How to Diagnose Thrush

Most of the time, a healthcare provider can diagnose thrush by visually examining the mouth and throat. Thrush, one of the most common diseases in infants, the elderly and people with suppressed immune systems, is caused by an overgrowth of a fungus called Candida in the mouth and throat.

However, in some cases, healthcare providers may need to take samples from these areas and send them to a lab for testing. In more severe cases, when thrush has spread to the esophagus, a diagnostic procedure called an endoscopy may be required.

test at home

While it doesn’t always cause symptoms, thrush can cause symptoms such as a white coating on the inside of the mouth and throat, a cottony feeling in the mouth, soreness, and/or loss of taste.

Certain self-exams are said to be helpful in diagnosis. However, they have no scientific basis. These include a practice called the “Candida spitting test,” which involves spitting into a glass of clear water immediately after waking up. Proponents argue that saliva sinking to the bottom of the glass — or clouding the surrounding water — may indicate the presence of thrush, but it’s not scientifically proven to be a reliable test.

lab testing

Your healthcare provider can diagnose thrush by doing a simple visual examination of your mouth and throat.

They may need to take a sample of an affected area (also called a lesion) in your mouth for microscopic examination. These samples usually involve gentle, painless scraping.

throat culture

In some cases, a healthcare provider may use a throat culture to help diagnose thrush. The procedure involves using a cotton swab to collect a sample from the back of the throat. While wiping your throat may be temporarily uncomfortable, it’s unlikely to cause pain.

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The sample is sent to the laboratory, where it is placed in a special environment to encourage cell growth and analysis.

other tests

Because certain underlying health problems, such as diabetes or a weak immune system, can increase your risk of thrush, your healthcare provider may perform further tests to see if you have any risk factors.

imaging test

To diagnose esophageal thrush, healthcare providers use a diagnostic procedure called endoscopy. This is an invasive technique that involves examining the esophagus, stomach and upper part of the small intestine using an endoscope: a flexible light-emitting tube with a camera at the end.

what to expect

Usually done by a gastroenterologist, endoscopy is usually done in a hospital or outpatient center. This process usually takes 15 to 30 minutes.

To help you relax during the endoscopy, you will most likely be given a mild sedative (usually given through an IV needle in your arm). Since it takes 24 hours for the sedatives taken before the endoscopy to wear off, you will need to arrange for a ride home from the hospital or outpatient center.

For your endoscopy, you will lie on an examination table while your healthcare provider passes the endoscope down your esophagus to your stomach. During surgery, a small camera at the end of the endoscope transmits video images to a monitor. This enables your healthcare provider to carefully examine the lining of your upper gastrointestinal tract.

At this point, your healthcare provider may also perform a biopsy (ie, removal of cells or tissue). If you have a biopsy, a pathologist will examine the sampled tissue to check for disease.

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Some people experience symptoms such as bloating or nausea shortly after an endoscopy. Also, you may have a sore throat for a day or two.

Some results from your endoscopy may be available immediately, and biopsy results will take a few days.

potential risks

While endoscopy is a safe procedure, it does carry risks of the following complications:

  • Bleeding from the site where your healthcare provider took a tissue sample
  • Perforation of the lining of the upper gastrointestinal tract
  • unusual reactions to sedatives, including breathing or heart problems

See your doctor right away if you experience any of the following problems after having an endoscopy:

  • chest pain
  • Difficulty breathing
  • swallowing problems or a sore throat that gets worse
  • Vomit
  • Increased abdominal pain
  • Bloody or black, tar-colored stools
  • fever

Differential diagnosis

In some cases, thrush may cause symptoms associated with other conditions. Therefore, your healthcare provider may consider the following when evaluating you or your child for thrush:

  • Aphthous ulcer
  • cytomegalovirus infection in children
  • enterovirus infection in children
  • esophagitis in children
  • Pharyngitis in children

Frequently Asked Questions

  • How is thrush diagnosed?

    Thrush can usually be diagnosed by its appearance and can be quickly confirmed by scraping from the mouth, genitals, or skin and looking for signs of fungus under a microscope using a 10% potassium hydroxide (KOH) solution. KOH solution dissolves skin cells while leaving Candida Fungal cells are intact.

  • What does thrush look like?

    • Oral candidiasis causes white patches to appear around the mouth, throat, and/or tongue, often with redness and irritation.
    • Vaginal candidiasis causes burning, itching, redness, soreness, and a cheese-like discharge that smells like yeast.
    • Penile candidiasis causes redness, itching, soreness, and balanitis (swelling of the head of the penis) as well as a foul-smelling, lumpy discharge under the foreskin.
  • How is esophageal thrush diagnosed?

    Esophageal candidiasis, as well as gastrointestinal or respiratory candidiasis, is the use of a flexible tubular endoscope (called an endoscope) to identify tissue outside the throat. Endoscopy, performed under anesthesia, allows healthcare providers to check the extent of the infection and biopsy tissue, which can then be cultured in a laboratory.

  • When is a blood test needed to diagnose thrush?

    When candidiasis is invasive (spread to distant organs, usually in severely immunocompromised people), a blood test called the T2Candida panel can be used to detect the type of candida Candida Fungi are involved. This blood test is much faster than culturing a fluid or tissue sample — three to five hours instead of six days. Fortunately, invasive fungal infections are extremely rare, so this test is rarely needed.

  • When should imaging tests be used to diagnose thrush?

    In patients with invasive candidiasis, magnetic resonance imaging (MRI) with contrast agents can show changes in the brain, kidneys, and other organ tissues consistent with infection. Blood tests and tissue biopsy can further confirm the diagnosis.

  • What other conditions look like thrush?

    If the diagnosis is uncertain, a healthcare provider may investigate other causes of thrush-like symptoms.

    Other conditions with similar symptoms include:

    • angular cheilitis
    • atrophic vaginitis
    • Lichen planus
    • Leukoplakia
    • Stomatitis
    • squamous cell carcinoma

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