Mastitis and breast abscess

Notes

## Basic introduction

  • Mastitis is an inflammatory condition of the breast that may sometimes be associated with infection and sometimes not
  • When mastitis is associated with lactation it is known as lactational mastitis or puerperal mastitis
  • Breast abscess is a localized collection of pus within the breast that arises as a complication of mastitis.

## Causes of mastitis/abscess

  • Milk stasis (primary cause)
  • Bacterial infections, mainly by Staphylococcus aureus, Staphylococcus albus, Escherichia coli, and Streptococcus in that order.

## Predisposing factors to mastitis

  • Breastfeeding per se.
  • Poor breastfeeding technique
  • Age (common in women aged 21-35yrs)
  • Primiparity
  • The first attack of mastitis predisposes to recurrence
  • Complications of delivery (may increase the risk of mastitis)
  • Trauma
  • Maternal stress and fatigue
  • Lack of time to breastfeed
  • Blocked milk ducts
  • Pressure on the breast e.g. from clothing
  • Nipple fissures, cracks and sores
  • Recent weaning

## Statistics

  • Between 10-33% of breast-feeding women develop lactation mastitis
  • Abscess are formed in 3-7% cases of mastitis
  • Mastitis mainly occurs 2-3 weeks after birth
Symptoms
  • It occurs only in one breast
  • Breast tenderness or warmth to the touch
  • General malaise
  • Abnormal discharge from the nipples
  • Aches
  • Fatigue
  • Lumpy and red breast
  • Pain or a burning sensation
  • Shivering and chills
  • Swelling of the breast
  • When abscess is formed, there is a collection of pus that causes a firm, red, and tender lump
  • Axillary lymphadenopathy (palpable)
  • Erythema in a wedge-shaped area
Diagnosis
  • Clinical review
  • Ultrasound in case of suspected abscess
  • Mammograms or breast biopsies (in cases which do not respond to treatment or on women who are not breastfeeding)
Differential
  • Breast cancer
  • Blocked milk duct
  • Breast engorgement
  • Breast trauma
  • Diabetes
  • Fat necrosis
  • Furuncle
  • Impetigo
  • Necrotizing fasciitis
Prevention
  • Appropriate management of breastfeeding to avoid milk stasis and infections.
Reference
  • Editorial: Puerperal mastitis. British Medical Journal, 1976, 1(6015):920-921.
  • Jahanfar S, Ng CJ, Teng CL; Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev. 2013 Feb 28;2:CD005458
  • Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  • Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf
Management
'-Deoxy-" '-Difluorocytidine
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