Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms usually include localized pain and redness. Frequent fevers and general pain are common. Onset is usually quite rapid and usually occurs within the first few months of labor. Complications may include abscess formation.
Risk factors include poor cover, cracked nipples, use of breast pumps, and weaning. The most common bacteria involved are Staphylococcus and Streptococci. Diagnosis is usually based on symptoms. Ultrasound may be useful for detecting potential abscesses.
Prevention is by breastfeeding regularly and appropriately. When the infection is present, antibiotics such as cephalexin may be recommended. Breastfeeding usually should be continued, because emptying the breast is important for healing. Temporary evidence supports the benefits of probiotics. About 10% of breastfeeding women are affected.
Video Mastitis
Signs and symptoms
Lactation mastitis usually affects only one breast and symptoms can develop rapidly. Signs and symptoms usually appear suddenly and they include:
- The tenderness or warmth of the breast as it is touched
- General malaise or feel sick
- Breast swelling
- Continual pain or burning sensation or while breastfeeding
- Reddish skin, often in wedge shapes
- Fever 101 F (38.3 C) or greater
- The affected breasts can then start to look thick and red.
Some women may also experience flu-like symptoms such as:
- Pain
- Chills and chills
- Feeling anxious or stressed
- Fatigue
Contact should be made with a healthcare provider with special breastfeeding competencies as soon as the patient recognizes the combination of signs and symptoms. Most women first experience flu-like symptoms and as soon as they may see a sore red area in the breast. Also, women should seek medical treatment if they notice abnormal vaginal discharge from their nipples, if breast pain makes it difficult to function daily, or they experience prolonged and unexplained breast pain.
Breast abscess
Breast abscess is a collection of pus that develops into the breast with different causes. During breastfeeding, breast abscesses rarely develop, most sources mention about 0.4-0.5% of women breastfeeding. Known risk factors are age above 30 years, primipara and delay in labor. No correlation was found with smoking status but this may be partly because fewer smokers choose to breastfeed. Antibiotics are not proven effective in prevention of lactation abscess but are useful for treating secondary infections (see section on breast abscess treatment in this article).
Keratinization of lactating duct lymphorous metaplasia may play a similar role in the pathogenesis of nonpuerperal subareolar abscesses.
Maps Mastitis
Cause
Since the 1980s mastitis is often divided into non-communicable and infectious sub-groups. However, recent research suggests that it may not be feasible to make divisions in this way. It has been shown that the type and number of potential pathogenic bacteria in breast milk is not correlated with the severity of the symptoms. In addition, although only 15% of women with mastitis in the study Kvist et al. Given antibiotics, they all heal and few experience recurrent symptoms. Many healthy breastfeeding women who want to donate breastmilk have potential pathogenic bacteria in their breastmilk but have no symptoms of mastitis.
Risk factors
Mastitis usually develops when milk is not removed properly from the breast. Milk stasis can cause milk ducts in the breast to become blocked, because breast milk is not properly and regularly expressed. It has also been suggested that blocked milk ducts may occur as a result of breast pressure, such as tight clothing or overly tight bras, though there is rare evidence for this presumption. Mastitis can occur when the baby is not attached properly to the breast while breastfeeding, when the baby has an irregular feed or has breastfeeding breastfeeding problems out of the breast.
The presence of cracks or nipple injuries increases the likelihood of infection. Tight clothes or a fitting bra can also cause problems when they condense the breasts. It is possible that infants carrying infectious pathogens in their noses can infect their mothers; the clinical significance of these findings remains unknown.
Mastitis, as well as breast abscess, can also be caused by direct trauma to the breast. Such injuries can occur for example during sports activities or due to a seat belt injury.
Mastitis can also develop due to contamination of breast implants or other foreign bodies, for example after nipple piercing. In such cases, the transfer of a foreign body is indicated.
Women who are breastfeeding are at risk of mastitis especially if they have sore or cracked nipples or have had mastitis before breastfeeding another baby. Also, the possibility of mastitis increases if women only use one position for breastfeeding or wear tight bra, which can restrict the flow of milk Difficulty in getting a breastfeeding baby to stick to the breast can also increase the risk of mastitis.
Women with diabetes, chronic illness, AIDS, or immune system disorders may be more susceptible to mastitis development.
Infection
Some women (about 15%) will require antibiotic treatment for infections usually caused by bacteria from the skin or mouth of infants entering the milk ducts through skin lesions on the nipple or through nipple opening. Infection is usually caused by Staphylococcus aureus . Infectious pathogens commonly associated with mastitis are Staphylococcus aureus , Streptococcus spp., And Gram-negative bacilli such as Escherichia coli . Salmonella spp. , mycobacteria, and fungi such as Candida and Cryptococcus have been identified in rare cases.
