1
|
Betts RC, Johnson HM, Eglash A, Mitchell KB. It's Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain. Breastfeed Med 2021; 16:318-324. [PMID: 33305975 DOI: 10.1089/bfm.2020.0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Health care providers treating lactating women for nipple and breast pain often attribute symptoms to Candida albicans infection. However, multiple other conditions may present with pain, erythema, and pruritis. We explored the experience of a breastfeeding medicine practice that received referrals for patients failing antifungal therapy and who desired further evaluation for alternative diagnoses. Materials and Methods: We conducted a retrospective chart review of breastfeeding women referred for evaluation of "yeast" to a breast surgery/breastfeeding medicine practice from July 2016 to August 2019. Results: Twenty-five women met inclusion criteria. Median age was 33 (range 24-43) and median months postpartum was 4 (range 0.5-18). All 25 women reported minimal to no improvement on oral and/or topical antifungal therapy. In addition to history and examination, milk culture was obtained in four women, punch biopsy in one, and core needle biopsy in one. No woman was confirmed to have a diagnosis of Candida. Diagnoses were changed to the following: subacute mastitis/mammary dysbiosis (n = 8), nipple bleb (n = 6), dermatitis (n = 6), vasospasm (n = 2), milk crust (n = 1), hyperlactation (n = 1), and postpartum depression (n = 1). Treatment included discontinuation of antifungal medication, as well as the following per individual diagnoses: antibiotics and probiotics; 0.1% triamcinolone cream; heat therapy; discontinuation of exclusive pumping; and antidepressant medication and counseling referral. All women experienced resolution of symptoms following revision of diagnosis and change in management (range 2-42 days). Conclusion: While persistent nipple and breast pain in breastfeeding is often attributed to Candida, this cohort demonstrates that providers should consider multiple other conditions in their differential diagnosis. Accurate, timely diagnosis is crucial, as pain is a risk factor for premature cessation of breastfeeding. Symptomatic resolution occurs on appropriate therapy.
Collapse
Affiliation(s)
- Ryan Colton Betts
- Ridley-Tree Cancer Center, Sansum Clinic, Santa Barbara, California, USA
| | - Helen M Johnson
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Anne Eglash
- Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Katrina B Mitchell
- Breast Surgical Oncology, Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico, USA
| |
Collapse
|
2
|
Ré ACS, Martins JF, Cunha-Filho M, Gelfuso GM, Aires CP, Gratieri T. New perspectives on the topical management of recurrent candidiasis. Drug Deliv Transl Res 2021; 11:1568-1585. [PMID: 33469892 DOI: 10.1007/s13346-021-00901-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 12/24/2022]
Abstract
Candidiasis is a common opportunistic infection caused by fungi of the Candida genus that affects mainly mucocutaneous tissues (e.g., vaginal, oral, and mammary). This condition has been known for a long time; thus, innumerous topical and systemic treatments are already available on the market worldwide. Yet, recurrent superficial candidiasis (RSC) is an expected outcome, still lacking effective and convenient treatments. Although several individual conditions may contribute to disease recurrence, biofilms' presence seems to be the main etiological factor contributing to antifungal resistance. More than proposing novel antifungal agents, current research seems to be focusing on improving the pharmaceutical technology aspects of formulations to address such a challenge. These include extending and improving intimate contact of drug delivery systems with the mucocutaneous tissues, increasing drug loading dose, and enhancing topical drug permeation. This review discusses the current understanding of the RSC and the use of pharmaceutical technology tools in obtaining better results. Even though several drawbacks of conventional formulations have been circumvented with the help of nano- or microencapsulation techniques and with the use of mucoadhesive formulation excipients, many challenges remain. In particular, the need to mask the unpalatable taste of formulations for the treatment of oral candidiasis, and the necessity of formulations with a "dryer" sensorial feeling and improved performances in providing higher bioavailability for the treatment of mammary and vaginal candidiasis.
Collapse
Affiliation(s)
- Ana Carolina S Ré
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Jayanaraian F Martins
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Marcílio Cunha-Filho
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Guilherme M Gelfuso
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil
| | - Carolina P Aires
- Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil
| | - Taís Gratieri
- Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil. .,Campus Universitário Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil.
