Treatment of Oral Thrush and Oral Ulcer

Abstract

Oral candidiasis (OC), commonly referred to as “thrush” encompasses infections of the tongue and other oral mucosal sites and is characterized by fungal overgrowth and invasion of superficial tissues [1–3]. The colloquial term “thrush” refers to the resemblance of the white flecks present in some forms of candidiasis with the breast of the bird of the same name. The etymology of oral thrush dates back to the time of Hippocrates (around 400 Before Christ (BC)) who, in his book “Of the Epidemics,” described OC as “mouths affected with aphthous ulcerations” [4]. The early descriptions of the disease predated the concept of “contagion” and, therefore, as recently as the early 1900s, it was thought that the disease was of host origin. Approximately 200 years were required before the etiological agent of thrush was correctly identified as a fungal pathogen. In 1771, Rosen von Rosenstein defined an invasive form of thrush; however, in 1839, Langenbeck was credited with first documenting a fungus associated with thrush in a patient with typhoid fever [5,6]. In 1846, Berg presented observations that thrush was caused by a fungus, which was classified in 1847 by the French mycologist, Charles Philippe Robin as Oidium albicans, the first use of albicans which means “to whiten” [6,7]. In 1923, Berkhout reclassified the fungus under the current genus Candida, a name derived from the Latin word toga candida, referring to the white toga (robe) worn by Roman senators of the ancient Roman republic, a probable reference to the whitish colonies on agar or white lesions [6–8]. However, it was not until 1954 that the binomial Candida albicans was formally endorsed. In the 1980s, there was a clear surge of interest in oral candidal infections largely due to the increased incidence of OC because of the escalation in the acquired immune deficiency syndrome (AIDS) epidemic, and, to date, OC remains the most common oral opportunistic infection in human immunodeficiency virus (HIV)-positive individuals and in individuals with weakened immune systems [9–13]. In fact, the opportunistic nature of the infection was first highlighted by Hippocrates, who referred to this malady as “a disease of the diseased” [14].