Purulent mastitis - Causes, symptoms and treatment. MF.

Purulent mastitis is a purulent inflammation of the breast tissue. There are two stages of inflammation of the breast: serous and purulent. Depending on the cause of the disease, the mastitis may be lactating and non-lactative. Most often, this disease occurs in women in the postpartum and lactation period( the period of breastfeeding).More often mastitis occurs in primiparous women. In most cases, lactational mastitis develops in the second to third week of a child's life, but can develop 10 months after birth.

Causes of purulent mastitis.

The causative agent of purulent lactation mastitis in most cases is Staphylococcus aureus. The entrance gates for infection are the cracks of the nipples, the mouth of the milk ducts. For the development of inflammation, a combination of infection and lactostasis( milk stagnation) is necessary, the latter serving as a trigger factor. If lactostasis is not resolved within 3-4 days, purulent mastitis develops.

The reasons for the milk stagnation in the mammary glands include the following:

• Breastfeeding failure,
• Inadequate and irregular expression of the milk after breastfeeding, violation of the pumping technique - coarse pumping( milk squeezing), leading to closed breast trauma;
• stiffness and nipple cracking,
• congenital breast changes( thin and convoluted milk ducts),
• mastopathy,
• previous operations on the mammary glands.

With milk congestion and infection in the mammary ducts, lactic fermentation and coagulation of milk begins, which leads to an even worse deterioration in the outflow and increases lactostasis. The pathological vicious circle develops. Milk and fermentation products are a favorable environment for the reproduction of bacteria, which leads to a rapid transition of inflammation to the purulent stage. At the initial stages, high fever and chills are caused by lactostasis. Due to stagnation, milk and fermentation products with pyrogenic action are absorbed through the damaged milk ducts into the blood, which causes a rise in temperature.

Non-lactational mastitis occurs less frequently than the lactation mastitis. The following causes of its occurrence can be identified:

• Breast trauma,
• Purulent skin and subcutaneous tissue disorders of the mammary gland( furuncle, carbuncle) with the transition of inflammation to the underlying tissues,
• Implantation of foreign bodies into the breast tissue,
• Suppuration of benign andmalignant neoplasms of the breast.

The spectrum of pathogens in this case is somewhat wider. In addition to the golden and epidermal staphylococcus a Pseudomonas aeruginosa, enterobacteria is often found.

Symptoms of purulent mastitis.

Purulent lactation mastitis in its development is usually serous and infiltrative stage.
Serous mastitis causes pain and heaviness in the mammary gland, chills and a fever of 38 ° C.The mammary gland increases in size, redness of the skin and soreness in the area of ​​inflammation are noted. The amount of expressed milk decreases.

When passing to the infiltrative stage, along with these symptoms, palpation of the gland reveals dense painful formation( infiltration) without clear boundaries and softening sites.

With preservation of lactostasis after 3 to 4 days, serous and infiltrative stages pass into a purulent complication stage with development of abscessed mastitis in most cases. In this case, the state of health worsens, the temperature rises above 38 ° C.The consolidation( infiltration) in the mammary gland becomes sharply painful, acquires clear boundaries, at the center of such formation it is possible to feel the softening, which indicates the development of the abscess. It is possible to develop many small abscesses in the infiltrate by the type of honeycombs filled with pus, this form is called infiltrative-abscessing. Symptoms of the latter differ little from the abscess of the breast. Acute purulent lactation mastitis.

With phlegmon of the breast, intoxication is more pronounced, the temperature reaches 39 ºС and higher. A distinctive feature is pronounced edema of the breast, which is dramatically increased in size, a cyanotic skin tone. Often, the nipple is drawn into the gland due to swelling.

The gangrenous form of mastitis proceeds malignantly, indicating the neglect of the purulent process. The skin of the gland is cyanotic-purple with areas of necrosis( black color), the process covers the entire gland. Perhaps the formation of epidermal blisters with cloudy bloody contents, as with a burn.

In the case of non-lactational mastitis, the clinical picture is erased. At the forefront in the initial stages of the disease develops the underlying disease, for example, furuncle or carbuncle. Then purulent inflammation of the gland itself is attached. The most commonly developed abscess of the breast.

Non-lactational mastitis as a complication of the abscessed boil of the right breast.

