Mastitis and breast abscess

Question 1

What is lactational mastitis?

Answer 1

Inflammation of the breast tissue associated with breastfeeding

Question 2

What are the causes of lactational mastitis? (2 categories)

Answer 2

• Obstruction of the duct

- Infection of the duct

Question 3

What is the most common bacteria associated with lactational mastitis?

Answer 3

Staph aureus

Question 4

What are the clinical features of lactational mastitis?

Answer 4

• Inflammation of the breast (erythema, pain, swelling, warmth)
• Nipple discharge
• Fever (if infection)

Question 5

Describe the management of lactational mastitis

Answer 5

Where mastitis is caused by a blockage of the ducts, management is conservative:

• Continue to breast feed/express milk
• Warm compresses
• Analgesia

When conservative management is not effective or infection is suspected (e.g. patient has a fever):

• Same as above, PLUS
• Antibiotics (flucloxacillin is first line, erythromycin if pen allergic)

Question 6

What is a rare complication of mastitis? How is this managed?

Answer 6

Breast abscess - managed with incision and drainage

Question 7

Which condition can occur following a course of antibiotics for lactational mastitis?

Answer 7

Candida of the nipple (this can also occur on its own, as a separate condition)

Question 8

What are the clinical features of candida of the nipple in mum? What about in baby?

Answer 8

Mum:
- Sore, dry/cracked, itchy nipples

Baby:

• Oral thrush
• Candida nappy rash

Question 9

Describe the management of candida of the nipple?

Answer 9

Both mum and baby need treatment or it will reoccur:

• Mum needs topical miconazole 2%, applied to the nipples after breastfeeding
• Baby needs oral miconazole gel or nystatin