M astitis, parenchymatous infection of the mammary glands, is seen primarily in lactating women. It is estimated that 2% to 33% of lactating women develop mastitis, which is more common in primiparas. Typically, the lactation process is well established before mastitis develops; the highest incidence is seen in the second and third weeks postpartum. It can occur antepartum, but this is rare. The infection is usually unilateral, and is preceded by marked engorgement. If it is left untreated, mastitis may develop into a breast abscess.
Mastitis is usually caused by the introduction of bacteria from a crack, fissure, or abrasion through the nipple that allows the organism entry into the breast. The source of organisms is almost always the nursing infant's nose and throat; other sources include the hands of the mother or birthing personnel and maternal circulating blood. The most common bacterial organism to cause mastitis is Staphylococcus aureus; others include beta-hemolytic streptococcus, Escherichia coli, Candida albicans, and rarely, streptococcus. Community-acquired and nosocomial methicillin-resistant S. aureus have also been found to cause mastitis. The actual organism can be cultured from the milk. Common predisposing factors relate to milk stasis and include incomplete or inadequate drainage of a breast duct and alveolus that occurs as a result of missed feedings; prolonged delay in infant feeding; abrupt weaning of the infant; and blocked ducts caused by tight clothing or poor support of pendulous breasts. Other predisposing factors include a history of untreated or undertreated infections and a lowered maternal immune function caused by fatigue, stress, or other health problems.
Although mastitis can occur in both men and women, it is uncommon in nonlactating women and rare in men. Ethnicity and race have no known effects on the risk for mastitis.
HISTORY. Before breast symptoms occur, chills, fever, and tachycardia are present. Usually the infection is unilateral; localized symptoms include intense pain, tenderness, redness, and heat at the infection site. In addition, the woman often feels as if she has the flu, with symptoms of muscular aching, fatigue, headache, and continued fever.
In reviewing breastfeeding history, note if the frequency or regularity of feedings has changed. Fully investigate (1) the length of time the infant spends feeding; (2) the time between feedings; (3) if the infant is falling asleep at the breast; (4) if the infant is sleeping through the night; (5) if the infant receives supplementary water, juice, or formula; and (6) if the infant receives bottled breast milk.
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