~~~~~~~~~
Summary: On Tue, 26 Sep 2006 Kika asked for ideas for a Mum, 15 months
postpartum, with bouts of thrush since 5 months postpartum -  topic
treatments by other clinicians for previous bouts included miconazol and
mupirocin, with oral fluconazol for the 3rd bout - all of which worked.  4th
bout, fluconazol + APNO.  Child asymptomatic, but wisely treated along with
Mum.  Now - mother's symptoms are back.

Kika wrote:  " ... The pain is back. Her nipples look reddish and dry,
eccema-like.
My first question was: is this really a yeast
infection? By the symptoms and the look, it could be,
and by the fact that it clears away with the
treatment. ...  My second question: how many times can a mom be
treated orally with antifungicals?  ....."

My first thoughts are: 1) is this really thrush this time? and 2) if it is,
are there other places with thrush that haven't been identified and
addressed?
1) As to whether it is really thrush, I notice that Kika has also quetioned
this.  The fact that the previous bouts responded to antifungal treatment is
indicative for those bouts, but this fresh bout still needs to be looked at
with clear eyes.  Key words used by Kika are "eczema-like".  Could it be
eczema, or perhaps a dermatitis from the earlier antifungals, or from other
causes?  (A common one is swimming in chlorinated water and leaving the
swimsuit on, rather than changing and showing immediately.)  The mother is a
medical doctor, and this possibility should be discussed with her. If this
is a likely cause of the current nipple problem, a hydrocortisone ointment
is likely to be effective, espec if the cause of the irritation is
identified and eliminated.
2)  I have seen Mums with persistent thrush where there have been other
sites, that hadn't been identified and treated, causing the candida organism
from these other sites to reinfect the treated site, the nipples.
Hand-washing is so important, as the hands are commonly the mode of
transmission from other sites (e.g. from a nailbed infection of the toes,
and in one case I saw, a ringworm on the leg). I would have expected the
systemic treatment, fluconazole, to have eliminated any other sites on this
mother.  So, what about the baby and the mother's partner?  Has the baby's
anal area been checked for redness, and treated if it is present?  (Careful
hand-washing, too, after changing the diaper.)  What about the mother's
partner?  If her partner's mouth has been in contact with her nipples, his
mouth should also have been treated.  "Jock itch", or an itchy rash in the
genital area, in the male partner is worth mentioning as a possible
reservoir for infection.

I think these two questions need to be addressed, *before* thinking of how
long a person can have antifungals, and which ones to use.
Good luck!

Virginia
in Brisbane, Queensland

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