mastitis
MASTITIS
Mastitis is the inflammation of the breast that may or may not be associated with bacterial infection.
Staphylococcus aureus is the most common organism associated with mastitis.
It may occur spontaneously or during lactation. It most frequently occurs during the first 6-8 weeks postpartum, although it may occur any time during breastfeeding.
Nonpuerperal mastitis is most commonly associated with breast cyst.
Breast abscess (collection of pus in the breast) is a complication of mastitis.

Introduction

  • May occur spontaneously or during lactation
    • Most frequently occurs during the first 6-8 weeks postpartum, although it may occur at any time during breastfeeding
    • A study showed that lactational mastitis is associated with decreased levels of carbohydrate, fat and energy in breast milk which may be due to the cytokine-induced inflammatory response and increased permeability of the blood-milk barrier
  • Incidence is 2-10% in lactating mothers, while <1% in nonpuerperal mothers
  • Nonpuerperal mastitis is most commonly associated with breast cyst
  • Breast abscess is a complication of mastitis, refers to the collection of pus in the breast

Definition

  • Inflammation of the breast
  • May or may not be associated with bacterial infection

Etiology

  • Staphylococcus aureus is the most common organism associated with mastitis, particularly methicillin-resistant S aureus (MRSA) in lactational mastitis
  • Other pathogens are streptococci (alpha, beta and non-hemolytic), Escherichia coli, Bacteroides species, Corynebacterium species
    • Consider Candida infection if with symptoms of burning nipple pain or radiating breast pain

Signs and Symptoms

  • Firm, erythematous, tender, swollen area in the affected breast
  • Skin that may appear shiny and tight with red streaks
  • Fever or temperature >38°C
  • May present with headache, myalgia, lethargy, nausea, anxiety, flu-like aching, or systemic illness
  • Axillary pain and swelling from reactive lymphadenopathy

Risk Factors

  • Incomplete breast drainage which may be caused by difficulties in infant attachment, missed feedings or infrequent feedings, infant mouth abnormalities (eg tongue-tie, cleft lip or palate)
  • Engorgement and/or chronic oversupply of milk
  • Abrupt or rapid weaning
  • Blocked nipple or milk ducts
  • Trauma to breasts or nipples
  • Excoriated or cracked nipples
  • Poor maternal health like fatigue, stress, malnutrition
  • Prior history of mastitis
  • Tight-fitting clothes or external pressure on the breast
  • Yeast infection
  • Illness in mother or baby
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