Oral Thrush - BNS 3rd year CMC pptx

Samikshya Banjara

1. Oral Thrush

2. Introduction Candidia has emerged as an important cause of neonatal infections and is associated with significant morbidity and mortality, especially in extremely low and very low birth weight infants (birth weight <1000 gram and <1500 gram respectively.

3. Contd.. There are two broad categories of candida infection in neonates: a) Mucocutaneous Candidiasis i ) Thrush ii) Diaper Dermatitis

4. Contd.. b) Invasive Infection: i ) Blood Stream ii) Urinary Tract iii)Central nervous system

5. Definition A Thrush is a mucocutaneous fungal infection of oral cavity caused by candida species which is usually harmless and easily treatable. Thrush presents as irregular white plaques with or without an erythematous base on the buccal, or lingual mucosal surface of mouth.

6. Contd … About 1 in every 7 babies develop oral thrush at some point. It is more common in younger babies.

7. Causes It is caused by dimorphous fungus (Yeast and filamentous forms) called “Candida albicans ’’- a commensal in oral mucosa (50%) and vaginal (25%).

8. Contd.. Infection with other species such as C. Parapsilosis , C. tropicalis and fluconazale - resistant C. glabrata may also be seen .

9. Risk Factors Maternal vaginal colonization with candida and birth asphyxia, low birth weight infants(<1500 grams) During breastfeeding; also greater in infants who are formula fed (contaminated bottle nipple and pacifier)

10. Contd.. Oral thrush can also affect babies if they have recently been treated with antibiotics and are immunocompromised.

11. Mode of transmission Vertical transmission (from mother to child); Heavy maternal candidia colonization or vaginitis During breastfeeding via maternal skin directly.

12. Contd.. Horizontal transmission (from health care workers to child) Contaminated hand of health workers. Exposure to surfaces that are contaminated. Contamination of medication.

13. Clinical Features Creamy white spots or patches on the tongue, gums, roof of the mouth or insides of the cheeks. Coating may look like curd or cottage cheese and usually cannot be rubbed off easily.

14. Contd.. Baby may not seem bothered by the patches, but may be reluctant to feed or keep detaching from the breast during feeds.

15. Diagnosis Usually diagnosed clinically based on the characteristic appearance of the lesion. In infants who fail topical therapy, a culture from the lesion may be useful to identify candida species.

16. Prevention To reduce the risk of developing Candidal infections include efforts to reduce candida cross- transmission and risk factors associated with fungal infection, and the use of prophylactic antifungal agents.

17. Contd.. Also includes sterilization or decolonization of items that are placed in infant’s mouth . Clean the tongue with soft gauze piece dipped with Normal Saline.

18. Treatment Appropriate topical antifungal for non invasive mucocutaneous candidiasis includes: Nystatin(oral suspension, at a dose of 0.5 ml to each side of mouth four times a day between feeds for 5 to 10 days.

19. Contd.. Neonates with inadequate response to Nystatin can be treated by: -Fluconazole (3mg/kg, once a day for seven days)