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Mastitis

Mastitis is an inflammation of the breast tissue that is usually caused by milk stasis and sometimes bacterial infection, common symptoms include fever, breast pain and swelling, and treatment involves antibiotics, supportive care like rest and fluids, and continuing breastfeeding while avoiding milk stasis. Mastitis can increase immune factors in breastmilk but does not generally harm infants, though it may decrease milk supply and motivation to breastfeed.

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CHRISTIAN SIDAYA
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74 views25 pages

Mastitis

Mastitis is an inflammation of the breast tissue that is usually caused by milk stasis and sometimes bacterial infection, common symptoms include fever, breast pain and swelling, and treatment involves antibiotics, supportive care like rest and fluids, and continuing breastfeeding while avoiding milk stasis. Mastitis can increase immune factors in breastmilk but does not generally harm infants, though it may decrease milk supply and motivation to breastfeed.

Uploaded by

CHRISTIAN SIDAYA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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MASTITIS

NCM 108
FRITZIE NECITAS A.DURAN, RN
LECTURER
Mastitis
An acute inflammation of the
interlobular connective tissue within the
mammary gland
Epidemiology
• Incidence 2-33%.
• Most common worldwide <10%
• Most common 2 nd
-3rd week postpartum
• 74-95% in first 12 weeks
• Can occur anytime in lactation

Presentation
• Systemic illness: Chills, myalgias
• Fever of ≥ 38.5 0C
• Tender, hot, swollen wedge-shaped erythematous area
of breast
• Usually one breast
Differential Diagnosis
• Fullness: bilateral, hot, heavy, hard, no redness
• Engorgement: bilateral, tender, +/- fever, minimal diffuse
erythema
• Blocked Duct: painful lump with overlying erythema, no fever,
feel well, particulate matter in milk

• Galactocele: smooth rounded swelling (cyst)


• Abscess: tender hard breast mass, +/-
fluctuance, skin erythema, induration, +/- fever
• Inflammatory Breast Carcinoma: unilateral,
diffuse and recurrent, erythema, induration
Causes
• Milk Stasis
• Stagnant milk increases pressure in breast
leading to leakage in surrounding breast tissue
• Milk, itself, causes an inflammatory response
• +/- Infection
• Milk provides medium for bacterial growth
Predisposing factors
• Improper nursing technique
• Timing of feeds
• Poor attachment
• Oversupply of milk
• Overabundant milk supply
• Lactating for multiples
• Rapid weaning
• Blocked nipple pore or duct
• Pressure on Breast
• Tight Bra
• Prone sleeping position
Predisposing factors
• Damaged nipple (nipple fissure)
• Primiparity
• Previous history of mastitis
• Maternal or neonatal illness
• Maternal stress
• Work outside the home
• Trauma
• Genetic
Flat or Inverted Nipples
• Begin treatment late in
pregnancy
• Stop if causes uterine
contractions
• Breast shells
• Wear 1 hour a day and
gradually increase to
several hours
• Dry area under nipple often
Offering Your Breast to
Baby

• Fingers underneath, thumb on top


of breast

• Fingers well behind areola


Microbiology
• Detection of pathogens difficult
• Usually nasal/skin flora
• Difficult to avoid contamination
• Milk culture
• Encouraged in hospital acquired, recurrent
mastitis, or no response in 2 days
Microbiology
• Staphylococcus Aureus
• Coagulase negative staphylococcus
• Also, Group A and B βhemolytic Strep, E. Coli, H. flu
• MRSA (methicillin-resistant staphylococcus aureus)
• Fungal infections
• TB where endemic – 1% of cases
Fungal infections
• Cryptococcal infection may mimic a neoplastic lesion
• Most common: Candida Albicans
• Genital tract
• Newborn oral colonization
• May lead to nipple fissure
• Thought to be associated with deep, shooting pains
and nipple discomfort
• Most commonly treated with fluconozole to ♀, oral
nystatin to infant
Breast abscess
A breast abscess is a painful build-up of
pus in the breast caused by an infection.
It mainly affects women who are
breastfeeding.
Treatment
• Supportive Therapy
• Rest, fluids, pain medication, anti-inflammatory agents,
encouragement
• Continue breast feeding
• Antibiotics that cover Staph and Strep
• Culture results
• Severe symptoms
• Nipple fissure
• No improved sx after 12-24 hours of milk removal
Treatment
• Dicloxicillin 500 mg qid
• Erythromycin if PCN allergic
• If resistant to treatment penicillinase-
producing staph, then vancomycin or
cefotetan until 2 days after infection subsides
• Minimum treatment 10-14 days
Granulomatous Mastitis
• Noncaseating granulomas in a lobular distribution
• Differential Diagnosis
• TB mastitis
• Foreign body
• Fat necrosis
• Autoimmune: sarcoid, erythema nodosum, polyarthritis
• Presentation
• Unilateral Breast lump
• No infection identified at presentation
Granulomatous Mastitis
• Can mimic Breast Ca on clinical, radiological, and cytological
exams
• Diagnosis: Histology
• Treatment:
• Antibiotics not helpful
• Corticosteroids
• Excision biopsy
Subclinical Mastitis
• No symptoms, usually unilateral
• Reduction in milk output
• Diagnosis: Increased milk sodium
• Causes
• Milk stasis, poor nutrition, +/- bacteria

• Public Health implication


• Poor infant growth
• Increased risk of HIV transmission

• Natural Hx and clinical implication unclear


Effect on Milk
Immune Factors
• IgA is predominant in milk
• Increased immune factors from both plasma and local
epithelial cells
• No adverse events documented in peds
• Poor growth documented likely related to poor milk production
• Contradictory studies showing benefit or harm

• Interest in pediatric vaccine development


• Mastitis can decrease motivation to
breast feed
• OK to Breastfeed (except HIV+)
Increased HIV transmission
risk
• Milk VL increases 10-20 fold
• Alternating breast/bottle increased risk
• Role of free virus vs cell bound virus unclear
• If ♀ must breast feed, then pump on affected breast (pasteurize)
and feed on unaffected
• Subclinical mastitis: Problem -Lab dxs only
Breast Cancer in Pregnancy
• More progressive
• Non Hormonal
Dependence
• Young Patient
• Worst prognosis
• Problem in diagnosis
Therapy
• trimester
1st
: Operation +Chemotherapy
in 2nd trimester
• 2nd & 3rd trimester : Operative +
Chemotherapy
• After delivery: Radiotherapy
• Termination of pregnancy : Not indicated

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