>Hi! I hope someone on this li*st will be able to give me some help!
...... she had a bout with thrush at two weeks old......
 mom appears
>to have thrush again, and she has informed me that since about 8 weeks PP
>she has had 2-3 day periods of RED sore nipples, which seem to go away
>with no treatment.    Well, the question is can thrush go away and come back at
>intervals like this?  This mom really wants to continue to nurse, but
>feels that if she must keep going through 2-3 days of pain every couple
>weeks it is not "worth it."  Could this be systemic thrush?  Should I
>have her see the baby's pedi for Tx baby and mom again?

Yes Heidi, thrush certainly can come and go like this. Sometimes it recurs
after mother or baby have been on antibiotics or have another illness, but
sometimes just recurs out of the blue. It would be worthwhile treating both
mother and baby again. Did mother take oral antifungal treatment the first
time?

Systemic candida infections are those where candida is deep-seated rather
than only on the mucous membranes (ie mouth or vagina) or skin. Systemic
candida may be localized primary diseases, with only one organ affected, or
disseminated candidosis (Candida septiceamia) where candida spreads in the
bloodstream to several organs. Local forms of systemic candida include
oesphageal candidosis, endocarditis and endophthalmitis. Candida in the
breastducts is thereotically a localized form of systemic candida infection
- but one we haven't been able to prove yet.

When thrush recurs it is not necessarily "systemic" or disseminated. I think
of it as thrush lingering on the nipples or in the baby's mouth and flaring
up again when it gets the chance. Like vaginal thrush: the organism often
lives in the vagina but only overgrows and causes inflammation and pain at
certain times (often after antibiotics, stress, premenstrually, etc).
Candida often lives in the bowel as well, so by giving oral antifungals we
are reducing the amount of candida in the body which may help reduce
recurrences.

For more information about thrush, look for (eg: in university libraries)
"Candida and Candidosis: A Review and Bibliography", F.C. Odds, Bailliere
Tindall, 1988, 2nd edition. (I hope he is working on a 3rd edition which
will say more about nipple/breast candida).

Lisa Amir
GP / LC in Melbourne, Australia
BTW are there combined preparations for thrush in the nappy area available
in the US or Canada? In Australia, Daktozin is a combination of miconazole
and zinc, specifically for treament of thrush on baby's bottoms.