MASTITIS (syn .: infant) - inflammation (mostly unilateral) of the mammary gland. In the overwhelming majority of cases, it is observed in the postpartum period in lactating women (lactational mastitis), sometimes in women who do not breastfeed the baby; rarely in pregnant women and infants (newborn mastitis). In 90% of patients the pathogen is Staphylococcus aureus. The most frequent entrance gates of infectious agents are nipple cracks; possible intracanalicular penetration of infectious agents through the lacrimal ducts of the gland when breastfeeding or expressing milk; extremely rare is the spread of infectious agents from endogenous foci (hematogenous and lymphogenous pathways). An important factor contributing to the emergence and development of mastitis is lactostasis (engorgement of the mammary glands).
Clinical signs of serous (beginning) mastitis: increased body temperature to 38–39 ° C, chills, deterioration of the general condition (headache, weakness), gradually increasing pain in the mammary gland, especially when feeding a child or expressing milk, increasing the gland in volume, hyperemia of the skin, the presence of painful seals. With late or ineffective treatment, serous mastitis within 1-3 days goes into infiltrative. At the same time the phenomena of intoxication increase; pains in the mammary gland are intensified, in which dense, sharply painful infiltration is felt; an increase in axillary lymph nodes. The duration of this stage is 5-10 days. If the infiltration is not absorbed, it usually suppresses. High purity of the body (39 ° C and more), chills, sleep disturbance, loss of appetite, increased local symptoms of inflammation, a significant increase and deformity of the mammary gland are characteristic of purulent mastitis.
Mastitis may be complicated by lymphangitis, lymphadenitis, dairy fistula formation (after spontaneous dissection, less often after surgery), rarely sepsis.
The diagnosis is established on the basis of complaints of the patient, anamnestic information and clinical manifestations, as well as data from additional studies. Leukocytosis , an increase in ESR, and sometimes a decrease in hemoglobin and red blood cell count are detected in the blood. Bacteriological examination of breast milk, pus is important, and at high body temperature and chills - blood. Ultrasound and thermography are also used, which allow detecting the initial changes, follow the dynamics of the process, for example, early to detect the transition of the infiltrative stage to purulent.
Treatment should begin at the first signs of the disease, which largely helps to prevent the development of purulent inflammation. Breastfeeding with mastitis is contraindicated due to the real threat of infecting the child, admission of antibiotics and other drugs used in the treatment of the mother. In case of serous and infiltrative mastitis, conservative treatment is carried out - antibacterial therapy mainly with broad-spectrum antibiotics. Semisynthetic penicillins (oxacillin, dicloxacillin), lincomycin or fuzidin are used , and, if necessary, broad-spectrum antibiotics, such as aminoglycosides (gentamicin, sisomycin, tobramycin), cephalosporins (cefamezin, cefuroxime); use a combination of semi-synthetic penicillins with aminoglycosides, etc. In case of purulent mastitis, surgical treatment is a wide opening of a purulent focus under general anesthesia. Also used excision of necrotic tissue, followed by drainage, the imposition of the primary suture and washing the wound cavity with antiseptic solutions for several days after surgery. They carry out antibacterial and infusion therapy, use antiseptic agents, immunostimulants, local proteolytic enzymes; use antihistamines, physiotherapeutic methods of treatment (microwave therapy, ultrasound, ultraviolet radiation, etc.).
The prognosis for timely initiated treatment is favorable. The question of the resumption of breastfeeding after suffering mastitis (with preserved lactation) should be addressed individually, depending on the severity of the process and the results of bacteriological examination of breast milk.
Prevention of postpartum mastitis is to teach women, especially primiparous, how to breastfeed. Necessary timely treatment of nipple cracks and lactostasis.
Mastitis of the newborn occurs when the breast is infected during a sexual crisis, accompanied by chopping up the mammary glands. Pathogens (mainly staphylococci) penetrate the gland tissue mainly by contact. Often mastitis develops on the background of pyoderma. Predisposing factor is mechanical irritation of the mammary gland (for example, squeezing a secret out of it, irritation with clothing).
At the beginning of the disease sharply increases, as a rule, one of the mammary glands. The skin over it in the 1st day is not changed or slightly hyperemic, with palpation, infiltration and pain are determined. Soon there is a pronounced hyperemia of the skin over the area of the lesion, while melting the glandular tissue - fluctuation. In most cases, the general condition of the child is disturbed - it sucks poorly, it becomes restless, the body temperature rises. Complication of mastitis of the newborn is often chest wall phlegmon (see. Cellulitis necrotic newborn). When a significant part of the gland melts in girls, its development can be disturbed. Sometimes there is obliteration of the ducts of the ducts, which subsequently leads to a violation of lactation.
The treatment is carried out in the hospital. Prescribed antibacterial, detoxification therapy. Local treatment depends on the stage of the inflammatory process (with infiltration - physiotherapy, with abscess - opening of an abscess with the introduction of drainage).
Prevention is to prevent infection and mechanical irritation of the mammary glands (compliance with sanitary and hygienic rules for the care of the newborn, sterile dry dressing with significant engorgement of the mammary glands).