THRUSH

Many people will suffer from thrush at some time in their lives. It is a fungal infection which is usually no more than a nuisance, and only present serious problems when associated with a severe generalized illness.

Thrush is caused by a fungus called Candida and can affect many parts of the body, but is particularly likely to affect the vagina. It can also occur at any time of life, from the first few weeks to old age.

Normally the infection causes little more than a serious irritation but it can sometimes spread through the blood stream to cause a severe general infection.

CAUSES

Compared with the number of bacteria that infect humans, there are very few fungi that cause problems and these fall into two groups: yeast’s and filamentous fungi. Candid is one of the yeast’s which are very similar in form to the type of yeast used to make bread rise. When examined under the microscope they are seen as small round organisms, while the filamentous fungi produce long threads made up of a series of single-celled organisms joined together like the sections of a drain -pipe. But it may be difficult to identify a particular Candid organism.

A number of different types of Candid cause disease, the commonest being Candid albicans (meaning white). Candid is an organism which is often present on the skin or in the gut of most people. If it starts to cause symptoms, this is because some other problem has allowed the Candid organisms to multiply to a greater extent than usually. For example, elderly people often develop thrush in their mouths, and the precipitating factor is usually a cut of abrasion, perhaps where an ill fitting denture rubs the gums or lips.

Vaginal thrush is the exception to this rule - it is very common for the Candid organism to breed in the vagina, even if the vaginal mucous (lining) is quite normal and healthy.

It is very unusual for Candid to get into the body and cause systemic or deep infections (infections of the internal organs and tissues). This is most likely to happen in people who already have some illness that lowers their resistance to infection. Systemic infections may occur when patients are on drugs that suppers the immune system, or when they have a disease - such as leukemia - which has this effect.

Rarely, there may be a chronic infection of the mouth or the vagina, or else where on the surface of the body. This is called chronic mucocutaneous candidiasis. The exact cause is not certain but it is an inherited defect in the immune system’s response to disease, and the problem starts in infancy or childhood.

Babies can also get thrush in their mouths any time after about the age of three weeks. This nearly always happens in those babies who are bottle fed rather than breast-fed, but it does not mean that there is anything wrong with the baby’s immune system.

SYMPTOMS

The two commonest sites of Candid infection are the mouth and the vulva and vagina, where infection is called vulvo-vaginitis. Infection in the mouth is most often found in people who wear dentures, and take the form of small white patches on the gums, lips and inside the cheeks. These may be very sore, particularly on eating and are usually worst in people who have a serious illness of almost any kind. The thrush may then affect large parts of the mouth and spread down into the gullet, making eating virtually impossible. This can be definite setback for someone recovering from a serious operation of illness.

Volvo vaginitis as a result of thrush causes a white discharge with a lot of irritation. It affects women of almost any age but it seems to be commoner in pregnancy and less common among children. Diabetics are particularly prone to vaginal thrush, and is often the reason why the disease initially comes to light before other symptoms develop.

Men also suffer from genital Candid infections. For example, inflammation of the tip of the penis (balanitis) is often caused by Candid. In men it is even more common for genital infection to be associated with diabetes than in women, although candidal banalities is overall less common than candidal vulvovaginitis.

Sometimes women get repeated vaginal thrush without some predisposing conditions like diabetes. This problem seem to be occurring more frequently and the conventional explanation is that these women are being repeatedly infected, perhaps by their sexual partners. This is, however, not a very satisfactory theory since Candida is an organism which nearly always exists in people, but is only occasionally the cause of symptoms. It has also been suggested that the increase in the incidence of chronic vaginal thrush is due to the wider use of the Pill and there is some evidence to support this view.

Candida causes infection of the internal organs in people who already have some other disease. Thus, for instance, the kidneys and urinary system may be involved in the case of diabetes. Surgery can also predispose to infection, and ‘invasive’ techniques - such as the use of a drip - may inadvertently introduce infection into the bloodstream. If this happens the only symptoms may be a swinging temperature, and it tends to occur in people who are already being treated for infections in the bloodstream.

DANGERS

The main danger of Candida is with those people who are very ill, and the iller they are, the more likely they are to suffer from systemic infection. The most serious infections are those affecting the heart, brain and eye. Endocarditis (heart valve infection) often requires surgery to replace the affected valve, although it may also follow a valve replacement operation. The problem also occurs with drug addicts.

TREATMENT

The treatment of simple thrush is effective and convenient, and differs greatly from that of systemic disease. The drugs which work on surface infection - nystatin and amphotericin B - are not absorbed when taken orally. The drugs are used in the form of pessaries and creams in the case of vaginal infection. Treatment by mouth particularly helps people with recurrent mouth infections, or where the infection has spread down into the gullet.

Once a systemic infection has been diagnosed, it is essential to use a treatment which reaches the bloodstream. The problem is that when amphotericin B is given by injection it becomes toxic and its effects have to be carefully monitored. Other new drugs are also effective and may ultimately prove more satisfactory. Chronic mucocutaneous candidacies is very difficult to treat since the defect lies with the body’s own ability to combat infection.