Oral thrush is a common fungal infection in babies caused by the yeast Candida albicans. It presents as white patches in the mouth that cannot be easily rubbed off. Risk factors include low birth weight, antibiotics use, and transmission from mother during birth or breastfeeding. Treatment typically involves antifungal medication like nystatin or fluconazole applied topically or given orally.

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)