Purulent mastitis is the most severe and unpleasant disease for women. Today we will pay special attention to the most severe of its forms - non-lactational purulent mastitis, since the he alth of a woman is the main condition for the he alth and prosperity of the nation.
Research history
From ancient times, a rare woman has passed the knowledge of the essence of the disease, which since ancient times was called breastfeeding, and later became known as mastitis. Yes, and no wonder, since this pathology, which is a massive infectious and inflammatory process in the mammary gland, and even tending to actively spread, often led to a purulent lesion of the glandular body of the mammary gland itself and adjacent tissues, and then to sepsis from -for the generalization of the infectious process.
Subtleties of statistics
In modern times, mastitis is usually divided into lactational, when milk production occurs in the mammary gland (most often purulent lactating mastitis), and non-lactational, which we would like to talk about today. According to recent statisticsdecades, in 90-95% of reported cases of mastitis, it developed in the period after childbirth, while non-lactational mastitis, which is not associated with pregnancy and childbirth, affects an average of about 5% of women.
Age categories
Non-lactational mastitis usually affects women between 15 and 60 years of age. In the specified age range, this form of mastitis, in contrast to lactation, does not manifest itself violently, and septic complications practically do not occur. In contrast, women who fell ill during the mentioned age period have to learn to coexist with mastitis for many years, because it often goes into a chronically relapsing form. However, non-lactating mastitis can affect not only women, but also men and babies of both sexes.
Etiology
Non-lactational purulent mastitis is not associated with lactation, occurs relatively rarely and is often caused by hormonal imbalance and a decrease in the immune response to infectious agents. As a rule, it is expressed by progressive unilateral or bilateral inflammation of the mammary glands.
Detailed reasons
It just so happened that most often non-lactational purulent mastitis develops when the hormonal background is disturbed in the female body or the immune response to infectious agents decreases. Typically, these periods include the following:
1. A massive decrease in estrogen levels, and at the same time a significant suppression of immune defense, manifests itself in the period of postmenopausal.
2. PeriodThe puberty of a teenager with its unstable hormonal background also becomes a powerful stress for the developing organism, which creates fertile ground for the development of such an undesirable disease. In addition, it is worth noting that non-lactational mastitis affects not only girls, but also boys during puberty.
3. It is impossible not to mention cases of infection of wounds after operations performed on the mammary gland, for example, after placing an implant or removing fibrocystic growths, with injuries of the mammary gland, which were accompanied by squeezing of its tissues.
4. Even the most invisible injury to the skin of the mammary glands or nipples can contribute to the penetration of infection and the development of non-lactational mastitis.
Disease forms
The disease we are considering usually occurs in two forms - acute and chronic. Acute non-lactational mastitis without timely admission to the hospital and adequate therapy from the catarrhal (infiltrative) form quite rapidly and relatively imperceptibly for a woman can transform into purulent non-lactational mastitis with an extremely severe course, when it is no longer possible to do without hospitalization in a hospital, and even before the generalization of the process there are only a few days, or even hours.
Pathogenesis
In the case of non-lactational mastitis, infectious agents usually enter the mammary gland through lesions on the skin, which are caused either by accidental injury or thermal injury, for example, whenusing a heating pad or an accidental burn, and sometimes because of small pustules on the skin of the mammary gland. Then the bacteria first damage the subcutaneous fat layer and the fatty capsule of the mammary gland, and then attack the glandular tissue for the second time.
Where less often women have to deal with chronic non-lactational mastitis, which usually develops when acute mastitis is left untreated, considering the first signs of improvement as an argument for stopping the medications and procedures prescribed by the doctor. In such cases, recurrence of mastitis becomes a constant companion of a woman, manifesting itself at the slightest hormonal disruption, after hypothermia, stress, or with a general weakening of the body's defenses.
Non-lactation purulent mastitis. Symptoms
At the very beginning of the development of acute non-lactational mastitis - in the serous stage, when the tissue of the affected part of the mammary gland is successively impregnated with serous fluid and leukocytes actively enter it - the woman notes the occurrence of pain in the mammary gland, in which one can palpate the compacted area with clear boundaries in one or more shares. The body temperature is increased to 37-38 degrees, and in some cases up to 39. In addition, during this period, a woman may be disturbed by severe general weakness. In extremely rare cases, the reverse development of the serous stage and the onset of spontaneous recovery occur, however, much more often, the stage of infiltration develops after the serous stage.
Bthe infiltrative stage in the affected mammary gland forms a painful seal without clear boundaries, called an infiltrate. At the same time, the skin above the infiltrate does not look inflamed at all, there is no edema in this area, and the local temperature remains within normal limits. The body temperature remains elevated, which is due to the active entry of bacterial products into the blood from the foci of lactostasis through the damaged ducts of the mammary gland. It is extremely important that a woman seek medical help from a mammologist, gynecologist or surgeon when the first symptoms appear, without waiting for their progression and transition to a purulent form. In the catarrhal stage, mastitis is treated extremely successfully and does not entail severe complications, as in the case of non-lactational purulent mastitis.
