Joseph R. Anticaglia, MD
Medical Advisory Board
Mitchell is a 63 y/o stockbroker with a history of lung cancer who underwent a resection of the left lung, and chemotherapy for the tumor in 2019. He smoked one to two packs of cigarettes most of his adult life, and was forced to retire on his 61st birthday because of difficulty breathing, due to COPD.
After an upper respiratory infection, his breathing became labored — he had to work hard to breathe. He was rushed to the emergency department of his local hospital, and the E. D. Doctor examined him, and ordered a CT of the chest. The CT report concluded that Mitchell had an infection of the right lung, with narrowing of the airway passages on both sides causing his shortness of breath. He was transferred to the hospital’s intensive care unit, medicated with antibiotics, steroid medications, face mask oxygen and I. V. fluids.
Three days later while in ICU., he complained of throat pain, and couldn’t swallow the soft diet that was prescribed for him. Examination of the mouth, and back of the throat showed findings consistent with oral thrush; white patches splattered on the back of the throat, the soft palate as well as on the tongue.
Oral thrush is an infection in the mouth and/or throat caused by the overgrowth of Candida albicans, a yeast-like fungus. The fungus is naturally found in small amounts in the mouth, but certain risk factors (see below) disrupt the normal balance of microorganisms in the mouth leading to the overgrowth of oral Candida.
This fungal infection can proliferate on the tongue, soft, or hard palate, inner cheeks, throat, and in other parts of the body. It is characterized by soft, curd-like, white lesions which when wiped away leave red (erythematous) areas that may bleed. Thrush is also known as Oral Candidiasis (kan-di-DIE-uh-sis).
Patients notice white patches in the mouth that can appear on the inner cheeks, soft palate, tongue, and throat. They have complained of a cottony sensation in the mouth, loss of taste, bad breath, and a sore, burning, red throat that made it difficult to swallow, and to eat. They may also be bothered by a cracking and redness at the corners of the mouth (angular cheilitis).
Factors that contribute to microorganism imbalance in the mouth that lead to overgrowth of Candida albicans, and oral thrush include:
Visual examination of the mouth and throat is usually sufficient to make the diagnosis. Odd shaped, curdlike lesions can be scraped, and examined under a microscope. On rare occasions, cultures, and sensitivity tests can be done to identify the fungus.
Treatment recommendations for oral thrush include:
Antifungal medication: It involves the use of topical, or antifungal medications in pill form to manage thrush. It also necessitates treating underlying conditions like diabetes, dry mouth, or COPD which predispose to this condition.
Good Oral Hygiene: The practice of good oral hygiene especially in people with weakened immune systems, entails rinsing your mouth with water after steroid-inhaler treatment, proper denture care, keeping regular dental visits, brushing, and flossing teeth.
Diet: Eat nutritiously, and if needed make the dietary adjustments to maintain a healthy oral flora, that is, a healthy balance of microorganisms in the mouth.
Oral thrush can affect anyone at any age. However, it’s more frequently encountered in the very young and older adults because of their weakened immune system. If you’re a healthy person, it’s a relatively minor problem. If you have a weakened immune system, it presents more of a challenge to manage, and can lead to serious consequences.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
