HEALTH WATCH

Thrush (oral candidiasis)

by Dr. Elliot Neufeld

and Gary Avis

Thrush is a very common infection in HIV-infected people, affecting up to 90 percent. It is characterized by either white patches (often described as looking like cottage cheese), reddish blotches, or a plaque-like growth in the mouth and upper throat. Although there may be no other symptoms, some people may also experience a change in taste, a sore throat, or a redness of the tongue.

Thrush is caused by a yeast-like fungi, Candida albicans, which is normally present in healthy adults, but rarely will develop into thrush unless the immune system has been compromised. Although it is much more common in HIV-infected people with CD4 counts under 200, it is not unusual for it to be present in people whose counts are greater than 500.

This is important mainly for two reasons: 1. Thrush is often the first sign of infection in HIV-infected people.

2. If the thrush spreads to the esophagus,

it is then considered to be an AIDS defining infection.

Several treatments for thrush are effective and available. The one that is prescribed by your doctor is usually based on the severity of the infection, the use of other medications and the potential side effects. The treatments currently used are:

1. Clotrimazole (Mycelex) troches. Troches are essentially oral lozenges.

2. Nystatin (Mycostatin). This medication is given in oral suspension (a syrup-like substance).

3. Ketoconazole (Nizoral). Note: this medication cannot be taken with Seldane. 4. Fluconazole (Diflucan).

The first two are considered topical (that is, applied to the specific area affected). The second two are considered to be systemic treatments (they affect or treat the entire body). If you have questions or would like further information, consult your doctor.

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