| |
Collapse
|
3
|
Douglas P. Overdiagnosis and overtreatment of nipple and breast candidiasis: A review of the relationship between diagnoses of mammary candidiasis and Candida albicans in breastfeeding women. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211031480. [PMID: 34269140 PMCID: PMC8287641 DOI: 10.1177/17455065211031480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications. AIM This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome. METHOD The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review. RESULTS There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes. DISCUSSION Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance. CONCLUSION Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
Collapse
Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Primary Care Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- The Possums Clinic, Brisbane, QLD, Australia
| |
Collapse
|
4
|
McGuinness D, Szafranska M. Candida and Breastfeeding: A Critical Commentary on the Dilemmas Around Diagnosis, Treatment, and Management. CLINICAL LACTATION 2020. [DOI: 10.1891/clinlact-d-20-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ObjectiveThe etiology of nipple pain in breastfeeding women can be challenging for healthcare professionals. The most common cause of nipple pain or damage in breastfeeding women is poor latch and positioning of the baby at the breast (Duncan, 2015). However, when position and attachment is not identified as the cause, controversy exists as to the etiology of the pain with nipple or breast thrush identified as a probable suspect.ReviewThe literature was reviewed to explore the diagnosis and management of thrush in breastfeeding women.FindingsThere is a lack of robust evidence in the literature to support an accurate diagnosis of candida as the cause of nipple and/or deep breast pain in breastfeeding women. Diagnosis and management strategies vary between the USA and Europe.ConclusionIt is important that clinicians supporting and working with breastfeeding women are aware of the differential diagnosis for both breast and nipple pain, as well as utilize their clinical skills effectively to offer the correct treatment and management to women presenting with candida like symptoms (Amir et al., 2013, Wilson-Clay & Hoover, 2017). Culture and sensitivity of mothers expressed milk may be supportive of a diagnosis; however, analysis of mothers' milk is not without its challenges. Breastfeeding women should not be treated for potential candida infection with a traditional clinical examination alone.
Collapse
|
5
|
Lebedevs T, Kendrick C. Pharmacological management of common lactation problems. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tamara Lebedevs
- Pharmacy Department Women and Newborn Health Service King Edward Memorial Hospital Perth Australia
| | - Claire Kendrick
- Pharmacy Department Women and Newborn Health Service King Edward Memorial Hospital Perth Australia
| |
Collapse
|
6
|
Kaski K, Kvist LJ. Deep breast pain during lactation: a case-control study in Sweden investigating the role of Candida albicans. Int Breastfeed J 2018; 13:21. [PMID: 29977322 PMCID: PMC5992756 DOI: 10.1186/s13006-018-0167-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background Deep breast pain during lactation, with or without accompanying nipple pain and soreness continues to be anecdotally linked to infection by Candia albicans despite lack of robust evidence in the literature that Candida albicans is the cause of women’s breast symptoms. Methods A case-control study of breastfeeding women in Sweden with (n 35) and without (n 35) symptoms that may be attributable to Candida albicans was carried out. The symptoms were radiating, burning and penetrating or non-penetrating breast pain with or without associated nipple pain during or after breastfeeding. The primary aim of the study was to test the hypothesis that breastfeeding women with symptoms commonly associated with Candida albicans infection will have a growth of Candida albicans in their breast milk significantly more often than women without these symptoms. A secondary aim was comparison of breastfeeding self-efficacy, measured by the BSES-SF (Breastfeeding Self Efficacy Scale –Short Form), between cases and controls. Results None of the women in the control group and eight of the women in the case group showed a growth of Candida albicans in their breast milk (p < 0.01), which confirms the hypothesis. There were no statistically significant differences in severity or type of symptoms between those in the case group with and without growth of Candida albicans in their breast milk. Results of the BSES-SF measurement showed no statistically significant differences between cases and controls. However, when analyses were stratified for parity, multiparous controls showed statistically significant higher scores for breastfeeding self-efficacy than multiparous cases. Conclusions Neither clinical symptoms nor microbial cultivation appear to be reliable means for making a diagnosis of Candida albicans infection of the breast. Skilled breastfeeding consultants should offer support and help with positioning, attachment and identification of physical impediments to successful breastfeeding. Professionals should be aware that it is possible that uncertainty in the breastfeeding situation may to some extent account for mothers’ breast symptoms. The ISRCTN (International Standard Randomised Controlled Trial Number) identity for this case-control study is ISRCTN88839993. The study was retrospectively registered on 30 November 2016.
Collapse
Affiliation(s)
- Kirsti Kaski
- 1Deparment for Obstetrics & Gynaecology, Helsingborg Hospital, 25187 Helsingborg, Sweden
| | - Linda J Kvist
- 2Health Sciences Centre, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| |
Collapse
|
7
|
Muddana A, Asbill DT, Jerath MR, Stuebe AM. Quantitative Sensory Testing, Antihistamines, and Beta-Blockers for Management of Persistent Breast Pain: A Case Series. Breastfeed Med 2018; 13:275-280. [PMID: 29630399 DOI: 10.1089/bfm.2017.0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is not uncommon for mothers to have persistent pain with breastfeeding beyond the first few weeks after birth. Persistent pain can be multifactorial, with neuropathic pain maintained by central sensitization being one dimension. Our knowledge in delineating categories of persistent pain is simple and not very sophisticated. METHODS We have developed and tested a Lactation Quantitative Sensory Test (L-QST) to quantify the neuropathic component of persistent breastfeeding pain. We present three case reports of neuropathic breastfeeding pain and treatment, and we discuss the potential role of histamine and catecholamines in persistent breastfeeding-associated pain. CONCLUSIONS The L-QST can be a useful tool to quantify neuropathic pain. Further studies are needed to test inter-observer reliability and reproducibility of this tool. Antihistamines can be considered for treating persistent pain in breastfeeding women with a history of allergy or atopy, and beta-blockers may be helpful in women with multiple pain disorders.
