Thrush

Thrush is an overgrowth of a fungus (Candida albacans). It makes colonies of whitish or cottage cheese-like patches in the mouth, throat or vagina. When the patches are wiped away, there will be redness or bleeding underneath. It is one of the most common infections linked to HIV infection. It occurs in HIV patients when CD4 cell counts fall below 350.

Most people wake up with morning mouth a pasty, bad tasting coating in the mouth. It usually goes away after brushing the teeth. That coating is Candida albacans. Normally, other bacteria in the body keep the fungus controlled.

Symptoms

Thrush sometimes has no symptoms. There may be some discomfort and burning in the mouth and throat. Foods may taste Òbad.Ó It can appear on and under the tongue, inside the cheeks and on the back of the throat. A person may also have cracking, redness, soreness and swelling at the corners of the mouth.

Thrush is not dangerous unless it grows in the throat (esophageal candiasis). Then it can cause a sore throat, difficulty swallowing, a loss of appetite, nausea and chest pain. Thrush in the throat (Candida esophagitis) is a sign that HIV-infection has become AIDS. Candida esophagitis occurs when CD4 cell counts are less than 200.

Causes

Candida albacans is a yeast that is naturally found in the body. An HIV-weakened immune system allows the yeast to grow out of control.

Prevention

Brushing after every meal, gargling with antiseptic mouth washes such as Listerine and not smoking help keep your mouth healthy. Regular visits to the dentist also help prevent thrush.

Limiting the amount of sugary and yeast-containing foods such as bread, beer and wine. Eating more yogurt and dairy products helps prevent thrush.

Diagnosis

A doctor will take a swab or sample of infected tissue to look at under a microscope. If candida cells are found, the diagnosis is thrush.

If the thrush is in the throat, the doctor may order an endoscopic examination. This 30- to 60-minute test uses a lighted, flexible tube with a camera on the tip (an endoscope). The patient is given a sedative to relax and a local anesthetic to prevent coughing or gagging. The endoscope is put into the throat so the doctor can see the esophagus, stomach and upper part of the small intestine.

Treatment

If the thrush is only in the mouth, there are liquids or lozenges that help. Nystatin (Mycostatin) liquid can be swished around the mouth and then swallowed. This is done several times a day. Mycelex (clotrimazole) troches are throat lozenges that are slowly dissolved in the mouth, distributing the medicine to the infected areas. Treatment takes 10 to 14 days.

If the thrush comes back after treatment, pills such as Diflucan (fluconazole) can be used.

It's important to get an accurate diagnosis before treating the condition. Overuse of the drugs raises the chance that they will stop working.

If thrush isn't treated, the symptoms will continue. In rare cases, candida can spread to the blood and be carried throughout the body.

It can be helpful to sip water or sugarless drinks often to prevent a dry mouth and help control thrush in the mouth. Chewing sugarless gum or sucking on sugarless hard candy also helps. Avoid smoking or tobacco, alcohol and salty foods. Use a humidifier at night.

Salt-water rinses (half a teaspoon of salt in a cup of warm water) or baking soda rinses (one teaspoon of soda in one cup of water) can help. Don't swallow the rinse water.