Recent research has shown that infectious pathogens play a much smaller role in pathogenesis than is usually assumed only a few years ago. The most detectable pathogens are the very common species that are a natural part of the breast fauna and the simple detection of their existence is not sufficient to prove the cause of the cause. In addition, there are indications that treatment with antibiotics may have minimal impact, and overall there is insufficient evidence to confirm or deny the effectiveness of antibiotic therapy to treat lactational mastitis.
Type
When it occurs in lactating mothers, it is known as puerperal mastitis, lactation mastitis, or lactation mastitis. When it occurs in women who are not breastfeeding, this is known as non-nifas or nonlaktasional. Mastitis can, in rare cases, occur in men. Inflammatory breast cancer has symptoms that are very similar to mastitis and should be ruled out.
Symptoms are similar for postpartum and nonpuerperal mastitis but predisposing and treatment factors can be very different.
Puerperal mastitis is breast inflammation with respect to pregnancy, breastfeeding or weaning. Because one of the most prominent symptoms is tension and breast enlargement, allegedly caused by a clogged milk ducts or excess milk. This is relatively common; estimates range depending on the methodology between 5-33%. However, only about 0.4-0.5% of breastfeeding mothers have an abscess.
Some predisposing factors are known but their predictions are minimal. It seems that proper breastfeeding techniques, frequent breastfeeding and avoiding stress are the most important factors that can be affected.
Mastitis mild cases are often called breast enlargement; the difference is overlapping and may be arbitrary or subject to regional variations.
The term nonpererperal mastitis describes inflammatory lesions in the breast unrelated to pregnancy and lactation. This article includes a description of mastitis as well as various kinds of mammary abscesses. Skin-related conditions such as dermatitis and folliculitis are separate entities.
Names for non-puerperal mastitis are not used very consistently and include mastitis, subareolar abscesses, ductal ectasia, periductal inflammation, Zuska disease and others.
Diagnosis
The diagnosis of mastitis and breast abscess usually can be done on the basis of physical examination. The doctor will also consider the signs and symptoms of the condition.
However, if doctors are not sure whether the mass is an abscess or a tumor, breast ultrasound may be performed. Ultrasound provides a clear picture of breast tissue and may help in distinguishing between mastitis and a simple abscess or in diagnosing a deep abscess in the breast. This test consists of placing an ultrasound probe over the breast.
In the case of infectious mastitis, culture may be needed to determine what type of organism causes the infection. Cultures are helpful in determining the specific types of antibiotics to be used in curing diseases. This culture can be taken from breast milk or from the aspirated material from the abscess.
Mammograms or breast biopsies are usually performed on women who do not respond to treatment or to women who are not breastfeeding. This type of test is sometimes ordered to exclude the possibility of a rare type of breast cancer that causes symptoms similar to mastitis.
Differential diagnosis
Breast cancer can coincide with or mimic the symptoms of mastitis. Only full resolution of symptoms and careful examination is sufficient to exclude the diagnosis of breast cancer.
The lifetime risk for breast cancer is significantly reduced for women who are pregnant and lactating. Episodes of mastitis do not seem to affect the lifetime risk of breast cancer.
Mastitis however causes great difficulty in the diagnosis of breast cancer and delayed diagnosis and treatment can lead to poor outcomes.
Breast cancer can coincide with mastitis or develop shortly thereafter. All suspicious symptoms that are not completely lost within 5 weeks should be investigated.
The incidence of breast cancer during pregnancy and lactation is assumed to be the same as the control. The course and prognosis are also very similar to age-appropriate controls. But the diagnosis during breastfeeding is very problematic, often leading to delayed diagnosis and treatment.
Some data suggest that noninflammatory breast cancer incidence increases within one year after nonpererperal mastitis episodes and special care is required for follow-up cancer screening follow-up. So far only data from short-term observations are available and the total increased risk can not be assessed. Because of the very short time between presentation of mastitis and breast cancer in this study it is considered highly unlikely that inflammation has a substantial role in carcinogenesis, but rather it appears that some precancerous lesions may increase the risk of inflammation (hyperplasia causes duct obstruction, hypersensitivity to cytokines or hormones) or lesions may have general predisposing factors.
A very serious type of breast cancer called inflammatory breast cancer appears with the same symptoms as mastitis (both puerper and nonpuerperal). This is the most aggressive type of breast cancer with the highest mortality rate. The IBC inflammatory phenotype is thought to be largely due to the invasion and blocking of the dermis lymphatics, but has recently shown that activation of the NF-B target gene can significantly contribute to the inflammatory phenotype. Case reports show that symptoms of inflamed breast cancer can recur after an injury or inflammation makes it even more likely to be mistaken for mastitis. Symptoms are also known to partially respond to progesterone and antibiotics, reactions to other common drugs can not be ruled out at this time.
