Thrush Due to Oral Cortisone Use in Adult Patient

Oral Candidiasis - Mouth Thrush 

Oral candidiasis, Mouth thrush, Candida infection of soft palate,Oral thrush, Yeast infection in mouth

Sometimes, white, cream-like lesions may occur as a result of a fungal infection called Candida albicans in the mouth. Although it is usually seen on the tongue and inner surfaces of the cheeks; It can be seen in the gums, palate and tonsils. It can spread to the inside of the larynx and larger areas in people with weakened immunity.

Why Is Thrush In The Mouth?

Normally, there are normal flora bacteria in our throat, which are protective for us. In people with weakened immunity (cancer, chemotherapy, radiotherapy treatment, oral systemic infections, use of drugs that disrupt the local flora), local fungal infection may grow easier and infection control may become difficult. Candida is an organism normally found in our mouth, but can sometimes overgrow, causing symptoms. The presence of a foreign body such as a prosthesis placed in the mouth may facilitate fungal infection in local contact areas. The patient I shared with you in this article was evaluated after oral inhaler cortisone spray, systemic cortisone tablet and broad-spectrum systemic antibiotic treatment due to lung infection, increased burning in the throat and discomfort when swallowing, and white thrush lesions were observed on the soft palate as seen in the photographs. The patient also smokes heavily. In this patient, it was planned to terminate the oral and systemic cortisone treatment, to stop smoking, to terminate the antibiotic treatment in order to eliminate the risk factors as soon as possible, and to apply a local mushroom solution to the patient, gargle with vinegar water, Mediterranean style diet, and a dietary change in order to prevent reflux were recommended.

Oral candidiasis, Mouth thrush, Candida infection of soft palate,Oral thrush, Yeast infection in mouth

Symptoms of Oral Candida Infection

Initially, the symptoms of oral thrush may go unnoticed, and mothers of toddlers may not even realize they have an infection for a long time. It may seem like a simple cause of unrest.

Signs and symptoms of an oral yeast infection may include:

- Patients can often see whitish lesions themselves. Creamy white lesions may be noticed on your tongue, gums, inside of your cheeks, and sometimes on your palate and tonsils. It may take longer for mothers to notice these lesions in infants.

- The structure of the lesions may resemble cottage cheese and appear slightly raised from the surface

- Patients may experience burning or pain in the throat, which can be severe enough to make it difficult to eat or swallow

- Bleeding may occur when the lesions are touched and mechanical cleaning is attempted.

- Taste changes, decreased sense of taste

- Redness, irritation and pain under the dentures placed in the mouth (prosthesis stomatitis)

- Cracking and redness in the corners of the mouth

- Having a cottony feeling in the mouth

May cause severe weakening of the immune system, in patients with cancer diseases or HIV/AIDS, the lesions may spread to the entire esophagus (Candida esophagitis). In this case, the complaints may increase, difficulty in swallowing and more severe pain when swallowing, a feeling of being stuck may occur.

- Babies with a candida infection may experience feeding problems. Babies may be more irritable and fussy. They can transmit the infection to their mothers during breastfeeding. The infection can then be transmitted recurrently between the mother's breasts and the baby's mouth.

The following symptoms may occur in mothers with candida infections in their breasts:

- More pain than usual during breastfeeding or sore nipples between feedings
- Having red, tender, cracked or itchy nipples
- Shiny or scaly skin in the areola area around the nipple
- Unusual pinprick pain in the breast

Oral candidiasis, Mouth thrush, Candida infection of soft palate,Oral thrush, Yeast infection in mouth

Oral Candida Causes

Normally, there are protective flora bacteria in all the holes and hollow spaces in our body. Our body has the capacity to distinguish between benign and malignant (pathogenic) microorganisms and to prevent the growth of malignant microorganisms in these areas.
When local protective mechanisms are damaged, harmful invading organisms such as malignant bacteria and fungi can begin to reproduce, and candina infection can occur. The most common candinda fungus subspecies is Candida albicans. In the presence of weakened immune system and local protective factors, its easy reproduction can be accelerated.

Oral Candida Risk factors

Factors that increase the risk of oral candida infection can be listed as follows:

- Diseases, drugs and various conditions that cause weakening of the immune system

Due to reduced immunity, oral thrush is more likely to occur in infants and the elderly. In the presence of certain medical conditions such as cancer, organ transplant, use of drugs that suppress the immune system, severe systemic infections, AIDS disease, the strength of the immune system may decrease.

