Spruw

Spruw, also known as oral candidiasis or thrush, is a fungal infection of the mouth and oropharynx caused mainly by Candida albicans. It presents with creamy white plaques on the tongue, inner cheeks, palate, and sometimes the throat. These plaques can be rubbed off, leaving red, inflamed tissue that may be painful. Other symptoms include a burning sensation, soreness, altered taste, and, in infants, reluctance to feed. Angualr cheilitis, or cracking at the corners of the mouth, can accompany the condition.

Causes and risk factors include disruption of the normal oral microbiota due to antibiotics, inhaled corticosteroids without a spacer, diabetes, immune suppression (such as HIV/AIDS or chemotherapy), denture use, dry mouth, or infancy. Conditions that impair immune function or mouth environment increase susceptibility.

Diagnosis is usually clinical, based on appearance and symptoms. Confirmation can be obtained by microscopic examination of scrapings with potassium hydroxide (KOH) preparation or by culture to detect Candida species.

Treatment involves antifungal medications. Mild to moderate cases are typically treated with topical agents such as nystatin suspension or clotrimazole troches. More extensive disease or esophageal involvement, or antifungal resistance, may require systemic therapy with fluconazole or itraconazole. In infants, dosing is weight-based. Management also includes addressing underlying risk factors, improving denture hygiene, and ensuring good mouth care. If using inhaled steroids, using a spacer and rinsing the mouth after inhalation can help prevent recurrence. In breastfeeding individuals, treating the infant and the mother may be necessary to prevent reinfection.

Prognosis is generally favorable with treatment, though recurrence can occur, particularly if risk factors persist.