Mastitis

Question 1

def

Answer 1

inflammation of breast with or without infection

Question 2

what are the different types of mastitis

Answer 2

1 with infection
-lactational (peurperal)
2 without infection
-non-lactational (duct ectasia)
-idiopathic granulomatous inflammation

Question 3

aetiology

Answer 3

1 with infection
-bacteria colonizing the skin
2 without infection
-duct ectasia
-foreign material (nipple piercing, breast implant)

Question 4

what bacteria commonly cause infectious mastitis

Answer 4

1 s. aureus

2 coagulase negative staphylococci

Question 5

what is duct ectasia

Answer 5

lactiferous ducts become blocked or clogged

causes greenish discharge

Question 6

epi

Answer 6

1-10% of lactating women worldwide

duct ectasia in 5-9% of non-lactating women

Question 7

history + examination

Answer 7

1 flu like symptoms
-malaise
-myalgia
-fever
2 breast warmth, swelling, tenderness, redness
3 decreased milk outflow

Question 8

risk factors

Answer 8

1 female
2 15-45yrs
3 lactation + milk stasis

Question 9

investigations

Answer 9

1 clinical examination
2 breast USS
-hypoechoiec lesion indicates abscess
3 aspiration
-purulent fluid indicates abscess 
4 milk, aspirate, discharge or biopsy tissue can be used for culture and sensitivity
-identify infection

Question 10

management of lactational mastitis

Answer 10

if mild mastitis: conservative treatment which includes effective milk removal (frequent breastfeeding or breast pumping)
if severe mastitis: medical and conservative treatment with flucloxacillin (oral-anti-staphylococcal penicillin) and effective milk removal

Question 11

management of non-lactational mastitis

Answer 11

1st line treatment: flucloxacillin (oral anti-staphylococcal penicillin) + fluconazole (antifungal therapy)
2nd line treatment: if MRSA indicated then give vancomycin + fluconazole

Question 12

complications

Answer 12

cessation of breast feeding
breast abscess (complicating mastitis)

Question 13

prognosis

Answer 13

if treated promptly and appropriately, most breast infections will resolve

Question 14

when should nursing mothers with a breast infection not breastfeed

Answer 14

if they are HIV infected

if they are being treated with trimethoprim or sulfamethoxazole