Collapse
Affiliation(s)
- Anitha Muddana
- 1 Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Diane T Asbill
- 2 Lactation Services Department, University of North Carolina Hospitals , Main Campus, North Carolina Women's Hospital, Chapel Hill, North Carolina
| | - Maya R Jerath
- 3 Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Alison M Stuebe
- 4 Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, North Carolina
| |
Collapse
|
8
|
Jiménez E, Arroyo R, Cárdenas N, Marín M, Serrano P, Fernández L, Rodríguez JM. Mammary candidiasis: A medical condition without scientific evidence? PLoS One 2017; 12:e0181071. [PMID: 28704470 PMCID: PMC5509296 DOI: 10.1371/journal.pone.0181071] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 06/26/2017] [Indexed: 01/10/2023] Open
Abstract
Many physicians, midwives and lactation consultants still believe that yeasts (particularly Candida spp.) play an important role as an agent of nipple and breast pain despite the absolute absence of scientific proofs to establish such association. In this context, the objective of this study was to investigate the microorganisms involved in sore nipples and/or painful "shooting" breastfeeding by using a variety of microscopy techniques, as well as culture-dependent and-independent identification methods. Initially, 60 women (30 diagnosed as suffering "mammary candidiasis" and 30 with no painful breastfeeding) were recruited to elucidate the role of their pumps on the milk microbial profiles. After realizing the bias introduced by using such devices, manual expression was selected as the collection method for the microbiological analysis of milk samples provided by 529 women with symptoms compatible with "mammary candidiasis". Nipple swabs and nipple biopsy samples were also collected from the participating women. Results showed that the role played by yeasts in breast and nipple pain is, if any, marginal. In contrast, our results strongly support that coagulase-negative staphylococci and streptococci (mainly from the mitis and salivarius groups) are the agents responsible for such cases. As a consequence, and following the recommendations of the US Library of Medicine for the nomenclature of infectious diseases, the term "mammary candidiasis" or "nipple thrush" should be avoided when referring to such condition and replaced by "subacute mastitis".
Collapse
Affiliation(s)
- Esther Jiménez
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Rebeca Arroyo
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Nivia Cárdenas
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - María Marín
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Pilar Serrano
- Unidadde Endocrinología y Nutrición, Hospital Virgen del Rocío, Seville, Spain
| | - Leonides Fernández
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - Juan M. Rodríguez
- Dpt. Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
9
|
Mediano P, Fernández L, Jiménez E, Arroyo R, Espinosa-Martos I, Rodríguez JM, Marín M. Microbial Diversity in Milk of Women With Mastitis: Potential Role of Coagulase-Negative Staphylococci, Viridans Group Streptococci, and Corynebacteria. J Hum Lact 2017; 33:309-318. [PMID: 28418794 DOI: 10.1177/0890334417692968] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lactational mastitis constitutes a significant cause of premature weaning. However, its etiology, linked to the presence of pathogenic microorganisms, has been scarcely reported. Research aim: The aim of this study was to describe the microbial diversity in milk samples from women suffering from lactational mastitis and to identify more accurately a collection of isolates belonging to coagulase-negative staphylococci, streptococci, and coryneform bacteria. METHODS This is a cross-sectional descriptive one-group study. A total of 5,009 isolates from 1,849 mastitis milk samples was identified by culture, biochemical, and/or molecular methods at the species or genus level. A more precise identification of a collection of 211 isolates was carried out by 16S rRNA gene sequencing. RESULTS Mean total bacterial count in milk samples was 4.11 log10 colony-forming units/ml, 95% confidence interval [4.08, 4.15]. Staphylococcus epidermidis was the most common species being isolated from 91.56% of the samples, whereas Staphylococcus aureus was detected in 29.74%. Streptococci and corynebacteria constituted the second (70.20%) and third (16.60%) most prevalent bacterial groups, respectively, found in this study. In contrast, Candida spp. was present in only 0.54% of the samples. Sequencing of the 16S rRNA gene revealed a high diversity of bacterial species among identified isolates. CONCLUSION Many coagulase-negative staphylococci, viridans group streptococci, and corynebacteria, usually dismissed as contaminant bacteria, may play an important role as etiologic agents of mastitis. Proper diagnosis of mastitis should be established after performing microbiological testing of milk based on standardized procedures. A reliable analysis must identify the mastitis-causing pathogen(s) at the species level and its(their) concentration(s).