Differentiate mastitis from lactostasis, which often precedes purulent inflammation. The main difference between mastitis and lactostasis is the absence of skin redness and swelling of the gland during milk congestion. After emptying the gland with lactostasis, the symptoms go away, the body temperature decreases.

Examination for purulent mastitis.

If these symptoms are found, it is necessary to consult a surgeon or polyclinic on duty. After the examination, it will be necessary to give an overall blood and urine test, a blood test for the level of sugar to exclude the presence of diabetes. In the clinical analysis of urine there is an increase in the number of leukocytes with a shift of the leukoformula to the left, an increase in ESR.From instrumental methods for the diagnosis of abscess in the mammary gland the most informative method is ultrasound. The latter allows to diagnose the accumulation of pus in the tissues of the breast, determine the location and size of the purulent focus, perform a puncture with subsequent bacteriological examination of the punctate.

Treatment of mastitis.

In the initial stages of inflammation development with lactostasis and serous mastitis, a conservative treatment is prescribed.

It is necessary to express the milk regularly every 3 hours. Milk is expressed first from a healthy breast, then from the patient. To relieve spasm from the milk ducts and to facilitate pumping 3 times a day intramuscularly inject antispasmodics( for example, no-shpa of 2 ml).Assign intramuscular administration of antihistamines for desensitization( for example, suprastin 3 times a day) and antibacterials of a broad spectrum of action. Carry out half-alcohol wraps of mammary glands, ultrasound or UHF-therapy.

In case of ineffectiveness of conservative treatment and development of purulent inflammation, an operation is performed - opening and draining the purulent focus under general anesthesia.

In the postoperative period, antibacterial therapy is continued, rinsing of the abscess cavity with solutions of antiseptics( chlorhexidine, furacillin, dioxygen), daily dressings are performed.

Breastfeeding can be continued only if the inflammation is relieved and negative bacteriological studies of milk are performed. In this case, the child can not be applied to either a healthy or a diseased mammary gland. Milk, expressed from a sick breast, is not used, but from a healthy mammary gland is subjected to pasteurization and fed from a bottle. Such milk is not subject to storage.

With relapsing and severe mastitis after lactostasis is stopped lactation is interrupted. Interruption of lactation is medicated with the help of such drugs as, for example, dostinex and parlodel.

Complications of purulent mastitis.

Complications of purulent mastitis are divided into complications of the disease itself and postoperative complications.

The complications of purulent mastitis itself include the development of phlegmon and gangrene of the breast, the clinical picture of which is described above, the latter, in turn, can lead to sepsis( blood poisoning).

To postoperative complications include the development of dairy fistula. Usually it closes within a month after recovery and is not a contraindication to breastfeeding. It is also possible suppuration of the postoperative wound and relapse of purulent mastitis. After surgery, a cosmetic defect may persist, and an operating injury followed by scarring and deformity of the breast can increase the likelihood of a second episode of the disease during the next pregnancy and breastfeeding.

Preventing purulent mastitis.

Prevention of purulent mastitis includes a number of activities.

• Increase the body's resistance by fully nourishing rich in proteins, carbohydrates and vitamins.
• Observance of personal hygiene rules. It is necessary to take a warm shower twice a day, change underwear. After feeding, the mammary glands should be washed with warm water without soap, wipe with a towel and left open for 15 minutes. Between the bra and the nipple, a sterile gauze napkin is placed, which is changed when impregnated with milk. The bra should be made of cotton fabric, it must be washed daily, dressed after ironing with a hot iron. He should not squeeze the chest.
• Cracks of the nipples should be treated in a timely manner, at the appearance of which it is necessary to stop breastfeeding from the sick side, to squeeze the milk into a bottle and feed through the nipple. The hole in the nipple should be made with a sewing needle heated to the fire. The resulting hole should be small, otherwise the child may refuse to take the breast. For the treatment of nipple cracks, various wound healing ointments and creams are used( for example, solcoseryl ointment, beponen cream).
• It is preferable to manually pump milk, especially from the outer quadrant of the breast, where milk stagnation is more common.

If these symptoms persist, consult a doctor. This will be the best prevention of complications of purulent mastitis, because timely treatment will avoid surgery or perform it as early as possible with the least severe cosmetic defect in the future.

It is better to overestimate the severity of your symptoms than it is too late to seek medical help.

Surgeon-physician Tevs DS