Thrush
The content of the article:
- Thrush causes and risk factors
- Forms of the disease
- Thrush symptoms
- Features of the course of thrush in children
- Diagnostics
- Treatment of "thrush"
- Possible complications and consequences
- Forecast
- Prevention of thrush
Thrush is one of the clinical forms of an infectious and inflammatory opportunistic disease of the skin, mucous membranes and internal organs, provoked by yeast-like fungi of the genus Candida, especially often by representatives of the species Candida albicans (in more than 70-80% of cases). In accordance with the name of the pathogen, this type of mycoses is designated as candidiasis.
Oral thrush
Opportunistic infections are caused by opportunistic microflora, which include Candida fungi. Under normal conditions, such microorganisms are not capable of causing disease, and often even endowed with useful functionality. With a decrease in local immune protection, their uncontrolled growth and reproduction begin, leading to the manifestation of pathological qualities.
Candida fungi are quite resistant to external influences and therapy, which is facilitated by a number of factors:
- a peculiar structure of the cell wall;
- the ability to produce proteolytic enzymes that provide penetration and firm fixation in the surface layers of the epithelium;
- high adhesive (sticking) ability;
- dermatonecrotic activity;
- reproduction by budding [formation of chlamydospores (modified cells covered with a dense membrane)].
Under normal conditions, Candida fungi are often present on the surface of the mucous membranes and skin, without leading to disease: from the oral cavity, Candida is sown in approximately 50% of somatically healthy people, from the mucous membrane and skin of the genitals - in 20-30%.
The true incidence of candidiasis is unknown due to low diagnosis, inactive symptoms in most cases, and a high incidence of latent course. According to some reports, at least one episode of thrush is present in the anamnesis in ¾ women, relapses are noted in 50% of cases.
Thrush causes and risk factors
The main cause of thrush is the intense local reproduction of Candida fungi, located on the surface of the skin and mucous membranes. The most favorable conditions for their active growth are an acidic environment (metabolic acidosis), a high level of humidity, a temperature of 30–37 ºС, a high concentration of glycogen in tissues against the background of a weakening of local immunity.
Conditions predisposing to the development of thrush:
- pregnancy (candidiasis develops in 20-30% of women);
- the use of oral contraceptives (especially those containing estrogens in high concentrations);
- prolonged psycho-emotional stress;
- acute stressful effects;
- taking antibacterial drugs (the risk of developing thrush increases as the duration of the course of antibiotic therapy increases);
- diabetes;
- suffered severe acute inflammatory diseases;
- condition after surgery;
- non-compliance with personal hygiene measures;
- hot climate (intense sweating);
- the use of aggressive cosmetics that disrupt the natural balance of microflora;
- the presence of sexually transmitted diseases;
- wearing synthetic underwear.
Pregnancy is a predisposing factor for the development of thrush
In addition to endogenous, thrush can be caused by exogenous causes - a drift from the outside. Infection in this case occurs in utero or after birth, in childhood or adulthood.
Intrauterine infection with Candida fungi is possible in several cases:
- transplacental penetration;
- intranatal (contact infection) when the child passes through the birth canal;
- ascending infection in case of a fungal infection of the cervix or vagina, the mother has candidal endometritis.
After birth, the infection can be transmitted to a child from the mucous membrane of the mother's mouth, from the skin of the nipples, hands. In addition to the mother, the source of infection for the newborn can be medical personnel transmitting fungi during invasive manipulations, or non-sterile material (oilcloths, diapers, nipples).
In adulthood, the main cause of thrush is unprotected sexual contacts, the use of dishes contaminated with mushrooms, and household items.
Forms of the disease
The main types of candidiasis:
- candidiasis of the nail plates (paronychia and onychia), skin and mucous membranes (superficial candidiasis);
- visceral (damage to internal organs);
- generalized candidiasis.
According to the degree of involvement of organs and tissues in the pathological process, the following types are distinguished:
- widespread candidiasis;
- local or focal, characterized by damage to a limited area or a separate organ.
Superficial candidiasis can be manifested by stomatitis, lesions of the lips and tongue, the formation of candidal seizures, a pathological process in the vaginal area and its vestibule or the glans and foreskin of the penis, colonization of large folds of the skin, skin of the palms and feet by the fungus.
In visceral candidiasis, various internal organs are affected: parts of the pharynx, esophagus, stomach, small and large intestines, bronchial tree, lung tissue.
Generalized candidiasis is diagnosed when Candida fungi enter the systemic circulation, which is rare (against the background of severe immunodeficiency states, in extremely malnourished patients).
Types of thrush, depending on the phase (severity) of the process:
- candidacy;
- acute form;
- chronic thrush.
In accordance with the etiological factor, thrush can be endogenous and exogenous. Endogenous thrush is an autoinfection, and exogenous thrush is the result of external infection.
Also, thrush can be complicated and uncomplicated.
On the basis of the presented classifications, it can be concluded that the term "thrush" is the accepted name in everyday life for superficial focal endo- or exogenous candidiasis of an acute or chronic course, localized in the genital or oral cavity. It is incorrect to call other forms of candidiasis thrush.