Collapse
Affiliation(s)
- Pilar Mediano
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Leonides Fernández
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Esther Jiménez
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain.,2 Probisearch SL, Tres Cantos, Madrid, Spain
| | - Rebeca Arroyo
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain.,2 Probisearch SL, Tres Cantos, Madrid, Spain
| | - Irene Espinosa-Martos
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain.,2 Probisearch SL, Tres Cantos, Madrid, Spain
| | - Juan M Rodríguez
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - María Marín
- 1 Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
10
|
Mammary candidiasis: molecular-based detection of Candida species in human milk samples. Eur J Clin Microbiol Infect Dis 2016; 35:1309-13. [PMID: 27177753 DOI: 10.1007/s10096-016-2666-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/26/2016] [Indexed: 11/26/2022]
Abstract
In this prospective and monocentric study, we investigated the performance of a commercialized real-time polymerase chain reaction (RT-PCR) test system for the specific detection of DNA from Candida albicans, C. dubliniensis, C. glabrata, C. krusei, C. lusitaniae, C. parapsilosis, and C. tropicalis in human milk samples of patients suspicious of mammary candidiasis. For this purpose, 43 breast-feeding women with characteristic symptoms of mammary candidiasis and 40 asymptomatic controls were enrolled. By culture, Candida spp. were detected in 8.8 % (4/46) and 9.3 % (4/43) of patient and control samples, respectively. Candida albicans (2/46), C. parapsilosis (1/46), and C. guilliermondii (1/46) were present in patient samples, and C. lusitaniae (3/43) and C. guilliermondii (1/43) were present in the controls. After RT-PCR was applied, Candida spp. were found to be present in 67.4 % (31/46) and 79.1 % (34/43) of patient and control samples investigated, respectively. PCR detection of C. albicans and C. parapsilosis revealed only a low sensitivity and specificity of 67.4 % and 41.9 %, respectively. Our data do not support the use of Candida RT-PCR for sensitive and specific diagnosis of mammary candidiasis.
Collapse
|
11
|
Risk Factors Predicting Infectious Lactational Mastitis: Decision Tree Approach versus Logistic Regression Analysis. Matern Child Health J 2016; 20:1895-903. [DOI: 10.1007/s10995-016-2000-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Collapse
Affiliation(s)
- Pamela Berens
- 1 Department of Obstetrics and Gynecology, University of Texas Health Sciences Center at Houston , Houston, Texas
| | - Anne Eglash
- 2 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Michele Malloy
- 2 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Alison M Steube
- 3 Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina.,4 Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health , Chapel Hill, North Carolina
| |
Collapse
|
13
|
Baeza C. Chronic Mastitis, Mastalgia, and Breast Pain. CLINICAL LACTATION 2016. [DOI: 10.1891/2158-0782.7.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Whereas the management of acute mastitis seems clear, there is little scientific evidence to support management of chronic mastitis/breast pain. This article reviews bacteriological findings, their possible meanings, and their use in clinical settings. Clinical experience, newer and more accurate microbiological techniques, and the growing knowledge about our metagenome have many insights to offer.
Collapse
|
14
|
|
15
|
Jiménez E, de Andrés J, Manrique M, Pareja-Tobes P, Tobes R, Martínez-Blanch JF, Codoñer FM, Ramón D, Fernández L, Rodríguez JM. Metagenomic Analysis of Milk of Healthy and Mastitis-Suffering Women. J Hum Lact 2015; 31:406-15. [PMID: 25948578 DOI: 10.1177/0890334415585078] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Some studies have been conducted to assess the composition of the bacterial communities inhabiting human milk, but they did not evaluate the presence of other microorganisms, such as fungi, archaea, protozoa, or viruses. OBJECTIVE This study aimed to compare the metagenome of human milk samples provided by healthy and mastitis-suffering women. METHODS DNA was isolated from human milk samples collected from 10 healthy women and 10 women with symptoms of lactational mastitis. Shotgun libraries from total extracted DNA were constructed and the libraries were sequenced by 454 pyrosequencing. RESULTS The amount of human DNA sequences was ≥ 90% in all the samples. Among the bacterial sequences, the predominant phyla were Proteobacteria, Firmicutes, and Bacteroidetes. The healthy core microbiome included the genera Staphylococcus, Streptococcus, Bacteroides, Faecalibacterium, Ruminococcus, Lactobacillus, and Propionibacterium. At the species level, a high degree of inter-individual variability was observed among healthy women. In contrast, Staphylococcus aureus clearly dominated the microbiome in the samples from the women with acute mastitis whereas high increases in Staphylococcus epidermidis-related reads were observed in the milk of those suffering from subacute mastitis. Fungal and protozoa-related reads were identified in most of the samples, whereas Archaea reads were absent in samples from women with mastitis. Some viral-related sequence reads were also detected. CONCLUSION Human milk contains a complex microbial metagenome constituted by the genomes of bacteria, archaea, viruses, fungi, and protozoa. In mastitis cases, the milk microbiome reflects a loss of bacterial diversity and a high increase of the sequences related to the presumptive etiological agents.