In the absence of adequate treatment, after 5 days the stage of infiltration passes into the stage of destruction, that is, destruction. The inflammatory process becomes purulent, and the mammary gland turns into a complete likeness of a sponge, soaked through with pus.
In the destructive stage, which is also known as acute purulent mastitis, the general condition of a woman deteriorates sharply, as toxins from the source of purulent inflammation continuously enter the bloodstream. The body temperature continues to rise and usually in this period is 38-40 degrees, and with it the general symptoms of intoxication increase. The affected mammary gland increases in size, becomes tense. The skin over the destruction zone becomes red, the saphenous veins expand. As the pain increases, it spreads to the areaarmpits, since regional lymph nodes are also quickly involved in the infectious process. The patient becomes unable to sleep and eat.
Views
Non-lactational purulent mastitis, a photo of which can be seen in medical reference books, requires a competent approach in making a diagnosis.
There are the following varieties:
1. Mastitis is abscessing, which is characterized by the fact that a large number of abscesses are formed in the affected mammary gland - cavities that are filled with pus. Usually, in the area of the infiltrate, you can palpate softening or feel under your fingers a liquid that shimmers when you feel it - a positive symptom of fluctuation (in 99% of cases).
2. Mastitis is infiltrative-abscessing. It tends to be more severe than the previous one. A dense infiltrate consists of many small abscesses of various sizes and shapes, so the symptom of fluctuation is positive only in 5% of patients. Such an infiltrate usually occupies no more than two quadrants of the mammary gland.
3. Phlegmonous mastitis. In this case, the mammary gland is totally enlarged and markedly edematous. The skin of the affected breast is pronouncedly red (and in some places bluish-red), tense, with an inverted nipple. Probing the gland is extremely painful, the symptom of fluctuation is positive. In more than half of the patients, the purulent lesion extends into at least three quadrants.
4. Gangrenous mastitis, as a rule, is accompanied by damage to the blood vessels and activethrombus formation. Since the normal blood supply to the mammary gland becomes impossible, its necrosis develops. At the same time, the gland is significantly enlarged, on its surface there are areas of tissue necrosis, blisters that are filled with ichor, the skin becomes bluish-purple. Inflammation covers the entire mammary gland. During this period, the condition of patients is extremely difficult, consciousness becomes confused, tachycardia increases against the background of a decrease in blood pressure. A clear picture of sepsis is formed in the blood. Of course, at this stage, the risk to the patient's life becomes extremely high.
Surgical treatment
If "non-lactational purulent mastitis" is diagnosed, its treatment can be either surgical or conservative.
Direct indications for surgical intervention are all destructive forms of the infectious-inflammatory process, purulent-catarrhal mastitis, the signs of which were described by us above.
In the case when drug therapy does not give a significant improvement within two days, the presence of a purulent process in the mammary gland is usually judged, which is the most direct indication for surgical intervention, which is performed exclusively in a hospital, usually under general intravenous anesthesia.
Subtleties of operation
During the operation, the abscess is carefully opened, cleaned, all non-viable tissues are excised and removed. Thus, purulent mastitis is completely eliminated. The operation is usually tolerated by womeneasily. After intervention in the mammary gland, drains must be installed to rinse the wound drip and not give bacteria even a tiny chance to activate. Drip washing of the wound is carried out from 5 to 12 days, which corresponds to the achievement of a good general condition by the patient and the disappearance of fibrin, pus and particles of necrosis from the washings.
Therapy after surgery
Also, after the operation, drug therapy is carried out, which is aimed at removing toxins from the body as soon as possible and thoroughly and correcting those disorders that have developed against the background of a purulent process. Antibiotics are required (intramuscularly or intravenously). Usually these are drugs of the cephalosporin series I, II, or, in the case of a secondary infection, III-IV generation.
Non-lactating purulent mastitis: treatment without surgery
Conservative treatment is possible only when the general condition of the patient remains relatively satisfactory, the disease lasts no more than three days, the body temperature does not exceed 37.5 degrees, there are no local symptoms of purulent inflammation, the pain in the projection of the infiltrate is moderate, the infiltrate is palpable no more than one quadrant of the breast, and in the general blood test does not increase the picture of progressive inflammation.
Most often women seek medical help in the initial stages of mastitis - serous or infiltrative, in which conservative treatment is possible and quite effective. First of all, it means providing rest to the affected mammary gland, forwhich women are advised to move less actively, wear a loose fabric bra or bandage, with which you can support the diseased breast, but do not squeeze it at all, so as not to provoke the progression of the process. In order to influence infectious agents, antibiotics (Cefalexin, Cefixime, Levofloxacin) are necessarily prescribed, they are usually administered intramuscularly, in doses not exceeding the average therapeutic dose. In addition to antibiotics, in order to reduce inflammation and swelling, the body is desensitized with the latest generation of antihistamines so as not to cause drowsiness in the patient and minimize side effects.
In addition to the "heavy artillery", vitamins of group B and vitamin C are prescribed to stimulate the body's defenses. resorption of the infiltrate and restoration of natural processes in the mammary gland.
Take care of yourself, remember about such an insidious disease as non-lactational purulent mastitis. Treatment can be by no means difficult if started in the earliest stages. He alth to you!
