MASTITIS (syn: breast) - inflammation (mainly unilateral) of the mammary gland. In the vast majority of cases, it is observed in the postpartum period in nursing women (lactational mastitis), sometimes in women who do not breast-feed a baby; rarely in pregnant and infants (mastitis of the newborn). In 90% of patients, Staphylococcus aureus is the causative agent. The most common entrance gates of infection pathogens are nipple cracks; intracanalicular penetration of pathogens through the mammary ducts of the gland during breastfeeding or expressing milk is also possible; extremely rare is the spread of pathogens from endogenous foci (hematogenous and lymphogenous pathways). An important factor contributing to the onset and development of mastitis is lactostasis (engorgement of the mammary glands).
Clinical signs of serous (incipient) mastitis: fever up to 38 - 39 ° C, chills, worsening of the general condition (headache, weakness), gradually increasing pain in the mammary gland, especially when feeding a baby or expressing milk, enlarged gland in volume, flushing of the skin, the presence of painful seals. With a delayed or ineffective treatment, serous mastitis becomes infiltrative within 1-3 days. At the same time, intoxication phenomena are increasing; intensifies pain in the mammary gland, in which a dense, sharply painful infiltrate is felt; an increase in axillary lymph nodes is noted. The duration of this stage is 5-10 days. If the infiltrate does not resolve, suppuration usually occurs. Purulent mastitis is characterized by high body temperature (39 ° C or more), chills, sleep disturbance, 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 milk fistulas (after spontaneous opening, less often after surgery), rarely sepsis.
The diagnosis is established on the basis of complaints from the patient, medical history and clinical manifestations, as well as data from additional studies. Leukocytosis , an increase in ESR, and sometimes a decrease in hemoglobin and the number of red blood cells are found in the blood. Bacteriological examination of breast milk, pus, and blood at high body temperature and chills is important. Ultrasound and thermography are also used, which allow you 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 begin when the first signs of the disease appear, which greatly contributes to preventing the development of purulent inflammation. Breastfeeding with mastitis is contraindicated due to the real threat of infection of the child, the intake of antibiotics and other medications used to treat the mother in his body. With serous and infiltrative mastitis, conservative treatment is carried out - antibiotic therapy is mainly with broad-spectrum antibiotics. Semisynthetic penicillins (oxacillin, dicloxacillin), lincomycin or fusidine are used , if necessary, broad-spectrum antibiotics, for example aminoglycosides (gentamicin, sisomycin, tobramycin), cephalosporins (cefamezin, cefuroxime); use a combination of semi-synthetic penicillins with aminoglycosides, etc. With purulent mastitis, surgical treatment is a wide opening of the purulent focus under general anesthesia. Also used is the excision of necrotic tissue, followed by drainage, the application of the primary suture and washing the wound cavity with antiseptic solutions for several days after the operation. They carry out antibacterial and infusion therapy, use antiseptic agents, immunostimulants, and local proteolytic enzymes; use antihistamines, physiotherapeutic methods of treatment (microwave therapy, ultrasound, ultraviolet radiation, etc.).
The prognosis for timely treatment is favorable. The issue of resuming breastfeeding after mastitis (with continued lactation) should be decided individually, depending on the severity of the process and the results of bacteriological examination of breast milk.
Prevention of postpartum mastitis is to educate women, especially primiparous, on 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 breast cutting. Pathogens (mainly staphylococci) penetrate into 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 a secret from it, irritation with clothing).
At the beginning of the disease, as a rule, one of the mammary glands increases sharply. The skin over it on the 1st day is not changed or slightly hyperemic, with palpation, infiltration, pain are determined. Soon there is a pronounced hyperemia of the skin over the affected area, with the melting of the gland tissue - fluctuation. In most cases, the general condition of the child is disturbed - he sucks poorly, becomes restless, and body temperature rises. A complication of mastitis in a newborn is often phlegmon of the chest wall (see Phlegmon necrotic newborn). When girls melt a significant part of the gland, its development may be impaired. Sometimes there is obliteration of the milky ducts, which subsequently leads to a violation of lactation.
Treatment is carried out in a hospital. Prescribe antibacterial, detoxification therapy. Local treatment depends on the stage of the inflammatory process (with infiltration - physiotherapy, with abscess formation - opening the 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 caring for the newborn, sterile dry dressing with significant engorgement of the mammary glands).