mastitis
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Etiology
- periductal mastitis
- Staphylococcus often drug-resistant
Epidemiology
Pathology
- periductal mastitis is a chronic inflammatory breast disorder
- squamous metaplasia of the mammary ducts
- ductal obstruction
- repetitive infections
Clinical manifestations
- fever
- breast tenderness
- erythema, tenderness & a palpable fluctuant mass suggests breast abscess
Laboratory
Diagnostic procedures
- breast biopsy if inadequate response to antibiotics
- - needle aspiration or incision & drainage if breast abscess
Differential diagnosis
Management
- infections are resistant to treatment
- cephalexin or dicloxacillin for treatment of MSSA
- amoxicillin clavulanate or cefotetan for MSSA resistant to cephalexin[4]
- Bactrim better than erythromycin or amoxicillin[2]
- clindamycin for MRSA
- continue emptying breast of milk either through pumping or continued breast feeding
- probiotics (Lactobacillus) isolated from human breast milk[2]
- surgical excision of the involved ductal system
More general terms
More specific terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 19, American College of Physicians, Philadelphia 1998, 2021
- ↑ 2.0 2.1 2.2 2.3 Arroyo R et al. Treatment of infectious mastitis during lactation: Antibiotics versus oral administration of lactobacilli isolated from breast milk. Clin Infect Dis 2010 Jun 15; 50:1551. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20455694 <Internet> http://dx.doi.org/10.1086/652763
- ↑ NEJM Knowledge+ Question of the Week. Sept 11, 2018 https://knowledgeplus.nejm.org/question-of-week/945/
- ↑ 4.0 4.1 NEJM Knowledge+