Collapse
Affiliation(s)
- Esther Jiménez
- Department of Nutrition, Food Science and Technology, Complutense University of Madrid, Madrid, Spain Probisearch, Tres Cantos, Madrid, Spain
| | - Javier de Andrés
- Department of Nutrition, Food Science and Technology, Complutense University of Madrid, Madrid, Spain Probisearch, Tres Cantos, Madrid, Spain
| | | | | | | | | | | | - Daniel Ramón
- Lifesequencing S.L., Parc Científic Universitat de València, Paterna, Spain
| | - Leónides Fernández
- Department of Nutrition, Food Science and Technology, Complutense University of Madrid, Madrid, Spain Probisearch, Tres Cantos, Madrid, Spain
| | - Juan M Rodríguez
- Department of Nutrition, Food Science and Technology, Complutense University of Madrid, Madrid, Spain Probisearch, Tres Cantos, Madrid, Spain
| |
Collapse
|
16
|
Chow BDW, Reardon JR, Perry EO, Laforce-Nesbitt SS, Tucker R, Bliss JM. Expressed Breast Milk as a Predictor of Neonatal Yeast Colonization in an Intensive Care Setting. J Pediatric Infect Dis Soc 2014; 3:213-20. [PMID: 26625384 PMCID: PMC6366660 DOI: 10.1093/jpids/pit090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/27/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Yeast colonization is a predictor for invasive infection in neonates. Candida albicans and Candida parapsilosis are leading causes of invasive fungal infection (IFI) in this population. This study examines maternal breast milk as a predictor of colonization of infants with yeast. METHODS Inclusion criteria were admission longer than 72 hours to the neonatal intensive care unit and parental consent. Cultures of expressed breast milk, when available, and swabs from oral, rectal, and inguinal sites were obtained weekly for 12 weeks, or until discharge, transfer, or death. Cultures were analyzed using standard laboratory methods. Clinical information was extracted from medical records. RESULTS One hundred thirty infants were enrolled from February 2011 to November 2012. Cultures were obtained in 129 patients. The median (interquartile range [IQR]) gestational age was 34.4 weeks (33.1-37.1 weeks). The median (IQR) birth weight was 2157.5 g (1740-3060 g). No infants developed IFIs. Twenty-nine (22%) infants were colonized with yeast. Potential correlates for colonization in univariate analysis included exposure to antenatal steroids, postnatal antibiotics, and receipt of breast milk containing yeast. Potential correlates that remained after multivariable logistic regression included exposure to antenatal steroids and receipt of breast milk containing yeast. In cases in which yeast was recovered from an individual infant and from the breast milk received by that infant, there was only 30% concordance between yeast species. DISCUSSION Recovery of yeast from breast milk is associated with colonization with yeast in the neonate. Because Candida transmission via breast milk had a 30% concordance, breast milk is only one of several ways colonization occurs. Further study is needed on mechanisms of colonization.
Collapse
Affiliation(s)
- B. D. W. Chow
- Brown University, Providence, Rhode Island,Hasbro Children's Hospital, Providence, Rhode Island,Corresponding Author: Joseph M. Bliss, MD, PhD, Women & Infants Hospital,
101 Dudley St, Providence, RI 02905. E-mail:
| | | | | | - S. S. Laforce-Nesbitt
- Brown University, Providence, Rhode Island,Women & Infants Hospital of Rhode Island, Providence
| | - R. Tucker
- Brown University, Providence, Rhode Island,Women & Infants Hospital of Rhode Island, Providence
| | - J. M. Bliss
- Brown University, Providence, Rhode Island,Women & Infants Hospital of Rhode Island, Providence
| |
Collapse
|
17
|
Mediano P, Fernández L, Rodríguez JM, Marín M. Case-control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy Childbirth 2014; 14:195. [PMID: 24902596 PMCID: PMC4063223 DOI: 10.1186/1471-2393-14-195] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 05/29/2014] [Indexed: 01/30/2023] Open
Abstract
Background The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis. Methods We conducted a case–control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors. Results The variables significantly- and independently-associated with mastitis were cracked nipples (P < 0.0001), oral antibiotics during breastfeeding (P < 0.0001), breast pumps (P < 0.0001), topical antifungal medication during breastfeeding (P = 0.0009), mastitis in previous lactations (P = 0.0014), breast milk coming in later than 24 h postpartum (P = 0.0016), history of mastitis in the family (P = 0.0028), mother-infant separation longer than 24 h (P = 0.0027), cream on nipples (P = 0.0228) and throat infection (P = 0.0224). Conclusions Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.
