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Mastitis

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Patient is fatigued due to caring for 2 young children ... Ill-fitting bra. Pumps, shields. Prior breast trauma or infection. Milk stasis ... – PowerPoint PPT presentation

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Title: Mastitis


1
Mastitis
Joe Breuner, M.D.
2
Thanks to
  • Doug Trotter, who gave this talk 18 months ago

3
Case Presentation
  • Healthy 25 year-old woman, G2P2, with a 6
    week-old infant
  • Infant is fully breast-fed
  • Patient is fatigued due to caring for 2 young
    children
  • Husband is Boeing engineer, stressed because of
    likely upcoming layoff

4
Case Presentation
  • At 6 week visit, she reports 2 episodes of
    moderately painful swelling in upper inner
    quadrant of R breast it occurred once in L
    breast
  • It usually resolves, but she wants to know why it
    happens, and what to do

5
Case Presentation
  • Exam
  • Afebrile
  • Looks tired but otherwise well
  • Normal nipple and breast no lumps or indurated
    areas
  • No skin changes or lymphadenopathy

6
Case Presentation
  • Exam
  • Afebrile
  • Looks tired but otherwise well
  • Normal nipple and breast no lumps or indurated
    areas
  • No skin changes or lymphadenopathy
  • Dx Milk stasis or plugged duct

7
Milk stasis
  • Risk factors for milk stasis
  • Fatigue, stress
  • Infrequent feeding
  • Incomplete emptying of breast
  • Ill-fitting bra
  • Pumps, shields
  • Prior breast trauma or infection

8
Milk stasis
  • Treatment for milk stasis
  • Heat application
  • Massage toward nipple
  • Frequent, relaxed nursing
  • Change position to promote emptying
  • Avoid pumps, shields

9
Case Presentation
  • Pt calls you Sunday afternoon, 3 PM, now 7 weeks
    postpartum
  • Had recurrent swelling of upper inner quadrant R
    breast yesterday, but didnt resolve
  • Now 2 hrs of fever, chills, increased tenderness

10
Case Presentation
  • Pt calls you Sunday afternoon, 3 PM, now 7 weeks
    postpartum
  • Had recurrent swelling of upper inner quadrant R
    breast yesterday, but didnt resolve
  • Now 2 hrs of fever, chills, increased tenderness
  • Dx Acute mastitis

11
Mastitis
  • Incidence 2 - 3 of lactating women

12
Mastitis
  • Incidence 2 - 3 of lactating women
  • More common at 2 - 6 weeks post-partum, but can
    occur at any time

13
Mastitis
  • Incidence 2 - 3 of lactating women
  • More common at 2 - 6 weeks post-partum, but can
    occur at any time
  • More common in primiparas, but probably due to
    bias

14
Mastitis
  • Incidence 2 - 3 of lactating women
  • More common at 2 - 6 weeks post-partum, but can
    occur at any time
  • More common in primiparas, but probably due to
    bias
  • Risk factors milk stasis, age 30, stress,
    fatigue, professional employment of mother or
    father

15
Mastitis
  • Normal breast architecture

16
Mastitis
  • 1970 Series
  • 71 cases of acute lactational mastitis
  • Peak incidence at 2-3 weeks postpartum
  • No infants weaned none became ill
  • 11 developed abscesses 75 of those required
    surgical drainage
  • Abscess more likely if antibiotics delayed
  • 8 developed mastitis in a later pg

17
Mastitis
  • 1975 Series
  • 65 cases in 2,534 women 2.5 incidence
  • Average onset 5 weeks postpartum
  • 14 had missed feed or rapidly weaned
  • 12 had nipple fissure beforehand
  • 74 had been nursing normally
  • 5 developed abscesses, all in pts who chose to
    wean

18
Mastitis
  • 1978 Series
  • Similar results to prior studies
  • No abscesses if prompt antibiotic treatment and
    continued nursing

19
Mastitis
  • Etiology
  • 50 or more S. Aureus
  • Other organisms E. Coli, S. pyogenes

20
Mastitis
  • Etiology
  • 50 or more S. Aureus
  • Other organisms E. Coli, S. pyogenes
  • Source infant nasopharynx (?)

21
Mastitis
  • Etiology
  • 50 or more S. Aureus
  • Other organisms E. Coli, S. pyogenes
  • Source infant nasopharynx (?)
  • Mechanism via milk ducts or nipple fissure

22
Mastitis
  • Treatment
  • Prompt antibiotics
  • PO Dicloxacillin, cephalexin, erythromycin
  • IV Nafcillin, cefazolin
  • Continued frequent nursing
  • Heat application
  • Massage toward nipple
  • Antipyretics

23
Mastitis
  • In non lactating or pregnant women, consider
    early referral, as cancer is much more common.

24
Breast Abscess
25
Breast Abscess
  • Breast abscess with early skin necrosis

26
Breast abcess
  • Consider diagnosis in mastitis which fails to
    respond to antibiotics after 2-3d (may not feel
    fluctuant)
  • refer to breast surgeon for incisional drainage
    and biopsy--
  • 10-15 of breast carcinomas in womenduring pregnancy or lactation

27
Breast Abscess
  • Inflammatory breast cancer

28
Neonatal Mastitis
29
Neonatal Mastitis
  • Occurs up to 5 weeks of age
  • Girls outnumber boys 2 1
  • Etiology 85 S. aureus, also E. coli, group D
    Streptococcus

30
Neonatal Mastitis
  • Occurs up to 5 weeks of age
  • Girls outnumber boys 2 1
  • Etiology 85 S. aureus, also E. coli, group D
    Streptococcus
  • Treatment
  • Prompt antibiotics (IV?)
  • Careful needle aspiration if abscess

31
Candida Infection
32
Candida Infection
  • Burning pain with nursing
  • Mild erythema pruritis of nipple findings may
    be subtle
  • Associated with thrush in the baby
  • May be intraductal

33
Candida Infection
  • Treat mother and baby with topical antifungals or
    Gentian violet
  • May be recurrent
  • If no response to topical therapy, may use oral
    fluconazole 150 mg qd X 5d

34
Mastitis
35
(No Transcript)
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