Treatment
In lactation mastitis, often emptying both breasts with breastfeeding is very important. Also important is the supply of adequate fluids for both mother and baby. The use of a pump to empty the breast is now considered somewhat controversial.
For lactating women with mild mastitis, massage and heat applications before meals can help as this can help unblock the canal. However, in case of more severe heat mastitis or massage can make symptoms worse and cold compresses are more suitable to resist inflammation.
Nonpuerperal mastitis is treated with drugs and possibly aspiration or drainage (see especially subareolar abscess treatment and treatment of granulomatous mastitis). According to BMJ best practice reports, antibiotics are commonly used in all cases of nonpererperal mastitis, with antibiotic replacement by antifungal agents such as fluconazole in cases of deep fungal infections, and corticosteroids should be used in cases of granulomatous mastitis. (with differential diagnosis for tuberculosis infection in the breast).
Antibiotics
In lactation mastitis, antibiotics are not required in the majority of cases and should be used only for bacterial infections. Dicloxacillin or cephalexin is sometimes recommended. The effects of antibiotics have not been well studied in 2013.
Breast abscess
Abscess (or suspected abscess) in the breast can be treated with aspiration of fine needle guided by ultrasound (percutaneous aspiration) or with incision and surgical drainage; each of these approaches is performed under the scope of antibiotics. In cases of postpartum breast abscess, breastfeeding from affected breast should be continued if possible.
For small breast abscesses, the aspiration of fine ultrasound-guided needles such as to fully drain the abscess is widely recognized as the preferred initial management.
One recommended treatment includes antibiotics, ultrasound evaluation and, if any fluid, fine-needle aspiration is guided by ultrasound on abscess with an 18 gauge needle, under lavage saline until clean. The exudate is then sent for microbiological analysis for pathogen identification and the determination of the antibiotic sensitivity profile, which in turn may provide an indication for altering antibiotics. In follow-up, mammography is performed if the condition has been resolved; otherwise, fine-needle aspirations that are ultrasound guided by lavage and microbiological analysis are repeated. If three to five aspirations still have not completed the condition, percutaneous drainage in combination with indicated catheter placement is indicated, and only if some effort on ultrasound guided drainage fails, surgical resection of inflamed lactiferous ducts (preferably after acute episodes ends). It should be noted, however, that even the excision of the affected duct does not always prevent recurrence.
Nonpererperal breast abscesses have a higher recurrence rate compared with a puerperal breast abscess. There is a high statistical correlation of nonpuerperal breast abscess with diabetes mellitus (DM). On this basis, it was recently suggested that diabetes screening should be performed in patients with such abscesses.
Despite recommendations for breast abscess treatment, a 2015 review found insufficient evidence as to whether the needle aspiration is comparable to incision and drainage, or if antibiotics should generally be given to women undergoing incisions and drainage.
Prognosis
The temperature and severity of symptoms in the presentation do not predict the outcome, women with sore or damaged nipples may need special attention.
Epidemiology
Mastitis is quite common among lactating women. WHO estimates that although the incidence varies between 2.6% and 33%, the prevalence globally is about 10% of women who breastfeed. Most mastitis women usually do so within the first few weeks after delivery. Most breast infections occur within the first month or two after delivery or at the time of weaning. However, in rare cases it affects women who are not breastfeeding.
Terminology
The popular use of the term mastitis varies by geographic area. Outside the US it is commonly used for niperal and nonpererperal cases, in the US the term non-peripheral mastitis is rarely used and alternative names such as ectasia ducts, subareolar abscesses and plasma cell mastitis are more commonly used.
Chronic cystic mastitis is an older name for fibrocystic disease.
American use: mastitis usually refers to the puerperium (occurring in breastfeeding mothers) mastitis with symptoms of systemic infection. Lighter cases of puerperal mastitis are often called breast enlargement.
In this Wikipedia article, "mastitis" is used in the original sense of definition as breast inflammation with an appropriate additional qualification.
Other animals
Mastitis occurs in other animals as in humans, and especially concerns in livestock, since milk from the udder of affected livestock can enter the food supply and pose a health risk.
This is a major condition in some species, such as dairy cattle. This is the cause of a lot of undesirable suffering for dairy cattle. This is a tremendous economic interest for the dairy industry, and also a concern for public health. The same considerations apply to mastitis in sheep and goats and other milk-producing women. It is also economically important in sowing, but, in this species, it is not related to public health. In other domestic women (queens, mares, etc.), it is more of an individual disease handled by veterinary practitioners.
Etymology and pronunciation
The word mastitis ( ) uses a combination of the mast- -itis form. The word
References
External links
- Mastitis on mayoclinic.com
- The Australian Breeding Association
Source of the article : Wikipedia
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