Collapse
Affiliation(s)
| | | | | | - María Marín
- Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| |
Collapse
|
18
|
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Collapse
Affiliation(s)
- Lisa H Amir
- 1 Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University , Melbourne, Australia
| | | |
Collapse
|
19
|
Witt AM, Burgess K, Hawn TR, Zyzanski S. Role of oral antibiotics in treatment of breastfeeding women with chronic breast pain who fail conservative therapy. Breastfeed Med 2014; 9:63-72. [PMID: 24387034 PMCID: PMC3934517 DOI: 10.1089/bfm.2013.0093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48). SUBJECTS AND METHODS We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks. RESULTS Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different. CONCLUSIONS Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
Collapse
Affiliation(s)
- Ann M. Witt
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
- Senders Pediatrics, Cleveland, Ohio
| | - Kelly Burgess
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Thomas R. Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Steven Zyzanski
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
20
|
|
21
|
Witt A, Mason MJ, Burgess K, Flocke S, Zyzanski S. A case control study of bacterial species and colony count in milk of breastfeeding women with chronic pain. Breastfeed Med 2014; 9:29-34. [PMID: 23789831 PMCID: PMC3903327 DOI: 10.1089/bfm.2013.0012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND An infectious etiology for chronic breast pain in breastfeeding women continues to be debated. Although recent data suggest that Staphylococcus aureus and coagulase-negative Staphylococcus (CNS) may cause chronic breast pain, no studies have used quantitative cultures to address this question. In this study we compared bacterial species and colony counts between breastfeeding women with (cases) and without (controls) chronic pain. SUBJECTS AND METHODS We enrolled 114 breastfeeding women in a prospective cohort study. Cases (n=61), breastfeeding women with breast pain for >1 week and no signs of acute infection, were matched with controls (n=53) by weeks postpartum and parity. RESULTS More cases had a history of mastitis (14% vs. 2%, p=0.036), cracked nipples (64% vs. 17%, p=0.001), and other breastfeeding difficulties. Enterobacter species growth was less likely in cases (0% vs. 7.5%, p=0.029). Cases had a significantly higher growth of S. aureus (19.7% vs. 1.9%, p=0.003). CNS frequency was similar between groups (75% vs. 79%, p=0.626), but median colony count growth was significantly lower in cases (900 colony-forming units/mL vs. 5,000 colony-forming units/ml, p=0.003). Growth of CNS and S. aureus was negatively correlated (r=-0.265, p=0.004). CONCLUSIONS Higher S. aureus growth in cases supports a pathogenic role for S. aureus and reinforces the need for future antibiotic treatment studies in breastfeeding women with chronic pain. In contrast, similar CNS frequency between groups, lower CNS colony counts in cases, and a negative correlation between S. aureus and CNS growth suggest that neither CNS, nor its overgrowth, causes chronic breast pain.
Collapse
Affiliation(s)
- Ann Witt
- 1 Department of Family Medicine, Case Western Reserve University , Cleveland, Ohio
| | | | | | | | | |
Collapse
|
22
|
Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open 2013; 3:e002351. [PMID: 23474794 PMCID: PMC3612759 DOI: 10.1136/bmjopen-2012-002351] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/31/2013] [Accepted: 02/08/2013] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate Candida species and Staphylococcus aureus and the development of 'nipple and breast thrush' among breastfeeding women. DESIGN Prospective longitudinal cohort study. SETTING Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community. PARTICIPANTS 360 nulliparous women recruited at ≥36 weeks' gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks. MAIN OUTCOME MEASURES Case definition 'nipple and breast thrush': burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk. RESULTS Women with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.
