26 May 2011

Clinical Quiz: Oral thrush

By Nigel Stollery

After having a sore throat and mouth for three days, a patient comes in to the pharmacy, saying she has seen 'ulcers'. She says she is struggling to swallow and has been taking paracetamol to help, but is not sure it's working. You look at her throat, and diagnose oral thrush.

QUESTIONS

1. Thrush (which is the diagnosis in this case) is caused by a fungus from the same family as athlete's foot. True or false?

2. Thrush is present in 50 per cent of the population's mouth. True or false?

3. Thrush is common and not associated with other medical conditions. True or false?

4. Oral thrush can occur as a side effect of using asthma inhalers. True or false?

5. The treatment of choice for oral thrush is a course of oral antibiotics. True or false?

DISCUSSION

1. False. Thrush is caused by Candida albicans, a member of the yeast family. The name comes from its resemblance to a thrush's speckled chest.

2. True. Candida albicans is a normal commensal, which only becomes symptomatic when an overgrowth of the organism occurs.

3. False. In severe or recurrent cases an immunocompromised state may be the underlying cause, such as HIV. Patients with severe or recurrent infection should be referred.

4. True. Steroid asthma inhalers can lead to oral thrush. The risk of this happening can be reduced by using a spacer device and by rinsing the mouth with water after using an inhaler.

5. False. As thrush is caused by a yeast oral antibiotics won't help, and in some cases can actually cause thrush as a side effect. A topical anti-yeast preparation is the treatment of choice, either as lozenges or a suspension.

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