Mastitis

Mastitis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Inflammation, often accompanied by infection, of the breast tissue resulting in pain, erythema, and edema
  • Lactational, most common—due to prolonged engorgement or poor drainage of milk
  • Nonlactational, less common—due to inflammation of subareolar ducts (periductal mastitis) or idiopathic granulomatous lobar mastitis
  • Often with systemic symptoms including:
    • Malaise
    • Fever
  • Incidence may be as high as 20% in lactating women
  • Onset typically 1–6 wk postpartum
  • Complications:
    • Cessation of breastfeeding (most common)
    • Recurrence
    • Abscess (up to 3% of cases)
    • Sepsis
    • Necrotizing fasciitis
    • Cutaneous fistula
    • Long lasting decrease in milk production

Pediatric Considerations
Can occur in infants, typically those <2 mo of age

Etiology

  • Staphylococcus aureus most common
  • Less common causes:
    • Coagulase-negative Staphylococcus
    • Streptococcus spp.
    • Escherichia coli
    • Haemophilus influenzae
    • Candida albicans
  • Risk factors:
    • Lactational
      • Nipple trauma
      • Poor infant latch
      • Local milk stasis
      • Poor maternal nutrition
      • Previous mastitis
      • Primiparity
      • Use of a breast pump
      • Advanced maternal age
      • Maternal diabetes
      • Maternal use of antibiotics
    • Nonlactational
      • Breaks in the skin barrier
      • IV drug use
      • Cigarette smoking
      • Trauma
      • Eczema or other dermatologic conditions
      • Systemic diseases

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Basics

Description

  • Inflammation, often accompanied by infection, of the breast tissue resulting in pain, erythema, and edema
  • Lactational, most common—due to prolonged engorgement or poor drainage of milk
  • Nonlactational, less common—due to inflammation of subareolar ducts (periductal mastitis) or idiopathic granulomatous lobar mastitis
  • Often with systemic symptoms including:
    • Malaise
    • Fever
  • Incidence may be as high as 20% in lactating women
  • Onset typically 1–6 wk postpartum
  • Complications:
    • Cessation of breastfeeding (most common)
    • Recurrence
    • Abscess (up to 3% of cases)
    • Sepsis
    • Necrotizing fasciitis
    • Cutaneous fistula
    • Long lasting decrease in milk production

Pediatric Considerations
Can occur in infants, typically those <2 mo of age

Etiology

  • Staphylococcus aureus most common
  • Less common causes:
    • Coagulase-negative Staphylococcus
    • Streptococcus spp.
    • Escherichia coli
    • Haemophilus influenzae
    • Candida albicans
  • Risk factors:
    • Lactational
      • Nipple trauma
      • Poor infant latch
      • Local milk stasis
      • Poor maternal nutrition
      • Previous mastitis
      • Primiparity
      • Use of a breast pump
      • Advanced maternal age
      • Maternal diabetes
      • Maternal use of antibiotics
    • Nonlactational
      • Breaks in the skin barrier
      • IV drug use
      • Cigarette smoking
      • Trauma
      • Eczema or other dermatologic conditions
      • Systemic diseases

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