Acute mastitis is characterized by the development of an inflammatory process in the tissues of the mammary gland. The disease is manifested by intense and severe arching pain in the chest, its compaction, swelling, redness of the skin, a sharp rise in temperature, and febrile syndrome. Mastitis is diagnosed during examination by a mammologist, an ultrasound of the mammary glands is additionally performed, and if necessary, mammography. The pathological process can lead to the formation of phlegmon, abscess, necrosis in the affected gland, the development of sepsis, and in some cases even death. In case of bacterial contamination of milk, breastfeeding should be discontinued. In the future, deformity of the mammary gland may develop, the likelihood of developing mastopathy and oncological tumors in the breast increases.
Breast infection
Acute mastitis occurs mainly due to infection of the breastbacteria. The pathology is manifested by swelling of the breast, a strong increase in size, soreness and increased sensitivity, hyperemia of the skin and fever.
The incidence of mastitis in breastfeeding mothers varies from 1 to 16%. The average figure is 5% of women, and measures to reduce the incidence in recent years have been ineffective. The vast majority of patients with mastitis are nulliparous or breastfeeding women for the first time. This is associated with the highest incidence of milk stasis due to inept pumping.
Women after thirty years of age, who are not breastfeeding for the first time, in most cases develop mastitis due to a decrease in the protective properties of the body, which is due to the presence of one or another concomitant chronic disease. In such cases, pathological symptoms are accompanied by manifestations of the underlying disease.
Reason for development
Acute mastitis is usually caused by a staphylococcal infection. But if another source of bacterial flora is present in a woman's body (infections of the oral cavity, respiratory system, urinary tract, reproductive organs), mastitis can be triggered by these foci. Sometimes the mammary glands become infected with Escherichia coli. The pathogen enters the breast tissue with blood flow, as well as through the milk ducts.
The most common cause of acute lactational mastitis is prolonged pathological lactostasis (stagnation of milk in the gland). AtIn the absence of an outflow of milk from any duct of the mammary gland, a favorable environment is formed for the growth and reproduction of pathogenic bacteria. An actively developing infection causes an inflammatory reaction, tissue suppuration, and febrile syndrome. At the same time, the patient may feel unwell - there is severe weakness, intoxication, in some cases - vomiting, nausea.
Classification of acute mastitis
Mastitis is a pathological process that always proceeds in an acute form. The disease is divided into types according to the nature of the developing inflammatory process: infiltrative, serous, purulent, gangrenous, abscessing and phlegmonous. Infiltrative, serous and purulent types of mastitis are phased stages of a single inflammatory process in the tissues of the gland - from the formation of a compacted area of serous inflammation to the formation of an infiltrate and the onset of a purulent process.
Abscess form
With abscessing acute form of mastitis, the focus of suppuration is localized and clearly limited. Phlegmonous mastitis is characterized by the spread of a purulent process through the tissues of the mammary gland. With a long course or a weakened immune system, the affected tissues of the gland begin to necrotize, and the gangrenous stage of mastitis begins.
There are also some clinical varieties of mastitis, the most common of which are: acute lactational, occurring in the postpartum period, neonatal mastitis and plasma cell.
Symptoms
Acute mastitis- this is in most cases a complication of lactostasis of inflammatory etiology in nursing mothers. In some cases, the disease develops without previous pronounced symptoms of milk stagnation. The disease is manifested by a painful induration in the mammary gland, hyperemia and hyperthermia of the skin in the area of induration. The patient has a fever and general symptoms of intoxication. With the progression of the disease, the pain intensifies, the gland increases, it becomes hot and dense to the touch. Breastfeeding and expressing milk in this condition are sharply painful. Along with milk, blood and pus may be released. Purulent mastitis of an acute nature often progresses with the formation of an abscess of the mammary gland.
Non-lactating women
There is also acute mastitis in a non-nursing woman. We will talk about the treatment below. Such cases relate to a pathology such as plasma cell mastitis, a rare disease that develops in older patients who have repeatedly given birth after the end of the lactation period. The pathological process is characterized by infiltration of tissues under the nipple with plasma cells and hyperplasia of the epithelial tissues of the excretory ducts. Acute mastitis of this form does not suppurate and has similar features with breast cancer.
Mastitis in newborns is a phenomenon in children of both sexes that occurs quite often. It is manifested by engorgement of the mammary glands and transparent discharge during pressure on them. This pathology, as a rule, is a consequence of the residual effects of maternal sex hormones. With the development of acute non-lactationmastitis and the formation of an abscess, surgical debridement of the purulent focus is performed, but most often the symptoms of mastitis in newborns subside on their own after a few days.
