6.2.1 Bacterial, viral and fungal infections in the mouth
As a health worker, you will know that inspecting the tongue of a person helps you to quickly assess whether he or she is healthy or not. In someone who is unhealthy, the tongue is often coated with a whitish or yellowish deposit that has a fur-like appearance. This may be caused by bacteria, viruses or a fungal infection (‘thrush’) growing on the tongue, which may be due to inadequate oral hygiene. You should also be aware that up to 50% of people who are HIV-positive have fungal, bacterial or viral infections in the mouth, which often occur early in the course of HIV infection. If you are involved in palliative care for someone who is terminally ill (see Study Session 3), you will notice that mouth infections such as thrush are very common as the person approaches closer to death.
Opportunistic infections in people living with HIV/AIDS are described in the Communicable Diseases Module, Part 3, Study Session 21.
Mouth infections may be treated by good oral hygiene (see Section 6.2.2) and by salt water mouth washes. Dissolve a large spoonful of salt in a cup of water which has been boiled and then allowed to cool. The patient should take a mouthful of the salt solution and hold it in his or her mouth for at least two minutes, using their tongue to move the solution around all parts of the mouth. Spit out the solution and repeat one or two more times. This should be carried out two or three times per day until the mouth remains clean.
Can you explain why infections in the mouth are common among people living with HIV/AIDS or in the later stages of a terminal illness?
The reason is because the immune system, which normally defends the mouth from infection, is no longer functioning adequately.
A patient with HIV/AIDS or a terminal illness, whose immune system is not working adequately, may need medical treatment for infections in the mouth and should be referred.