This article is professionally consulted by otolaryngologists at General Internal Medicine - Outpatient Department – Vinmec Hải Phòng International Hospital.
This is a rare disease and easily recognized but patients usually neglect and underestimate it. Symptoms of oral thrush (oropharyngeal candidiasis) are typically unclear and difficult to realize. The two most common complaints are cough and itchy throat.
1. What is Oropharyngeal Candidiasis?
Oropharyngeal Candidiasis (oral thrush) is an oropharyngeal mucosal inflammation caused by fungal infection.
Oropharyngeal Candidiasis (OPC) is the most common opportunistic infection, frequently occurring in individuals with immunocompromised (weakened immune systems), chronic anemia, and diabetes mellitus. Most cases are caused by a rare Candida species, called mold. Prolonged use of antibiotics, corticosteroids, cytotoxic drugs, diabetes, pulmonary tuberculosis, and vitamin deficiencies can all contribute to OPC development.
Individuals working in polluted environments, inhaling airborne fungal spores, or ingesting fungal-contaminated food are at increased risk of OPC.
According to studies, Candida is a primary causative agent of oropharyngeal candidiasis. This fungus colonizes the mouth, throat, and gastrointestinal tract. When oropharyngeal mucosal immunity is reduced and the pharyngeal pH shifts from alkaline to acidic due to gastroesophageal reflux, Candida can proliferate, leading to OPC and its associated symptoms.
2. Symptoms of Oropharyngeal Candidiasis
Symptoms of OPC are often unclear and difficult to recognize. The two most common complaints are cough and throat itching.
Early signs to realize may include sharp, localized pain in the affected area of the throat. Even though these symptoms are often mild, the patients can feel discomfort.
Due to the lack of distinct symptoms, patients often present with persistent coughs unresponsive to antibiotics. This cough can result from an initial allergic reaction to fungal spores, later progressing to an inflammatory cough due to inflammation. The cough significantly impacts daily life. Some patients experience throat itching, burning, and dysphagia (difficulty swallowing) because they often neglect and underestimate this cause. These symptoms may emerge after a common cold with cough, sneezing, or runny nose, and may be resistant to antibiotic treatment.
Some patients may also report halitosis (bad breath) with a sour or foul odor.
The patient’s oropharyngeal mucosa is reddened, the tongue is coated with a foul odor, and the posterior pharyngeal wall is studded with small lymphoid follicles. There is an increased pharyngeal mucus, easy bleeding upon manipulation, and potentially pseudomembranous. These pseudomembranous can appear grayish and friable (easily broken down). Patients may also experience increased saliva secretion in the hypopharynx (the lower of the throat) and an uncomfortable itchy sensation in the throat, which makes the perceived severity of the itch even worse.
OPC typically causes only discomfort but does not affect overall health. However, secondary bacterial infection or severe immunodeficiency can worsen this condition, resulting in increased pain and dysphagia.
If the infection spreads to the intestines, it may impair nutrient absorption. In severe cases, OPC can disseminate to the lungs and liver, causing organ damage.
3. Causes of Oropharyngeal Candidiasis
The most common cause is Candida albicans. This fungus is also responsible for vaginal candidiasis; therefore, women with vaginal candidiasis may transmit the infection to infants during childbirth or to sexual partners.
Other contributing factors include:
- Poor oral hygiene, frequent denture use
- Immunodeficiency
- Chronic anemia
- Malnutrition
- Prolonged use of antibiotics or corticosteroid anti-inflammatory drugs
- Smoking
- HIV/AIDS
- Cancer
- Diabetes mellitus
- Women with vaginal candidiasis
4. Consequences of Oropharyngeal Candidiasis
OPC causes significant discomfort and affects daily life. Untreated, it can lead to secondary bacterial infections. In immunocompromised individuals, OPC may cause intense pain, and dysphagia if the infection spreads to the esophagus.
If this infection spreads to the intestinal, it can impair nutrient absorption. Furthermore, OPC can cause damage to the liver and lungs.
5. Treatment of Oropharyngeal Candidiasis
Antifungal medications used to treat OPC can be hepatotoxic (harmful to the liver). Therefore, accurate diagnosis is crucial before treatment.
OPC can be difficult to treat because the fungus's chitinous cell wall makes it resistant to medication. Therefore, you should consult your doctor about potentially longer treatment to achieve the best results.
The physician will determine the appropriate treatment strategy (various methods and medications) based on the severity of the infection and the patient's immune status. Antifungal medications can have significant side effects and require close monitoring and strict adherence to the prescribed regimen.
OPC is recurrent easily, so thorough treatment is crucial for this condition, including the prescribed dose and duration.
Individuals at high risk for Candida infection should adopt a healthy diet and exercise regimen to boost their immune systems and overall health.
To prevent Candida overgrowth, it is advisable to avoid spicy foods, quit smoking, and maintain meticulous oral hygiene
Oropharyngeal candidiasis is a rare otolaryngology disease. It's often difficult to recognize and usually does not cause severe health complications. However, to minimize its impact on daily life, patients should not ignore or dismiss its symptoms.
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