studies on oral thrush treatments have demonstrated that it is just as effective as clotrimazole and nystatin, but is more convenient and better tolerated. Ketoconazole is less effective than fluconazole, but can be used as an alternative options if for any reason fluconazole cannot be used.
The next step, after treating the infection, is to identify and treat (if possible) the underlying health problems or conditions that caused the oral thrush, in order to prevent similar problems in the future. With proper medical treatment, most of the simple oral thrush infections can be effectively treated in about 2 weeks.
Another alternative is Gentian Violet, an older treatment that doesn’t require a prescription. Keep in mind that it is rather messy and can turn your baby’s lips and clothing purple, so it is not as popular as other treatments.
How can thrush be prevented?
The following practices can help minimize your chance of developing thrush:
and Follow good oral hygiene practices. Brush your teeth at least twice a day and floss at least once a day.
and Avoid mouthwashes or sprays. These products can destroy the normal balance of microorganisms in your mouth.
and See your dentist regularly. Especially if you have diabetes or wear dentures.
and Limit the amount of sugar and yeast-containing foods you eat. Foods such as bread, beer, and wine encourage Candida growth.
and If you smoke, quit. Ask your doctor or dentist about ways to help you kick the habit.
NYSTATIN
Drug information
Nystatin is a polyene antifungal antibiotic obtained from Streptomyces nursei. The molecular formula for Nystatin is C47H75NO17. The molecular weight of Nystatin is 926.1.
Use of Nystatin
Nystatin is a prescription antifungal medication. It is available in a variety of different forms and is used to treat a variety of different fungal infections. Specifically, it is approved to treat fungal infections caused by the Candida species of fungi. This type of fungus is a common cause of thrush, diaper rash, yeast infections, and many other infections.
This product is used to treat Candida infections on the surface of the skin (for ointment, cream, or powder products), in the vagina (for vaginal tablets), or the mouth and digestive tract (for the oral forms). Because nystatin is not significantly absorbed into the bloodstream (even when taken by mouth), it is not a good treatment for other types of fungal infections, such as bloodstream, bladder, or brain infections.
How does Nystatin work?
Nystatin works by binding to ergosterol, an important component of the fungal cell membrane. This changes the fungal cell membrane, making it more “leaky” and allowing for the leakage of important cellular contents to occur.
Because human cells do not contain ergosterol, nystatin targets only the fungal cells, not the human cells.
Preparations-
and Nystatin cream– 100,000 units per gram
and Nystatin ointment– 100,000 units per gram
and Nystatin powder (for skin use) — 100,000 units per gram
and Nystatin vaginal tablets — 100,000 units per tablet
and Nystatin oral suspension — 100,000 units per mL
and Nystatin oral tablets-lozenges- — 500,000 units per tablets
