Thrush: This is behind the fungal infection

Thrush is an infectious disease of the skin and mucous membranes caused by the Candida fungus. This is a unique form of candidiasis. The most common types of thrush are oral thrush and diaper thrush, which is common in babies, but thrush can also occur in skin folds or the genital area. In the following, we will introduce you to the different forms of fungal infection and explain how to recognize and treat the symptoms of thrush.

Candidiasis and Thrush – Definition

Thrush is a subspecies of candidiasis (also candidiasis or Candida mycosis). Candidiasis is a collective term for various infectious diseases caused by an excessive proliferation of Candida fungi.

These fungi can spread through the blood throughout the body and infect the organs. This is then referred to as systemic candidiasis. This can trigger life-threatening sepsis.

If the candidiasis is localized on the skin or mucous membranes, this is called thrush. Other names are local candida mycosis or mucocutaneous candidiasis. In the past, thrush was also called moniliasis.

 

Candida: yeast is the cause

Candida – the fungus that causes candidiasis or thrush – is a genus of yeast fungi. Around 150 different types of Candida can cause serious fungal infections (mycoses). The most common cause of thrush is the subspecies Candida albicans.

Depending on their type, Candida fungi are also found on and in the body of most healthy people. The fungi often settle superficially on the skin and mucous membranes, the mouth and throat, the large intestine, and the external genitalia.

As a rule, contagious fungi are a natural part of the skin, mouth and intestinal flora. They do not cause discomfort as long as their reproduction is limited by the balance of other microorganisms and the immune system. Problems only arise when the fungi multiply excessively or break through the natural barriers of the skin and mucous membrane. Thrush infections or systemic candidiasis are then often the result.

Fungal infection with many faces

Thrush can affect different parts of the body. The most common areas affected by the fungal disease are:

• mouth and throat (oral thrush)
• Skin in the diaper area in diaper-wearing babies and adults (diaper thrush, also known as diaper fungus)
• Genital mucosa (vaginal fungal infection or infection of the glans or foreskin)
• moist folds of the body or skin, for example, between the toes or fingers, in the groin or around the anus (intertriginous candidiasis)
• Nail folds (finger and toenails)
• nipples (thoracic thrush)
• oesophagus (thrush esophagitis)

Thrush is typically localized. However, a transition to other body regions is possible. For example, oral thrush can spread to the throat, oesophagus, or gastrointestinal tract if left untreated. 

Blood infection and serious consequences such as pneumonia or meningitis are also possible. Therefore, thrush should always be treated by a doctor.

 

Risk Factors: Common triggers of thrush

Thrush usually only develops when the body’s natural defence mechanisms fail, and the fungus can spread unhindered. Typical risk factors that favour the development of thrush are, for example:

• taking medication such as antibiotics or cortisone
• for nutrient deficiency
• Changes in the skin or mucous membrane that make it easier for the fungus to penetrate, for example, wounds, lack of ventilation of the skin due to bandages or a change in the pH value
• a weakened immune system, for example, due to infections, diseases such as diabetes mellitus, HIV or cancer, or as a result of chemotherapy
• Children and older adults often have a weak immune system.
• Missing teeth, ill-fitting dentures, smoking, or a dry mouth can all contribute to oral thrush.
• Skin thrush is common in people with work-related moist skin (such as cleaners) or in the skin folds of people who are severely overweight.
• Babies and newborns often suffer from oral thrush or diaper thrush. The latter is caused by wearing diapers, where the fungus finds an ideal warm, humid climate.
• Mother and child often infect each other while breastfeeding. The mother’s nipples often become diseased as a result of moisture under the nursing pads or the baby’s oral thrush.

Typical symptoms

Depending on the affected body region, thrush causes different symptoms. The following signs are typical of the fungal infection of the skin and mucous membranes:

• Oral thrush: white, easily removable plaque and a reddened mucous membrane in the oral cavity, tongue, or throat. Depending on the shape, the pads can also be stuck or missing. Here are details on the symptoms of oral thrush.
• Skin thrush (usually in skin folds, for example, under the breasts, in the armpits or the groin area): severe redness, scales, bumps, itching, sometimes a burning sensation and pain
• Thrush on toenails and fingernails: redness, swelling and pain when touched
• Vaginal thrush  (often aggravated by high estrogen levels during pregnancy): itching, burning, reddening and swelling of the mucous membrane, whitish coating, sometimes crumbly white discharge
• Thrush on the glans (thrush balanitis) or the foreskin (thrush balanoposthitis): burning, itching, inflammation of the glans or foreskin, bumps and small blisters
• Thrush on the breast:  pink, sometimes shiny, sore nipples, itching, burning, pain, swelling, dry and scaly skin, sometimes with white patches or blisters
• Diaper thrush: red, white-rimmed bumps, scales, red, inflamed skin in the diaper area, sometimes also in the thighs, abdomen or back, often associated with diaper rash.