Collapse
Affiliation(s)
- Lisa H Amir
- Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
23
|
Heller MM, Fullerton-Stone H, Murase JE. Caring for new mothers: diagnosis, management and treatment of nipple dermatitis in breastfeeding mothers. Int J Dermatol 2013; 51:1149-61. [PMID: 22994661 DOI: 10.1111/j.1365-4632.2011.05445.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breastfeeding is thought to be the most optimal form of infant nutrition. Nursing mothers are generally advised to continue breastfeeding until the infant is two years of age or beyond. Unfortunately, however, a majority of nursing mothers will discontinue breastfeeding much earlier than recommended. The most common reason for early discontinuation of breastfeeding is nipple pain. It is, therefore, essential that dermatologists know how to appropriately diagnose and effectively treat nipple pain associated with nipple dermatitis among nursing mothers. This review article provides a detailed discussion on the clinical features and management of various causes of nipple dermatitis during lactation, including problems with infant latch-on, congenital oral anomalies, plugged lactiferous ducts, atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, yeast infections, bacterial infections, herpes simplex virus, and Raynaud's phenomenon of the nipple.
Collapse
Affiliation(s)
- Misha M Heller
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | |
Collapse
|
24
|
Dennis CL, Schottle N, Hodnett E, McQueen K. An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeeding women: a randomized controlled trial. Breastfeed Med 2012; 7:473-9. [PMID: 22428572 DOI: 10.1089/bfm.2011.0121] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The negative outcomes associated with painful and damaged nipples have been widely documented in the breastfeeding literature. Numerous studies have been conducted evaluating topical preparations to treat nipple pain and damage with equivocal findings. No studies have evaluated the effectiveness of the increasingly popular all-purpose nipple ointment (APNO). The purpose of this trial is to evaluate the effect of the APNO versus lanolin on nipple pain among breastfeeding women with damaged nipples. SUBJECTS AND METHODS A double-blind, randomized controlled trial was conducted in a large single-site, tertiary-care hospital in Toronto, ON, Canada. Breastfeeding women (n=151) identified as having damage to one or both nipples were randomized to apply either APNO (intervention group) or lanolin (control group) to their nipples according to the trial protocol. The primary outcome was nipple pain at 1 week after randomization measured using the Short Form McGill Pain Questionnaire. Additional outcomes at 1 week after randomization and 12 weeks postpartum included nipple yeast symptoms and/or mastitis, rates of breastfeeding duration and exclusivity, and maternal satisfaction with infant feeding method and treatment ointment. RESULTS There were no significant group differences in mean pain scores at 1 week after randomization. Women in the lanolin group reported significantly greater satisfaction with their infant feeding method and had nonsignificantly higher breastfeeding duration and exclusivity rates at 12 weeks postpartum. CONCLUSION Results suggest that APNO is not superior to lanolin in treating painful, damaged nipples.
Collapse
Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
25
|
McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, Geddes DT. Nipple pain during breastfeeding with or without visible trauma. J Hum Lact 2012; 28:511-21. [PMID: 22689707 DOI: 10.1177/0890334412444464] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nipple pain is a major cause of early weaning. The causes of nipple pain are diverse, and most treatments involve experience-based assessment. There is little knowledge of the intensity or variation in pain experienced by breastfeeding women. Given the high breastfeeding initiation rates, it is important to evaluate pain experienced by lactating women in detail. OBJECTIVE To investigate and compare the pain experienced by breastfeeding women using objective measures. METHODS The type, effect, and severity of pain were measured using the McGill Pain Questionnaire, Brief Pain Inventory, and Visual Analogue Scale, respectively, for 2 groups of breastfeeding women. One group were experiencing persistent nipple pain despite treatment, and the other had obvious signs of nipple trauma. RESULTS Pain intensity and interference scores were highly variable for both groups. Mothers with nipple trauma reported significantly higher mean pain intensity and breastfeeding interference. Higher pain intensity scores were related to higher interference scores. After accounting for pain intensity, higher interference with general activity, mood, and sleep interference was related to longer duration of pain. There was no difference in MPQ class scores. CONCLUSIONS The ramifications of nipple pain extend far beyond the act of breastfeeding, particularly for women whose pain lasts several months. Given the lack of evidence-based treatments, it is not surprising that pain is a major contributor to premature weaning. Further research into the causes of nipple pain is necessary to enable the implementation of effective interventions, thus reducing further complications such as infection and postnatal depression. Detailed pain analysis may assist in assessing the success of these interventions.
