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mastitis
Etiology:
- periductal mastitis
- Staphylococcus often drug-resistant
Epidemiology:
- common during lactation [2]
Pathology:
- periductal mastitis is a chronic inflammatory breast disorder
- squamous metaplasia of the mammary ducts
- ductal obstruction
- repetitive infections
Clinical manifestations:
- fever
- breast tenderness
- erythema, tenderness & a palpable fluctuant mass suggests breast abscess
Laboratory:
- complete blood count (CBC): leukocytosis
Special laboratory:
- breast biopsy if inadequate response to antibiotics
- - needle aspiration or incision & drainage if breast abscess
Differential diagnosis:
- inflammatory breast cancer
- breast abscess
Management:
1) infections are resistant to treatment
2) cephalexin or dicloxacillin for treatment of MSSA
- amoxicillin clavulanate or cefotetan for MSSA resistant to cephalexin [4]
- Bactrim better than erythromycin or amoxicillin [2]
3) clindamycin for MRSA
4) continue emptying breast of milk either through pumping or continued breast feeding
5) probiotics (Lactobacillus) isolated from human breast milk [2]
6) surgical excision of the involved ductal system
Specific
inflammatory breast cancer; mastitis carcinomatosa
General
bacterial infection
breast disease; mammary gland disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 19,
American College of Physicians, Philadelphia 1998, 2021
- Arroyo R et al.
Treatment of infectious mastitis during lactation:
Antibiotics versus oral administration of lactobacilli isolated
from breast milk.
Clin Infect Dis 2010 Jun 15; 50:1551.
PMID: 20455694
http://dx.doi.org/10.1086/652763
- NEJM Knowledge+ Question of the Week. Sept 11, 2018
https://knowledgeplus.nejm.org/question-of-week/945/
- NEJM Knowledge+