Skin thrush in early infancy.

Thrush is generally regarded as one of the rarer infections of the skin of the newborn and young infant, but its occurrence is probably more frequent than its recognition. The high susceptibility of the oral mucosa to Monilia albicans during the early weeks of life is well known and it would be surprising were it limited to this structure. Invasion of the alimentary tract and other internal organs has been reported by Ludlam and Henderson (1942) and by Lederer and Todd (1949). Pulmonary moniliasis has assumed greater significance since the advent of antibiotic therapy and has received considerable attention during the past few years. Nikolowski (1953) recently pointed to the danger of generalized moniliasis in adult patients who, suffering from a localized mycosis, had for one reason or another to undergo treatment with large doses of an antibiotic. This danger also exists in infancy. Moniliasis of the skin in infants may appear sporadically or in small epidemic outbreaks in institutions such as maternity nurseries or babies hospitals. Mayer, Gotz and Seitz (1951) reported an epidemic in 40 infants under the age of 5 months which presented itself under the picture of erythrodermia desquamativa (Leiner), intertrigo and seborrhoeic dermatitis, involving also the scalp. The disease started in each case in the anal region and spread from there upwards or downwards. Of 35 babies who were examined bacteriologically, 17 had Monilia albicans on the skin and in 30 it was found in the stools. The incubation period was estimated as lasting from 14 to 28 days. Moniliasis of the skin in infants is commonly accepted as associated with thrush of the oral cavity and as arising in the perianal area whence it spreads to other parts of the body. The faeces are regarded as the usual source of infection. The primary lesion often appears as a small, flat, brownish-red papule without any inflammatory reaction in the surrounding skin. Later desquamation occurs on the surface of the papule and at its periphery, so that the lesion is surrounded by a characteristically rolled-in epithelial border. An alternative early manifestation is a small vesicle. which ruptures after a short time, the epithelium again forming the typical border which surrounds an erythematous area denuded of its epithelial covering. When several of these foci merge larger areas of the skin may be involved and present a typical clinical picture. Difficulty, however, may arise if the infection is superimposed on other skin manifestations not primarily related to the Monilia albicans infection. During the past year we had opportunity to observe 11 cases of skin thrush in young infants, four of which were noticed practically simultaneously in a minor outbreak in a unit for premature infants, one premature infant was admitted from a maternity unit with an extensive rash at the age of 4 weeks, and six others were seen at different times in a clinic for well babies. These cases differ in a number of features from the description encountered in the paediatric literature and seem to warrant special discussion.