Thrush Clinical Presentation

Updated: Jan 17, 2019
  • Author: Mudra Kumar, MD, MRCP, FAAP; Chief Editor: Russell W Steele, MD  more...
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Presentation

History

Parents of children with thrush usually notice a white coating in the child's mouth.

Infants may have trouble feeding in severe cases.

Medical history may include the following:

  • Recent antibiotic or steroid use may suggest a predisposing cause.

A study found that the adverse effects of antibiotics such as amoxicillin were underreported as treatment with amoxicillin or amoxicillin-clavulanic acid commonly results in candidiasis. The study concluded that clinicians need information about both harms and benefits when prescribing antibiotics. [2, 3]

  • Diarrhea, rashes, failure to thrive, hepatosplenomegaly, or repeated infections suggest an underlying immunodeficiency. [4]

Maternal history may include the following:

  • Vaginal candidiasis is a source of perinatal exposure to infection.

  • HIV status may provide a clue to a predisposing factor.

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Physical

Lesions often start as tiny focal areas that enlarge to white patches on oral mucosae (see the image below).

White plaques are present on the buccal mucosa and White plaques are present on the buccal mucosa and the undersurface of the tongue and represent thrush. When wiped off, the plaques leave red erosive areas. Courtesy of Matthew C. Lambiase, DO.

When scraped with a tongue blade, lesions are difficult to remove and leave behind an inflamed base that may be painful and may bleed.

Candidal infection in the diaper area may accompany thrush. Examine an infant with diaper dermatitis for oral lesions. [5]

Differentiate thrush from a coated tongue.

Thorough physical examination is critical, especially for patients with recurrent thrush and for older children. Pay attention to the child's growth, rash distribution, lymphadenopathy, hepatosplenomegaly, and other potential sites of infection (eg, mucocutaneous candidiasis [6, 7, 8] ).

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Causes

Consider an underlying immune deficiency such as AIDS, especially in recurrent cases and in older infants. For chronic infection, chronic mucocutaneous candidiasis should be considered.

Systemic antibiotic use may disrupt the normal flora, promoting candidal overgrowth.

Use of systemic and inhaled steroids is associated with increased incidence of oral thrush.

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