Purulent mastitis: how dangerous is it?
The disease of purulent mastitis remains an urgent problem of modern surgery, despite the success achieved by medicine in the treatment of infections. The main difficulties encountered in patients with this pathology are long hospitalization, a large number of relapses of the disease and repeated cases of surgery, blood poisoning, as a severe complication of mastitis, pronounced cosmetic problems after treatment.
Content:
- Causes of the disease
- Classification and symptoms of purulent mastitis
- Diagnostics
- Purulent mastitis treatment
- Should you continue to breastfeed after treatment?
- Complications of purulent mastitis
- Prevention
Causes of the disease
This disease develops in 0.6-3.5% of women after giving birth. Approximately 50% of cases of lactational purulent mastitis occur in the first month after childbirth. Stagnation of milk in the ducts of the gland (lactostasis), lasting from 3 to 5 days, becomes a predisposing factor. The causative agent of the disease is pathogenic bacteria, in 93-95% of cases it is Staphylococcus aureus.
Infection route:
- Nosocomial infection;
- Infection in the hospital from visitors, medical staff;
- Transmission of infection from a child suffering from inflammatory diseases of the nasopharynx, pustular inflammation of the skin.
Most often, purulent mastitis develops in an organism weakened by difficult childbirth, postpartum complications, somatic diseases that a woman has.
Non-lactational purulent mastitis is much less common, its appearance does not depend on breastfeeding.
The reasons for its development:
- The consequences of injury;
- Purulent inflammatory diseases of the subcutaneous tissue (eczema, furunculosis);
- Fibrocystic mastopathy and its complications (fibroadenoma, intraductal papilloma);
- Malignant tumors of the breast;
- Implantation of synthetic materials into breast tissue;
- Tuberculous, syphilitic lesions of the breast.
The causative agents of non-lactational mastitis are a combination of an anaerobic infection with enterobacteria or Staphylococcus aureus. In 20% of cases, bacteria belonging to the Enterobacteriaceae family, P. aeruginosa, are sown.
Classification and symptoms of purulent mastitis
There are the following types of purulent inflammation of the mammary gland:
- Acute serous mastitis;
- Acute infiltrative mastitis;
- Abscessive purulent mastitis (divided into apostematous, mixed mastitis and breast abscess);
- Phlegmonous purulent mastitis;
- Necrotizing gangrenous mastitis.
Depending on the location of the inflammatory process, the following forms of purulent mastitis are distinguished:
- Subcutaneous;
- Retromammary;
- Subareolar;
- Intramammary;
- Total.
The disease begins with lactostasis - stagnation of breast milk. If stagnation lasts 3-4 days, it goes into the serous stage.
Her symptoms:
- Breast pain, heaviness;
- Body temperature rises to 38?;
- The affected breast increases in size;
- The skin over the site of inflammation turns red;
- The volume of expressed milk decreases.
Lack of treatment, reduced immunity lead to further development of the disease - the appearance of a dense infiltrate. A few days later, purulent abscessing mastitis begins.
Symptoms:
- Body temperature above 38? C;
- Deterioration of health, weakness;
- Sharp soreness in the area of infiltration;
- The seal acquires clear boundaries, its center softens.
With an infiltrative-abscessed form, many small abscesses are formed, filled with purulent contents.
With the phlegmonous form of mastitis, intoxication phenomena intensify, the temperature rises to 39 ° C. The mammary gland swells greatly, increasing in size, the skin acquires a bluish tint. Because of the swelling, the nipple is pulled into the gland.
Diagnostics
If one or more symptoms of purulent mastitis appear, you should consult a surgeon as soon as possible. After a visual examination, the doctor may prescribe an ultrasound scan - the most informative method that allows you to determine the location of the focus of purulent inflammation. Under the control of ultrasound, it is easy to perform a puncture of the affected tissues for bacteriological examination of a biopsy.
Laboratory diagnostic methods:
- General blood analysis;
- General urine analysis - ESR is increased, leukocyte formula is shifted to the right;
- Bacteriological examination of the discharge taken by puncture with a thick needle;
- Blood for sugar.
Purulent mastitis treatment
There are various approaches to the treatment of purulent mastitis - from gentle methods to radical surgical methods. In almost all cases, surgical intervention is required in the inflammation focus. In the initial stage, it is possible to introduce an antibacterial drug (penicillin) into the abscess cavity. Before manipulation, the skin of the breast is anesthetized with novocaine, then the tissues are opened and pus is removed from the cavity.
Then novocaine and an antibiotic are injected there, repeating the treatment daily.
Every day the amount of pus decreases, the temperature decreases, the intensity of pain decreases, and the state of health improves. As soon as the discharge becomes serous-bloody, we can say that the treatment was successful. Additionally, a woman is prescribed a blood transfusion.
The advantages of the method:
- The chest is almost not injured;
- It is possible to keep breastfeeding;
- There are no cosmetic defects of the breast.
A similar method of treating purulent mastitis is not used for phlegmonous and gangrenous forms of the disease. If after 3 days from the start of treatment, the woman's well-being does not improve, the temperature does not decrease, a radical surgery is performed under general anesthesia.
An incision is made towards the nipple to remove pus, then a drainage system is installed for 5-10 days to drain the purulent discharge. During this time, novocaine, antiseptics and antibiotics (Dioxidin, Furacillin, Chlorhexidine, Penicillin) are injected into the incision. After 8-10 days, the stitches are removed.
Should you continue to breastfeed after treatment?
Until the results of bacteriological examination of milk from healthy and damaged breasts are known, you should not feed your baby with breast milk. If milk has positive characteristics in a healthy breast, it can be expressed, pasteurized, and used to feed the baby (How to Express Breast Milk, How Much and How to Store?).
If mastitis takes on a severe course, complicated by relapses, breastfeeding is stopped with a medication (Dostinex, Parlodel).
Complications of purulent mastitis
The negative consequences of the disease are divided into complications of mastitis (phlegmon, gangrene, blood poisoning) and postoperative complications:
- Milk fistula;
- Inflammation of the surgical wound;
- Relapse of purulent mastitis;
- Cosmetic defect;
- Scarring and deformation of the breast.
Prevention
To prevent purulent inflammation of the mammary gland, preventive measures must be taken:
- Eat rationally and fully to maintain immunity;
- Timely take a shower, change linen;
- Wear an exactly-sized cotton bra;
- After feeding, wash the breast with warm water, leaving it open for 10-15 minutes;
- Treat cracked nipples (bepanten, solcoseryl ointment);
- Express milk without letting it stagnate.
At the slightest suspicion of the onset of inflammation in the mammary gland, you should immediately consult a doctor. In this case, it is possible to minimize the consequences of purulent mastitis as much as possible.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
