Diagnosis and treatment of mastitis in breastfeeding women

摘要

Amir: Mastitis means inflammation of the breast, so I diagnose mastitis when a woman has systemic symptoms as well as local breast signs and symptoms. In my research, I have used the definition of at least 2 breast signs/symptoms (pain, lump/hardness, redness) and fever or at least 1 systemic symptom (lethargy, aching, headache, nausea and so on). I don't believe we should use the term mastitis as a synonym for breast (or nipple) pain. Some people refer to "Candida mastitis" which makes no sense to me.Trupin: I define every case of breast infection or inflammation as mastitis. The utility of this approach is that the patients who are getting treated have that diagnosis tagged to their evaluation and medication. Mastitis usually presents as pain and induration confined to 1 quadrant of the breast tissue. The Academy of Breastfeeding Medicine (ABM) defines mastitis as "tender, hot, swollen, wedge-shaped area of breast associated with temperature of 38.5 C or greater,"1 and I agree with this general definition. The World Health Organization states that a third of women with mastitis won't have fever. The formal definition of milk stasis is few bacteria and few WBCs (under 103 each). Infectious inflammation of the breast is defined as greater than 103 bacteria per mL of milk and greater than 106 WBC per mL of milk. Non infectious mastitis, has greater than 106 leukocytes, but less than 103 bacteria per mL of milk.2 We are virtually never obtaining cultures of the milk; therefore, we do not have any way of assessing this.