MASTITIS

MASTIT (syn: chest) - an inflammation (predominantly one-sided) of the mammary gland. In the overwhelming majority of cases, there is a postpartum period in lactating women (lactation mastitis), sometimes in women who do not breastfeed; Rarely - in pregnant and infants (mastitis of newborns). In 90% of patients, the causative agent is Staphylococcus aureus. The most frequent entrance gates of infectious agents are nipple cracks; It is possible and intrakanalikulyarnoe penetration of pathogens of infection through the milk ducts of the gland during breastfeeding or decanting milk; The spread of infectious agents from endogenous foci is extremely rare (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: an increase in body temperature to 38-39 ° C, chills, worsening of the general condition (headache, weakness), gradually intensifying pain in the mammary gland, especially when feeding the baby or decanting milk, enlarging the gland in volume, Hyperemia of the skin, the presence of painful seals. With delayed or ineffective treatment, serous mastitis passes into infiltration within 1-3 days. At the same time, the phenomena of intoxication are increasing; Pains in the mammary gland are amplified, in which a dense sharply painful infiltrate is probed; There is an increase in axillary lymph nodes. The duration of this stage is 5-10 days. If the infiltrate does not resolve, it usually fades. Purulent mastitis is characterized by high body temperature (39 ° C or more), chills, sleep disturbances, loss of appetite, increased local symptoms of inflammation, a significant increase and deformation of the mammary gland.

Mastitis can be complicated by lymphangitis, lymphadenitis, the formation of dairy fistula (after spontaneous dissection, less often after surgery), rarely sepsis.

Diagnosis is established based on patient complaints, anamnestic information and clinical manifestations, as well as additional research data. In the blood there is leukocytosis , an increase in ESR, sometimes a decrease in hemoglobin and the number of erythrocytes. Important is the bacteriological study of breast milk, pus, and with high body temperature and chills - blood. Ultrasonic testing and thermography are also used, which allow to detect initial changes, monitor the dynamics of the process, for example, early detection of the transition of the infiltrative stage to purulent.

Treatment should be started when the first signs of the disease appear, which largely helps to prevent the development of purulent inflammation. Breastfeeding in mastitis is contraindicated because of the real threat of infection of the child, the ingestion of antibiotics and other medications used to treat the mother. With serous and infiltrative mastitis conservative treatment is carried out - antibacterial therapy is mainly based on broad-spectrum antibiotics. Apply semisynthetic penicillins (oxacillin, dicloxacillin), lincomycin or fuzidine, if necessary - broad-spectrum antibiotics, for example aminoglycosides (gentamicin, sizomycin, tobramycin), cephalosporins (cefamezin, cefuroxime); Use a combination of semisynthetic penicillins with aminoglycosides, etc. With purulent mastitis, surgical treatment is a wide opening of a purulent focus under general anesthesia. The excision of necrotic tissues is also applied, followed by drainage, application of the primary suture and washing the wound cavity with solutions of antiseptics for several days after the operation. Antibacterial and infusion therapy is carried out, antiseptic agents, immunostimulants, topical proteolytic enzymes are used; Use antihistamines, physiotherapy methods of treatment (microwave therapy, ultrasound, ultraviolet irradiation, etc.).

The prognosis with the timely begun treatment is favorable. The question of the resumption of breastfeeding after the transferred mastitis (with preserved lactation) should be solved individually, depending on the severity of the process and the results of bacteriological study of breast milk.

Prevention of postpartum mastitis is the training of women, especially primiparas, the rules of breastfeeding. Timely treatment of nipple cracks and lactostasis is necessary.

Mastitis of the newborn occurs with infection of the mammary gland during the period of sexual crisis, accompanied by ablation of the mammary glands. Pathogens (mainly staphylococci) penetrate the gland tissue mainly by contact. Often mastitis develops against the background of pyoderma. A predisposing factor is mechanical irritation of the mammary gland (for example, squeezing out secretions from it, irritation with clothing).

At the onset of the disease, one of the mammary glands, as a rule, sharply increases. The skin above it in the first day is not changed or slightly hyperemic, with palpation determined by infiltration, soreness. Soon there is a pronounced hyperemia of the skin over the affected area, with melting of the gland tissue - fluctuation. In most cases, the general condition of the child is disturbed - it sucks badly, becomes restless, body temperature rises. The complication of a newborn mastitis is often the phlegmon of the chest wall (see Phlegmon necrotic newborn). When melting a large part of the gland in girls, its development may be disrupted. Occasionally, obliteration of the lactiferous ducts occurs, which subsequently leads to a violation of lactation.

Treatment is carried out in a hospital. Assign antibacterial, detoxification therapy. Local treatment depends on the stage of the inflammatory process (with infiltration - physiotherapy, with abscessing - opening the abscess with the introduction of drainage).

Prevention is to prevent infection and mechanical irritation of the mammary glands (compliance with the sanitary and hygienic rules for the care of the newborn, sterile dry bandage with significant engorgement of the mammary glands).