Gynecology Book

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Mastitis

Aka: Mastitis, Breast abscess, Lactation Mastitis
  1. Epidemiology
    1. Incidence: 9-33% of lactating women
    2. Most common in first few weeks and nearly all cases within first 3 months
  2. Pathophysiology
    1. Generally occurs in Lactation several weeks postpartum
    2. Bacteria enter through a cracked nipple
  3. Etiology
    1. Staphylococcus aureus
    2. Escherichia coli
    3. HaemophilusInfluenzae
  4. Symptoms
    1. Fatigue
    2. Malaise
    3. Myalgias
    4. Headache
  5. Signs
    1. Fever
    2. Unilateral Breast inflammation
      1. Warmth
      2. Tenderness
      3. Erythema
    3. Observe for signs of Breast abscess
      1. Requires needle aspiration
  6. Labs: Milk Culture
    1. Indications (not routine)
      1. Severe Mastitis
      2. Refractory despite optimal antibiotics for at least 48 hours
      3. Hospital acquired infection
    2. Technique
      1. Cleanse nipple
      2. Hand express small quantity of Breast milk and discard
      3. Hand express a sample into a sterile container
  7. Differential Diagnosis
    1. Inflammatory Breast Cancer
  8. Management: General Measures
    1. Continue with frequent Breastfeeding
      1. Risk of Breast abscess if Breast engorgement occurs
      2. Safe for infant to continue to feed despite infection (except if mother HIV positive)
      3. Ensure proper technique (see prevention below)
    2. Tylenol
    3. Ensure adequate hydration
    4. Apply warm packs and local massage
    5. Alternate feeding positions
    6. Antifungals (Monilial Infection)
      1. Topical Antifungals on Breast
      2. Oral Nystatin for infant
  9. Management: Antibiotics
    1. Course: 10 to 14 days
    2. Coverage: Staphylococcus aureus (or as directed by culture)
    3. Antibiotics: Nursing Mothers
      1. Amoxacillin-Clavulanate (Augmentin) 875 mg orally twice daily
      2. Cephalexin (Keflex) 500 mg orally four times daily
      3. Dicloxacillin 500 mg orally four times daily
      4. Clindamycin 300 mg orally four times daily (for MRSA)
      5. Ciprofloxacin 500 mg orally twice daily (for MRSA)
    4. Antibiotics: Non-Breast Feeding women
      1. Trimethoprim-sulfamethoxazole (Septra) 160mg/800 mg orally twice daily (for MRSA)
  10. Complications
    1. Breast abscess
      1. Obtain bacterial culture
      2. Treat with needle aspiration or Incision and Drainage
  11. Follow-up
    1. If not better in 48 hours examine Breast for abscess
      1. Consider Incision and Drainage
    2. Early antibiotics prevent abscess formation
  12. Prevention
    1. Optimal Breast Feeding Technique with good latch-on by infant
    2. Address predisposing factors early
      1. Sore nipples suggest problems
        1. Correct latch-on problems
        2. Address dry nipples with lanolin
        3. Avoid plastic-backed Breast pads
        4. Evaluate infant for anatomic problems (e.g. short frenulum, Cleft Palate)
      2. Cracked nipples colonized with Staphylococcus aureus should be treated
        1. Oral antibiotics (e.g. Dicloxacillin) are preferred
        2. Livingstone (1999) J Hum Lact 15:241-6
      3. Blocked milk ducts should be unblocked
        1. Blocked ducts will appear with a bleb overlying a tender, red area adjacent to nipple
        2. Remove bleb with moist cloth
      4. Yeast infection should be treated (both infant and mother)
        1. Infant: See Thrush for management options
        2. Mother
          1. Topical agents: Nystatin or Ketoconazole
          2. Oral agents: Fluconazole 400 mg on day #1, then 200 mg orally daily for 10 days
          3. Chetwynd (2002) J Hum Lact 18:168-71
  13. References
    1. Spencer (2008) Am Fam Physician 78(6): 727-32
    2. Barbosa-Cesnik (2003) JAMA 289:1609-12

Mastitis (C0024894)

Definition (NCI) An infectious process affecting the breast.
Definition (NCI) A disorder characterized by an infectious process involving the breast.
Definition (NCI) A condition in which breast tissue is inflamed. It is usually caused by an infection and is most often seen in nursing mothers.
Definition (MSH) INFLAMMATION of the BREAST, or MAMMARY GLAND.
Concepts Disease or Syndrome (T047)
MSH D008413
ICD9 611.0
ICD10 N61
SnomedCT 155955007, 155952005, 266641007, 198110007, 266644004, 45198002, 266579006, 198099006
French MASTITE, Maladie inflammatoire du sein, Inflammation du sein, INFLAMMATION DU SEIN, Mastite
English BREAST INFLAMMATION, MASTITIS, Mastitis, NOS, Inflam disorders of breast, Inflammatory breast dis.NOS, Inflammatory breast diseases NOS, Inflammatory disorders of breast, Inflammatory disease of breast, Breast inflammation, Breast inflammation NOS, mastitis (diagnosis), mastitis, Breast inflammation NOS (disorder), Inflammatory disease of breast (& [mastitis]) (disorder), BREAST DISEASE INFLAMMATORY, Inflam disease of breast, Inflammatory breast diseases NOS (disorder), Breast infection, Mastitis [Disease/Finding], Mastitis, inflammatory breast disease, breasts inflammation, inflammatory disease of breast, breast inflammation, Inflammatory breast disease, Inflammatory disorder of breast, Inflammatory disorder of breast (disorder), Mastitis (disorder), breast; inflammation, inflammation; breast, Inflammatory disease of breast (& [mastitis]), Mastitis NOS
Portuguese MASTITE, Doença inflamatória da mama, Inflamação da mama, INFLAMACAO DA MAMA, Mastite
Spanish MASTITIS, Enfermedad inflamatoria de la mama, Inflamación mamaria, Mastitis, Inflammatory disorder of breast, Inflammatory disease of breast (& [mastitis]), Inflammatory disease of breast, Inflammatory breast disease, MAMA, INFLAMACION, Breast inflammation NOS, enfermedad inflamatoria de la mama, enfermedades inflamatorias de la mama, SAI (trastorno), enfermedades inflamatorias de la mama, SAI, inflamación mamaria, SAI (trastorno), inflamación mamaria, SAI, mastitis (trastorno), mastitis, trastorno inflamatorio de la mama (trastorno), trastorno inflamatorio de la mama
German MASTITIS, Brustentzuendung, entzuendliche Erkrankung der Brust, BRUSTENTZUENDUNG, Entzuendliche Krankheiten der Mamma [Brustdruese], Mastitis
Japanese 乳腺炎, ニュウボウエンショウセイシッカン, ニュウセンエン, 乳房炎症, ニュウボウエンショウ, 乳房炎症性疾患
Swedish Bröstkörtelinflammation
Dutch mastitis, inflammatoire borstaandoening, borstontsteking, mamma; ontsteking, ontsteking; mamma, Ontstekingsprocessen van mamma, Mastitis
Italian Infiammazione mammaria, Malattia infiammatoria del seno, Mastite
Czech mastitida, Zánět prsu, Mastitida, Zánětlivé onemocnění prsu
Finnish Mastiitti
Russian MASTIT, МАСТИТ
Korean 유방의 염증성 장애
Croatian MASTITIS
Polish Zapalenie sutka
Hungarian Emlő gyulladásos betegsége, Emlő gyulladás, mastitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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