Thrush symptoms
The main signs of thrush of the urogenital sphere (vaginal candidiasis, balanitis or balanoposthitis):
- intense itching, which is of a constant nature (subsiding and renewing in waves), burning and local pain (in the perineum, vagina and its vestibule in women and the glans of the penis and foreskin in men);
- discomfort during intercourse;
- cheesy discharge with a characteristic pungent smell of sour milk in women;
- whitish crumbly plaque on the skin and mucous membranes;
- soreness when urinating;
- hyperemia and local edema of the skin of the genital organs;
- in men, cloudy discharge may appear in the urine.
The main symptom of thrush of the urogenital sphere is intense itching in the area of the prosthesis.
Signs of oral thrush (including candidal stomatitis, glossitis, cheilitis):
- whitish or yellowish-gray non-uniform plaque with inclusions of small dense grains on the surface of the cheeks, tongue, palate, inner surface of the lips;
- specific fermented milk smell from the mouth;
- white coating on the tongue, especially intense at the root;
- hyperemia of the oral mucosa;
- soreness, burning;
- with stomatitis, painful small erosion and ulcerative defects of the mucous membrane, covered with a curdled bloom, are noted;
- in severe cases, cracks with focal tissue seals are formed on the skin of the lips and the oral mucosa, tightly welded to the underlying surface, exposing the edematous, hyperemic and eroded mucous membrane when removed.
Features of the course of thrush in children
The infection of the child occurs either in utero or after birth. Thrush symptoms appear within a few weeks.
Prematurity, congenital immunodeficiency states, taking antibacterial drugs in the first days (weeks) of life, neglect by the mother of hygiene measures during breastfeeding, the use of insufficiently clean dishes, pacifiers, frequent regurgitation (shift of the acid-base balance of the oral cavity to the acidic side) are risk factors for the development thrush of newborns.
In addition, the clinical manifestation of thrush may occur during teething periods in infants and toddlers, hormonal changes in adolescents.
Thrush in children is manifested by a characteristic plaque in the mouth or genitals.
The following signs indicate the possible presence of thrush in an infant:
- anxiety;
- sleep disorders;
- refusal to eat;
- unreasonable crying;
- rejection of the nipple;
- obsessive touching with hands to the genital area or oral cavity (depending on the localization of the process).
When examining the oral cavity or genitals with thrush in children, there is a characteristic plaque, hyperemia of the skin and mucous membrane, a specific sour smell.
Diagnostics
Diagnosis of thrush is usually carried out on the basis of a characteristic clinical picture. In case of doubtfulness of the alleged diagnosis, the following studies are carried out:
- microscopy of a smear from the oral cavity or genitals with the detection of Candida fungi in the material;
- polymerase chain reaction (determination of pathogen DNA sites);
- sowing material taken from a smear on nutrient media.
A characteristic feature is the presence of a certain amount of fungi in a normal smear of a healthy woman, therefore, to establish a reliable diagnosis of thrush, a combination of signs of local dysbiosis with an increased concentration of Sandida fungi is necessary.
Treatment of "thrush"
The basis for the treatment of thrush is antimycotic drugs, the range of which is very wide:
- polyene series (natamycin, nystatin, levorin, amphotericin B);
- imidazole series (clotrimazole, ketoconazole, miconazole, bifonazole, etc.);
- triazole series (fluconazole, itraconazole);
- other drugs (griseofulvin, flucytosine, chloronitrophenol, dequalinium chloride, iodine preparations, etc.).
Also in the therapy of thrush are used:
- eubiotics - in order to normalize the balance of microflora;
- if necessary - immunostimulants, modulators;
- herbal decoctions, extracts (extracts of cloves, cinnamon, allspice);
- local remedies to relieve signs of inflammation.
The most common treatment for urogenital candidiasis is a combination of topical (creams, suppositories) and systemic (oral preparations) agents. Treatment of thrush in this case is carried out in parallel in both sexual partners, it is recommended to refuse sexual relations for the period of therapy.
For the treatment of thrush, antimycotic drugs are prescribed
When treating thrush of the oral cavity, specific treatment is combined with non-specific methods: lotions, rinses containing antiseptics, local antimicrobial drugs. It is not recommended to forcefully remove plaque or films from the oral mucosa, since this can lead to tissue trauma and subsequent secondary infection.
Possible complications and consequences
The main negative consequence of mild and moderate thrush is a short-term decrease in the quality of life, which is fully restored after the therapy.
With a severe course of thrush, the following complications may develop:
- accession of a secondary bacterial infection;
- the development of resistance to therapy;
- candidal septicemia;
- involvement of neighboring organs in the inflammatory process.
In infants, oral thrush leads to food refusal and, as a result, weight loss.
Forecast
With timely diagnosis and complex qualified treatment, the prognosis for thrush is favorable.
Prevention of thrush
- Use of barrier methods of contraception.
- Compliance with hygiene of the intimate area and oral cavity.
- The use of eubiotic drugs against the background of antibiotic therapy.
- Refusal to use aggressive cosmetics that violate the balance of microflora.
- Timely treatment of diseases that can cause thrush.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