- In the presence of uncontrolled diabetes, oral candida infection may be facilitated because both the immune system will be adversely affected and the amount of sugar in the saliva will increase.

- It may be easier for babies to have oral thrush if the mother has a vaginal yeast infection. The infection can be transmitted to babies through the vaginal canal.

- Local and oral cortisone therapy, antibiotic therapy. These medications can upset the balance of naturally occurring flora and microorganisms in your body and facilitate oral fungal infection. Medications such as prednisone, inhaled corticosteroids or antibiotics may increase your risk of oral thrush when used in repeated doses.

- Use of oral prosthesis. Especially the use of upper palate prosthesis can be used as a suitable medium - surface area for local foreign body effect and fungi, and may facilitate local fungal infection in contact areas.

- In cases that cause dry mouth, reflux, and decrease in saliva, mucosal flora bacteria may be adversely affected and fungal infection may be facilitated.

- Smoking 

- Inadequate oral care

Source of Candida

Candida normally lives in our body without causing any problems or infections in the mouth, throat and the rest of the digestive tract. Sometimes when the balance of local and systemic immunity is changed, Candida can multiply and increase in number, causing infection in these areas.

Oral Candidiasis Complications

Oral thrush is generally not a serious problem in healthy people (children and adults). Elimination of risk factors is usually sufficient for treatment.

However, oral thrush may be a more serious condition in patients with cancer diseases, HIV infection, severe systemic infections, and patients taking various immunosuppressive drugs, which can cause severe suppression of the immune system. In untreated patients, systemic candida infections may occur. The disease may spread to the food or to different areas, and treatment may be difficult.

Oral Candida Diagnosis and Diagnostic Tests

Only local whitish lesions are sufficient for diagnosis. Local culture can be taken to confirm the diagnosis. Examination of the culture sample taken under the microscope makes the diagnosis of candida. In the endoscopic examination, the esophagus and oral mucosa can be seen, and the diagnosis can be confirmed by the presence of lesions accompanied by the patient's symptoms.

Oral candidiasis, Mouth thrush, Candida infection of soft palate,Oral thrush, Yeast infection in mouth

Oral Candida Prevention and Treatment

The following recommendations are helpful in the treatment and prevention of oral candida infections:

- In case of using inhaled cortisone, rinse your mouth with water after using the medicine and brush your teeth. In this way, the cleaning of cortisone particles remaining in the mouth can be achieved.

- Take care of your oral care. Brush at least twice a day and floss daily or as often as your dentist recommends. Do not consume foods with artificial sugar and sweets containing burnt sugar, which facilitate the formation of tartar on the teeth.

- Pay attention to the care of oral prostheses. Remove your dentures at night and clean them with washing solutions, toothbrushes. Make sure the dentures fit properly and do not cause irritation. You can get information about cleaning your dentures from your dentist.

- Get information from your doctor about diabetes treatment and have your blood sugar follow-ups done well. Do not consume foods with a high glycemic index. Lowering blood sugar and keeping it in the normal range are beneficial in reducing the amount of sugar in saliva and preventing candida infection.

- Treatment of systemic infections

- For the treatment and prevention of dry mouth, drinking plenty of water, consuming liquids without diuretic properties, intranasal irrigation with local saline to reduce nasal congestion. Consumption of natural vegetables with high water content.

- Treatment of vaginal yeast infection of mothers

- Cessation of the use of systemic antibiotics.

Oral Candida Treatment

In the treatment, it is beneficial to apply local antifungal solutions with cotton, use local acidifying liquids (such as organic vinegar), use local antiseptic sprays and mouthwashes. Oral and systemic antifungal drugs may also be required in patients with serious diseases and conditions (with the above-mentioned risk factors) that cause a weakened immune system. Since the side effects of systemic antifungal drugs are high, simple local treatments are usually sufficient in healthy people without risk factors.

Cortisone, Antibiotic Treatment Ended After Two Weeks!

Candida infection of soft palate,Oral thrush,Yeast infection in mouth,Mouth thrush,Oral candidiasis,

Candida infection of soft palate,Oral thrush,Yeast infection in mouth,Mouth thrush,Oral candidiasis,

As seen in the photos above, the mucosa returned to almost normal two weeks after the patient's inhaled corticosteroid, systemic corticosteroid and antibiotic treatment was terminated. The patient was advised to apply a local antifungal solution with cotton wool, to rinse the mouth with vinegar water, and to stop smoking.

The link group you can click to read the articles about candida infection that I have previously published on this website >>

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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