By: Scott Pangonis, MD, MS, FAAP & S. Elizabeth Williams, MD, MPH, FAAP
Candida is a type of yeast, part of the fungus family that normally lives in and on our bodies. It can be found on the skin and in the mouth, for example, and in the intestinal tract and genital area. Most of the time,
Candida does not cause any problems. However, when it overgrows, it can cause infections such as candidiasis. These fungal infections can become chronic.
What is thrush?
Candidiasis infection of the mouth, also called oral
thrush, is common in infants and toddlers. Thrush can also affect fingernails, eyes, and skin folds of the neck and armpits, as well as the diaper area, including the vagina and folds of the groin.
How do infants and children get thrush and other
Pregnancy & birth. Newborns can get a
Candida infection from their mothers. This can happen while they're still in the uterus, but also during passage through the vagina during birth. Most of these infections are caused by Candida albicans, although other species of
Candida are becoming more common.
Medicine. Sometimes, children develop candidiasis after taking
antibiotics. While antibiotics fight germs that make a child sick, they sometimes also affect the “good" bacteria that help keep the body's balance of microbes in check. This gives fungi like
Candida a chance to overgrow. Using inhaled
steroids for asthma without rinsing the mouth with water afterward inhaler use can also lead to candidiasis.
Health conditions. In some children with serious health challenges, the fungus may enter the bloodstream. Those most risk of bloodstream infections with
premature or very low birthweight infants, children with long-term intravenous (IV) catheters, and children with weakened immune systems caused by
cancers or medicines. For these children, oral nystatin and fluconazole are often used to prevent candidiasis.
Candida infections become chronic or occur in the mouth of older children, it may be a sign of an immune system challenge, such as human immunodeficiency virus (HIV) infection.
Candida infections of the skin, mouth (thrush), or vagina in children over 2-3 years of age, can also be a sign of
Signs & symptoms of
Infants. In infants, symptoms include painful white or yellow patches on the tongue, lips, gums, palate (roof of mouth), and inner cheeks (thrush). It can also spread into the esophagus, making it painful to swallow. Candidiasis can make a
diaper rash worse, producing redness and sensitivity in the affected area, along with a raised red border in some cases.
Teens. Teenage girls who develop a vaginal
yeast infection may have symptoms such as itching, pain, redness, and/or a thick, “cheesy" vaginal discharge. A yeast infection often follows antibiotic therapy.
Children taking IV medications. Symptoms are different for children who get
Candida infections while receiving
chemotherapy treatment, or other long-term home medications delivered through an IV catheter. In these cases, the fungus gets into the blood system. Once in the blood, the yeast can travel throughout the body, causing infection of the heart, lungs, liver, kidneys, eyes, brain, and skin. The early signs of a
Candida bloodstream infection are fever and blockage of the IV catheter.
How is a
Candida infection diagnosed?
Your pediatrician will often make the diagnosis by examining your child and reviewing symptoms. Scrapings of
Candida lesions (sores) inside the mouth or other spots can be further examined for signs of the infection.
An ultrasound or CT scan can detect candidal lesions that have developed in the brain, kidney, heart, liver, or spleen after a bloodstream infection. Cultures of the blood or mouth lesions are sometimes taken to grow the fungus in the laboratory and identify the type and sensitivity of the yeast.
Antifungal drugs are used to treat candidiasis. The antibiotic nystatin is often prescribed for children with infections such as oral thrush or a
Candida-related diaper rash, for example. The specific medicines given for candidiasis vary, depending on the part of the body where the infection is concentrated.
If candidiasis has spread through the bloodstream, your pediatrician will usually recommend treatment with an IV medicine. Some of these IV medicines cause uncomfortable side effects, but are still reliable medicine for serious, invasive fungal infections. However, most medications used to treat candidiasis are well tolerated by most children.
How long does it take for
Candida infections go away?
Once treatment starts, most candidiasis infections get better within about 2 weeks. It is not uncommon for infections to return, however. Long-lasting thrush is sometimes related to pacifiers or
bottles that have not been properly boiled to remove the fungus.
The infection is much more difficult to treat in children with catheters or weakened immune systems. Typically, the catheter must be removed or replaced to effectively treat infections that are from with these devices. Tests are also usually done to see if the infection has spread to other parts of the body. Antifungal therapy can take weeks to months for the more challenging infections.
Talk with your pediatrician if you think your child may have symptoms of
Candida infection, or whenever you have any questions about your child's health.
About Dr. Pangonis
Scott Pangonis, MD, MS, FAAP is a board-certified pediatrician. He is an Assistant Professor in Pediatric Infectious Diseases at Akron Children's Medical Center. Within the American Academy of Pediatrics, he is a member of the Section on Infectious Diseases.
About Dr. Williams
S. Elizabeth Williams MD, MPH, FAAP, is a board-certified pediatrician who is currently an Assistant Professor of General Pediatrics at Tennessee at Monroe Carrell Jr. Children's Hospital in Nashville. Within the American Academy of Pediatrics, Dr. Williams serves on the Education Subcommittee of the Section on Infectious Diseases.