eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Thrush: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Mudra Kumar, MD, MBBS, MRCP, Associate Professor, Department of Pediatrics, University of South Florida College of Medicine
Contributor Information and Disclosures

Updated: Jan 23, 2009

Follow-up

Complications

  • Very rarely, extensive tracheal and esophageal involvement in thrush may lead to dysphagia and respiratory distress in otherwise healthy hosts.
  • Bronchopulmonary candidiasis has been reported.
  • Systemic dissemination may occur in immunosuppressed patients.
  • Candidal esophagitis is a common complication of thrush in immunocompromised patients. In one study, it was the most common opportunistic infection in adults with acquired immunodeficiency syndrome (AIDS) (13.3 episodes per 100 person-years).

Prognosis

  • Thrush is considered a self-limited disease, but resolution is hastened by medical therapy.

Patient Education

  • Discuss thrush etiology and incidence as part of general reassurance to the parents of the healthy newborn or infant.
  • If indicated, offer information about the necessity of further evaluation for underlying immune dysfunction.
  • For excellent patient education resources, visit eMedicine's Yeast and Fungal Infections Center. Also, see eMedicine's patient education article Candidiasis (Yeast Infection).

Miscellaneous

Medicolegal Pitfalls

  • Serious consideration and determination of the possibility of immune dysfunction is critical for patients beyond infancy, especially those with no apparent underlying cause for thrush (eg, antibiotics, corticosteroids).
  • Immunodeficiency should also be considered in the infant with severe thrush associated with failure to thrive, severe eczema, and other infections.
 


More on Thrush

Overview: Thrush
Differential Diagnoses & Workup: Thrush
Treatment & Medication: Thrush
Follow-up: Thrush
References
[ CLOSE WINDOW ]

References

  1. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. Sep 1997;16(9):885-94. [Medline].

  2. Kalfa VC, Roberts RL, Stiehm ER. The syndrome of chronic mucocutaneous candidiasis with selective antibody deficiency. Ann Allergy Asthma Immunol. Feb 2003;90(2):259-64. [Medline].

  3. Liu X, Hua H. Oral manifestation of chronic mucocutaneous candidiasis: seven case reports. J Oral Pathol Med. Oct 2007;36(9):528-32. [Medline].

  4. Rowen JL. Mucocutaneous candidiasis. Semin Perinatol. Oct 2003;27(5):406-13. [Medline].

  5. Raucher HS. Should we be treating oral thrush?. Pediatr Infect Dis J. Mar 1998;17(3):267. [Medline].

  6. [Best Evidence] Adams NP, Bestall JC, Lasserson TJ, et al. Fluticasone versus placebo for chronic asthma in adults and children. Cochrane Database Syst Rev. 2005;CD003135. [Medline].

  7. Baley JE. Neonatal candidiasis: the current challenge. Clin Perinatol. Jun 1991;18(2):263-80. [Medline].

  8. Brown RS, Berg W, Schlesinger W, Childers EL. The CDx brush biopsy and the diagnosis of oral candidiasis. Dent Today. Aug 2007;26(8):96, 98-9. [Medline].

  9. Butler KM, Baker CJ. Candida: an increasingly important pathogen in the nursery. Pediatr Clin North Am. Jun 1988;35(3):543-63. [Medline].

  10. Egusa H, Soysa NS, Ellepola AN, Yatani H, Samaranayake LP. Oral candidosis in HIV-infected patients. Curr HIV Res. Nov 2008;6(6):485-99. [Medline].

  11. Gonzalez Gravina H, Gonzalez de Moran E, Zambrano O, et al. Oral Candidiasis in children and adolescents with cancer. Identification of Candida spp. Med Oral Patol Oral Cir Bucal. Oct 2007;12(6):E419-23. [Medline].

  12. Kumamoto CA, Vinces MD. Alternative Candida albicans lifestyles: growth on surfaces. Annu Rev Microbiol. 2005;59:113-33. [Medline].

  13. Kwon-Chung KJ, Bennett JE, eds. Medical Mycology. Philadelphia, Pa: Lea & Febiger; 1992:2288-301.

  14. Liguori G, Lucariello A, Colella G, De Luca A, Marinelli P. Rapid identification of Candida species in oral rinse solutions by PCR. J Clin Pathol. Sep 2007;60(9):1035-9. [Medline].

  15. Nokta M. Oral manifestations associated with HIV infection. Curr HIV/AIDS Rep. Feb 2008;5(1):5-12. [Medline].

  16. Ozturk MA, Gunes T, Koklu E, et al. Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit. Mycoses. Nov 2006;49(6):484-92. [Medline].

  17. Pankhurst C. Candidiasis (oropharyngeal). Clin Evid. Jun 2005;1701-16. [Medline].

  18. Perniola R, Congedo M, Rizzo A, et al. Innate and adaptive immunity in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Mycoses. May 2008;51(3):228-35. [Medline].

  19. Roland NJ, Bhalla RK, Earis J. The local side effects of inhaled corticosteroids: current understanding and review of the literature. Chest. Jul 2004;126(1):213-9. [Medline]. [Full Text].

  20. Russell C, Lay KM. Natural history of Candida species and yeasts in the oral cavities of infants. Arch Oral Biol. Aug 1973;18(8):957-62. [Medline].

  21. Segal BH, Steinbach WJ. Combination antifungals: an update. Expert Rev Anti Infect Ther. Oct 2007;5(5):883-92. [Medline].

  22. Shepherd J. Thrush and breastfeeding. Pract Midwife. Dec 2002;5(11):24-7. [Medline].

  23. Su CW, Gaskie S, Jamieson B, Triezenberg D. Clinical inquiries. What is the best treatment for oral thrush in healthy infants?. J Fam Pract. Jul 2008;57(7):484-5. [Medline].

  24. Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook. 7th ed. 2000.

  25. Terai H, Shimahara M. Tongue pain: burning mouth syndrome vs Candida- associated lesion. Oral Dis. Jul 2007;13(4):440-2. [Medline].

  26. Vazquez JA. Posaconazole for the management of mucosal candidiasis. Future Microbiol. Jun 2007;2:245-56. [Medline].

  27. Vazquez JA, Sobel JD. Mucosal candidiasis. Infect Dis Clin North Am. Dec 2002;16(4):793-820, v. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

thrush, Candida albicans, C albicans, candidal diaper rash, candidiasis, diaper dermatitis, fungal infection, hepatosplenomegaly, human immunodeficiency virus, HIV, immune dysfunction, lymphadenopathy, monilia, moniliasis, mucocutaneous candidiasis, oral candidiasis, oral thrush, oropharyngeal yeast infection, polyendocrine disorders, vaginal candidiasis, white tongue coating

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Mudra Kumar, MD, MBBS, MRCP, Associate Professor, Department of Pediatrics, University of South Florida College of Medicine
Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Leslie L Barton, MD, Professor, Program Director, Department of Pediatrics, University of Arizona School of Medicine
Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.