Muguet or oral candidiasis in babies: symptoms and treatments

Thrush or oral candidiasis is a fungal infection of the mouth caused by the pathogen Candida albicans, a diploid yeast-shaped fungus of the saccharomycete family. The prevalence of this pathology increases in immunosuppressed patients, but in any case, it is more common in infants under 1 year of age, with an incidence of 38 affected per 10,000 inhabitants.

C. albicans is an opportunistic pathogen, since lives in the respiratory, gastrointestinal, and genitourinary tracts normally in the human being. During lactation, candidiasis is a common event (the infant becomes infected by the maternal flora at the time of delivery), but from the first year of age it can be a sign of immunodeficiency.

For these reasons, thrush is more common in children under 6 months of age and in older adults, who are more prone to immune problems. If you want to know everything about this pathology in babies, keep reading.

About Candida albicans

As we said, in almost all cases the condition is caused by the fungus Candida albicans, although this is not always the case. As indicated by the medical portal StatPearls, the infection sometimes finds its cause in C. glabrata, C. tropicalis or C. krusei. However, these pathogens infect people over 80 years of age.

Like the rest of mushrooms, those of the genus Candida They are non-photosynthetic heterotrophic microorganisms that feed on the sugars and carbohydrates present in the superficial mucous membranes of the organism. They grow best at a temperature of 37 degrees Celsius and present different phenotypes, such as yeast and hypha.

Candida albicans produces 95% of cases of oral candidiasis, but not all people with this microorganism develop the disease. According to the magazine Journal of Fungi, 80% of the world population is an asymptomatic carrier of the fungus, which colonizes the gastrointestinal and genitourinary tract without causing major problems.

Unfortunately, C. albicans it adapts very well to changes, so it can proliferate excessively in certain environmental events or if the patient is immunosuppressed.

Pathogenic mechanism

The species of Candida They cause thrush in adults when their immune system is weakened, either locally, secondarily, or by taking certain drugs. The uncontrolled growth of the fungus gives rise to a pseudomembrane that passes through an adhesion of the pathogen to the wall of the colonized epithelium cells.

Once it has adhered and multiplied on the mucosal surface, C. albicans begins a filamentation and the formation of germ tubes. After that, the fungus produces phospholipase and proteinase enzymes that cause localized tissue damage and an inflammatory response. Systemic colonization of the host depends entirely on the efficiency of the immune system.

Candidiasis consists of an abnormal proliferation of the fungus in the mouth, even starting from a natural presence of it in the area.

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Thrush symptoms

We have explored what candidiasis is in general and how it multiplies C. albicans in its host. At this point, we see of special interest to cover the symptoms of oral infection in neonates.

The portal Kidshealth and other medical sources help us describe the most common symptoms, which are as follows:

  • White or "creamy" lesions on the tongue and inner cheeks: this corresponds to the invasion of the filamentous form in the mucous tissue. The growth of the pathogen within the infant's mouth can be observed with the naked eye. These wounds look similar to cottage cheese.
  • Mild pain and bleeding: It is common for the mucous membranes to bleed if they are scratched or subjected to a rubbing motion with the structures of the mouth.
  • Cracking of the corners of the lips: whitish plaques may extend to the corner of the mouth. Unlike normal residues, these stains cannot be cleaned with a damp cloth.
  • Discomfort: some babies may be unable to drink breast milk or suck, as they will experience irritation in the oral system.

As striking as the velvety lesions in the oral cavity of the newborn are, the cited medical sources emphasize that it is an easy-to-treat condition. In babies it is conceived as a normal infection that does not go beyond the pediatric area.

Causes of oral thrush in babies

As another article published in StatPearls, up to 37% of newborn children will be affected by thrush during their first months of life. Newborns are colonized by Candida when passing through the birth canal, although it can also jump to the new host during the act of lactation.

This is not a worrisome clinical event, as it only denotes that the newborn's immune system is not fully developed. However, outside the initial stage of breastfeeding, an oral yeast infection can be one of the first symptoms of immunodeficiency in the infant.

Risk factor's

The fact that a newborn is infected does not imply anything; the immune system is expected to be unfamiliar with the fungus. That an oral candidiasis appears in adults, in any case, it can be worrying.

Some of the risk factors for developing thrush, beyond breastfeeding, are the following:

  • Have poor general health, something that usually accompanies the fact of being old.
  • Wear teeth: up to 65% of the elderly who need dentures develop oral candidiasis. Artificial teeth give Candida a perfect microenvironment for its multiplication.
  • Have depressed salivary glands: saliva contains antimicrobial and antifungal agents that keep pathogenic populations at bay.
  • Take antibiotics: there are bacterial colonies that, inhabiting the oral mucosa, indirectly prevent fungal overgrowth. If these are removed, Candida it lacks competitors and can be expanded.
  • Have HIV or AIDS: unfortunately thrush is one of the first symptoms in HIV-positive people. More than 90% of people with AIDS develop yeast infections at some point in their lives.

As the National Library of the United States indicates, some steroid-based treatments and chemotherapy also promote thrush. Anything that depresses the immune system or eliminates commensal microorganisms from the oral mucosa stimulates the overgrowth of C. albicans.

Diagnostic tests

According to the Mayo Clinic, if oral yeast infection affects only the mouth, a physical examination is sufficient. To do this, it is thoroughly examined, a sample of the mucosa is taken and observed under a microscope. Lastly, a blood test can be done to try to find evidence of possible immunosuppression.

In children younger than 6 months, the last step is usually not necessary. As we have said, this infection is considered part of the norm in the growth of a newborn, so it does not have to show an underlying pathological picture.

Samples from the oral cavity can be analyzed under the microscope to confirm that it is this fungus.

Treatments for oral thrush in babies

Thrush may disappear after 1 to 2 weeks in newborns. In any case, sometimes an antifungal approach is necessary, so in all cases it is better to go to the pediatrician.

Depending on the severity, the options are as follows:

  • Slight pictures: A topical treatment is recommended, that is, of direct application in the affected oral area. The pediatrician may also prescribe foods rich in Lactobacillus, a symbiotic bacterium in our body that can limit the growth of other pathogens.
  • Moderate cases: Fluconazole, a drug specialized in treating superficial and systemic fungal diseases, is used. In moderate cases, 200 milligrams are administered in a single dose and then 100 milligrams for 7-14 days. We insist that this treatment is not usual and is contemplated in sick, immunosuppressed adults.
  • Cases that do not respond to the usual treatment: here itraconazole and posaconazole are used, requiring the patient to stop eating for about 48 hours during the onset.

As we have said, in many cases thrush in babies disappears by itself. Unless the newborn's immune system is depressed and unresponsive to the above approaches, no other systemic treatments are used.

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Oral yeast infection is not a concern in babies

Thrush or oral candidiasis is completely normal in babies. This is your body's response to the first colonization of C. albicans, so you don't need to be overly alert or throw your hands on your head. It is a picture included in the habituality of the newborn.

On the other hand, if thrush appears in an older child or adult, it may be a sign of immunodeficiency. In these cases, doctors will perform accessory tests on the patient to try to figure out what is causing the yeast infection.

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