Collapse
|
26
|
Betzold CM. Results of microbial testing exploring the etiology of deep breast pain during lactation: a systematic review and meta-analysis of nonrandomized trials. J Midwifery Womens Health 2012; 57:353-64. [PMID: 22758357 DOI: 10.1111/j.1542-2011.2011.00136.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Controversy over the etiology of deep or burning breast pain during lactation continues to persist, despite a long history of published studies and case reports. This article reviews the literature exploring the etiology of deep breast pain, summarizes the results, and identifies possible explanations for the controversies surrounding this disorder. METHODS A clinical query and a librarian-assisted search of MEDLINE were used to find articles published between 1896 and 2010. Inclusion criteria consisted of comparing microbial testing results from symptomatic and asymptomatic lactating women. Cases were restricted to those experiencing deep or burning breast pain when possible. RESULTS Prospective studies consisting of 1 unmatched case-control and 6 cohorts were found. Trials typically detected higher microbial levels in the milk or nipple(s) or both of symptomatic women, irrespective of the detection method or type and range of microbes (bacterial, yeast, or fungal) studied. Case milk samples were positively associated with finding Staphylococcus aureus (relative risk ratio [RR] 7.29; 95% confidence interval [CI], 3.25-16.36) or Candida (RR 8.45; 95% CI, 3.96-18.06). Moreover, recent reports about small-colony variants and biofilm-producing organisms may explain the atypical symptoms unique to this disorder. DISCUSSION In lactating women reporting deep breast pain, evidence consistent with infection is persistently found, and explanations exist for the disorder's atypical characteristics. Although lactating women with deep breast pain are more likely to test positive for Candida, the risk of testing positive for S aureus is also present. Thus, these women should have cultures done. Management options include treating immediately while awaiting results or waiting until results are available to guide treatment. With either approach, providers must consider the risk of falsely negative tests.
Collapse
|
27
|
Contreras GA, Rodríguez JM. Mastitis: comparative etiology and epidemiology. J Mammary Gland Biol Neoplasia 2011; 16:339-56. [PMID: 21947764 DOI: 10.1007/s10911-011-9234-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/16/2011] [Indexed: 10/17/2022] Open
Abstract
Mastitis is broadly defined as the inflammation of the mammary gland; however, the concept of mastitis is customized to address its social and clinical impact in the case of humans and the health, welfare, and economic consequences for other mammals. There are many microbial, host, and environmental factors that influence the development of mastitis. Some are common to all mammals as well as inherent to each species. Together these factors influence the most prevalent etiological agents for each species and might determine the possibility of interspecies transmission with its consequences to public health. The present review will summarize and compare reports on mastitis etiology and its epidemiology in humans and food animal species.
Collapse
Affiliation(s)
- G Andres Contreras
- Department of Large Animal Clinical Sciences, Michigan State University, D202 VMC, East Lansing, MI 48824, USA.
| | | |
Collapse
|
28
|
Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Cooklin AR, Fisher JRW, Payne MS. The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol. BMC Pregnancy Childbirth 2011; 11:54. [PMID: 21777483 PMCID: PMC3151214 DOI: 10.1186/1471-2393-11-54] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 07/22/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. To date, the organism(s) associated with the development of breast thrush have not been identified. The CASTLE study will also investigate the impact of physical health problems and breastfeeding problems on maternal psychological health in the early postpartum period. METHODS/DESIGN The CASTLE study is a longitudinal descriptive study designed to investigate the role of Staphylococcus spp (species) and Candida spp in breast pain and infection among lactating women, and to describe the transmission dynamics of S. aureus and Candida spp between mother and infant. The relationship between breastfeeding and postpartum health problems as well as maternal psychological well-being is also being investigated. A prospective cohort of four hundred nulliparous women who are at least thirty six weeks gestation pregnant are being recruited from two hospitals in Melbourne, Australia (November 2009 to June 2011). At recruitment, nasal, nipple (both breasts) and vaginal swabs are taken and participants complete a questionnaire asking about previous known staphylococcal and candidal infections. Following the birth, participants are followed-up six times: in hospital and then at home weekly until four weeks postpartum. Participants complete a questionnaire at each time points to collect information about breastfeeding problems and postpartum health problems. Nasal and nipple swabs and breast milk samples are collected from the mother. Oral and nasal swabs are collected from the baby. A telephone interview is conducted at eight weeks postpartum to collect information about postpartum health problems and breastfeeding problems, such as mastitis and nipple and breast pain. DISCUSSION This study is the first longitudinal study of the role of both staphylococcal and candidal colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida spp between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.
Collapse
Affiliation(s)
- Lisa H Amir
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
| | - Meabh Cullinane
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
- University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC 3052, Australia
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Sepehr N Tabrizi
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
- University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC 3052, Australia
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC 3052, Australia
- University of Melbourne Department of Paediatrics, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | | | | | - Jane RW Fisher
- Jean Hailes Research Unit, Monash University, Clayton, VIC 3168, Australia
- Centre for Women's Health, Gender and Society, University of Melbourne, Carlton, VIC 3053, Australia
| | - Matthew S Payne
- Mother & Child Health Research, La Trobe University, Melbourne, VIC 3000, Australia
- Women's Centre for Infectious Diseases, Bio 21 Institute, Parkville, VIC 3052, Australia
| |
Collapse
|
29
|
|