Diagnostic measures
The focus of the inflammatory process in the mammary gland is diagnosed by palpation. In addition, the woman has an increase in axillary lymph nodes on the side of the affected gland (sometimes moderate pain on palpation). Suppuration is characterized by the definition of a sign of fluctuation.
When ultrasound of the mammary glands is visualized a typical picture of the inflammatory process. Mastitis of the serous type is characterized by a smoothed echographic picture of the structures of the gland, thickening of the skin, expansion of the milk ducts and subcutaneous tissue. The infiltrate in the gland looks like a clearly defined limited area of reduced echogenicity, with further progression, a “honeycomb” pattern is detected. In addition, with ultrasound, the development of abscesses is well visualized and necrotic zones are determined. The reliability and specificity of this method reaches 90%.
Because acute mastitis is usually easy to diagnose, mammograms are usually not done. With a dubious picture on ultrasound, an aspirate is taken for histological examination (aspiration fine-needle biopsy of the breast under ultrasound control). For bacteriological examination, specialists can take milk from the affected mammary gland.
With a sluggish course of the inflammation process and due to the formation of fibrous tissue around it(sacking of the focus) speak of the transition of the pathology into a chronic form. In this case, the clinical symptoms are usually mild, but on palpation, an inactive dense roller soldered to the skin is diagnosed. Next, we will talk about the treatment of acute mastitis.
Therapy
At the slightest suspicion of the development of acute mastitis, it is urgent to contact a mammologist, since in the treatment of this pathology it is important to timely identify and take measures to eliminate the causes of mastitis and inhibit the infectious process. Delay in seeking medical attention or self-medication is unacceptable, since the disease is prone to rapid progression and the formation of an abscess. In case of purulent mastitis, surgical treatment is necessary.
When diagnosing this disease at the stage of a serous process or the formation of an infiltrate, conservative therapy is carried out. The patient is prescribed antibiotics with the use of potent broad-spectrum drugs. In this case, serous mastitis disappears in 2-3 days. The resorption of the infiltrate can take up to 7 days in duration. If, during inflammation, the patient has a pronounced intoxication of the body, she is shown detoxification measures (glucose infusions, electrolyte solutions). In case of excessive lactation, drugs are prescribed to suppress it.
What else is the treatment of acute mastitis. The purulent form of the disease, as a rule, requires surgical intervention. The developed abscess of the gland is a direct indication for urgent surgical sanitation -mastitis is opened and the purulent focus is drained.
Contraindication for breastfeeding
Progressive forms of mastitis, regardless of the stage of the disease, are a direct contraindication to further breastfeeding (even with he althy breasts), since milk contains infectious agents and toxic elements of tissue decay. For a child, such nutrition can cause dysbacteriosis and disorders of the functional state of the digestive tract. Since the treatment of mastitis involves the use of antibiotics, feeding during this period is also unsafe for the baby. Antibiotics can significantly harm the normal development of organs and tissues. During the treatment of mastitis, milk can be expressed, pasteurized and then fed to the baby.
Indications for suppression of lactation are: the absence of positive dynamics in infiltrative and serous mastitis for 3 days of antibiotic therapy, the transition of the disease to a purulent form, the focus of infection directly under the nipple, purulent mastitis in the past, concomitant systemic pathologies that significantly worsen well-being women.
Possible Complications
Any infectious process caused by staphylococcus aureus can be complicated by generalization of the infection and the occurrence of septic complications:
- meningoencephalitis or meningitis;
- bacterial pericarditis or endocarditis;
- sepsis (presencemultiple foci of infection - pneumonia, osteomyelitis, etc.);
- DIC;
- toxic shock.
Complications of acute mastitis can be life-threatening.
Prevention
Prophylactic measures are combined with measures to prevent lactostasis, as this condition precedes mastitis in the vast majority of situations.
For the prevention of congestion in the mammary gland, careful emptying of the breast is necessary: regular feeding and further pumping of milk residues. In the case when the baby has enough milk from one breast, at the next feeding it must be applied to the other mammary gland.
The main preventive measure to prevent mastitis is the timely diagnosis and sanitation of any infectious foci in the body, but it should be understood that systemic antibiotic therapy during lactation is categorically contraindicated.
Prophylaxis is of particular importance in the postpartum period, especially if a woman has given birth for the first time. At the same time, the milk ducts and nipple are not yet prepared for breastfeeding, so it is necessary to consult with a mammologist in time and take measures to eliminate milk stagnation. A good way to prevent lactostasis is breast massage in the first days after childbirth. The glands at the same time are painful, have a dense structure, increased skin temperature, however, even with this, regular pumping of breast milk and massage are recommended.