Swab allows diagnosis

Depending on the type of thrush, thrush can sometimes be diagnosed based on the symptoms. Usually, the doctor also inquires about previous illnesses and asks whether medication is being taken or other risk factors are present.

The microscopic examination of a smear or samples of affected skin or mucous membrane is the most common method for detecting thrush and can usually quickly ensure the diagnosis. This is often necessary, especially in adults, to rule out other diseases with similar symptoms.

If there are no symptoms, a positive test for Candida fungi is not considered evidence of thrush or candidiasis since the yeast fungus is also found in many healthy people.

 

Other methods of detecting thrush

Further imaging procedures, such as gastroscopy in the case of thrush in the oesophagus, may be necessary for a precise diagnosis of thrush, for example, taking a tissue sample. A blood test can also detect antibodies against the Candida fungus. However, this procedure is controversial and usually optional.

If necessary, the exact type of yeast can be determined with the help of fungal cultures. This is of particular interest when an administered drug does not work, and resistance of the fungus is suspected.

What helps with a thrush infection?

The treatment of the various forms of thrush is carried out with the help of locally applied antimycotics, i.e. antifungal agents. Commonly used drugs include nystatin, amphotericin B, clotrimazole, fluconazole, and itraconazole. If the remedies are used as prescribed for the recommended duration of therapy, thrush can usually be controlled quickly and easily – thrush is considered to be easily curable.

Depending on the affected part of the body, various preparations against thrush are available, for example:

• solution
• mouthwash
• cream or ointment
• Nail polish
• Tablet
• suppository

Homoeopathic remedies and home remedies can be used in consultation with the doctor. However, it is strongly discouraged to treat thrush with homoeopathy or home remedies alone.

Thrush often returns

When treating thrush, following the doctor’s instructions and using the antifungal medication for the prescribed duration is essential. Otherwise, stopping treatment prematurely can quickly lead to a relapse or spread of the fungal disease.

So that the thrush does not return, the cause should permanently be eliminated if possible; for example, the underlying disease that caused it should be treated. If no apparent risk factors can be identified, it is essential to clarify the causes of the outbreak of the thrush infection. Thrush is often the first sign of a weakened immune system due to a previously unnoticed disease, such as diabetes or HIV.

 

Complementary measures for treatment

Drug treatment of thrush should always be supplemented by appropriate hygiene measures to avoid spreading the infection. The thrush infection should not be touched with bare hands to prevent a smear infection.

The other supplementary measures depend on the type of thrush disease:

• After the Candida fungi have come into contact with clothing, towels or bed linen, the laundry should be washed at least 60 °C or with appropriate hygiene detergents.
• Ensuring adequate ventilation of the affected areas is essential with thrush in skin folds. For example, gauze strips can be placed in the skin folds to keep the skin dry.
• In the case of oral thrush, oral hygiene items such as toothbrushes should be replaced – the same applies to pacifiers or teats. Thorough cleaning is recommended for dentures or braces.
• Care should be taken for diaper thrush to keep the diaper area clean and dry and to ventilate it regularly. Fresh changing mats are always necessary to avoid contracting the fungal infection.

People who suffer from thrush are often advised to eat a diet low in carbohydrates and sugar because the Candida fungus feeds on sugar. However, the effectiveness of this antifungal diet is debatable.

Infection with Candida fungi

Candida fungi can quickly spread to other body areas or from one person to another. Follow these tips to prevent infecting others:

• If there is a thrush infection in the genital area, the use of condoms is recommended since the disease can be transmitted through sexual intercourse.
• Oral thrush in babies often affects the nipples of breastfeeding mothers and vice versa. Therefore, treatment should usually include mother and child, and breastfeeding should be avoided during the infestation.
• Candida fungi often settle in the mouth and can be transmitted via the saliva. Kissing or drinking from a glass together can be enough for infection.
• Candida fungi can also be transmitted via the hands – for example, from parents to newborns. Good hand hygiene is, therefore, essential when handling babies. 

Prevention of thrush

Candida fungi, the cause of thrush, are also widespread in healthy people but only cause symptoms when the immune system is weakened. Therefore, thrush can only be prevented to a limited extent. Strengthening the immune system through a healthy lifestyle and a balanced diet, hygiene – especially in the intimate area – and condoms can help prevent infection with fungi.

People whose immune system is weakened, for example, due to illness or long-term medication use, should be susceptible to thrush infection and pay close attention to possible signs.

 

Prevent diaper thrush and oral thrush in babies.

To prevent thrush in babies, it is advisable to rule out vaginal thrush in the mother before birth. Otherwise, the child could be infected with the Candida fungi at birth. But the child can also become infected later, for example, through the saliva or the hands of the parents.

Parents should pay particular attention to the hygiene of pacifiers, teethers and teats to prevent oral thrush. Mothers who breastfeed their children should also prevent inflamed nipples, for example, by changing nursing pads frequently. Bathing the baby too often or too infrequently and changing diapers too infrequently can upset the child’s skin environment and thus promote diaper thrush.