1
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Camargo BTS, Sañudo A, Kusahara DM, Coca KP. Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations. Rev Bras Enferm 2023; 77:e20220773. [PMID: 38088688 PMCID: PMC10704699 DOI: 10.1590/0034-7167-2022-0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. METHODS a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. RESULTS 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. CONCLUSIONS assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
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Affiliation(s)
| | - Adriana Sañudo
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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2
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Bashiri A, Amiri-Farahani L, Salehiniya H, Pezaro S. Comparing the effects of breastfeeding in the laid-back and cradle position upon the experiences of primiparous women: a parallel randomized clinical trial. Trials 2023; 24:109. [PMID: 36782308 PMCID: PMC9926697 DOI: 10.1186/s13063-023-07143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND AIM Appropriate positioning is crucial to successful breastfeeding and its continuation. Positioning can create, prevent, or correct breastfeeding problems. This study aimed to determine and compare the effects of both the laid-back and cradle positions upon the breastfeeding experiences of primiparous (cisgender) women. METHODS A parallel randomized clinical trial was conducted with a sample of primiparous women (n = 168) with a gestational age of between 31 and 34 weeks, referring to the perinatal clinic of Shahid Gharazi Hospital in Malayer (Hamadan Province, Iran). Participants were recruited via convenience sampling and allocated to one of two groups: intervention (laid-back position) (n = 85) and control (cradle position) (n = 83) using the random block method. Breastfeeding education was given to both groups during two sessions (weeks 31-34 and 35--37 of pregnancy) by "baby-friendly" accredited hospitals in Iran. The intervention group was instructed on how to breastfeed using the laid-back position. The control group was instructed on how to breastfeed using the cradle position. In the immediate postnatal period, breastfeeding positions were assessed in both groups. Breastfeeding experiences were measured once at the time of participants returning home and again at both 1 week and 2 weeks following birth, using the breastfeeding experience scale. Data analysis was undertaken using the SPSS software version 21. A value of P < 0.05 was considered significant. RESULTS No statistically significant difference was observed between the two groups in terms of concerns relating to participants nor their breasts, milk insufficiency, neonate, process, or breastfeeding experience at any time point measured. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in intervention group were 26.07 (4.533), 26.85 (3.812), and 26.65 (4.632) respectively. The means (SDs) of breastfeeding experience at the time of discharge, 1 week, and 2 weeks after childbirth in control group were 25.42 (3.315), 26.68 (3.872), and 25.41 (4.05) respectively. CONCLUSION There is no difference in breastfeeding experiences whether the laid-back or cradle position is used. Thus, broader education on breastfeeding and the provision of comprehensive support may be more effective in optimizing one's experience of breastfeeding. TRIAL REGISTRATION Registration date: 2021 July 21, Code: IRCT20180427039436N10, https://irct.ir/user/trial/57054/view.
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Affiliation(s)
- Asefe Bashiri
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Nursing and Midwifery Care Research Center, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Sally Pezaro
- The University of Notre Dame, Australia and Assistant Professor, The Centre for Healthcare Research, Coventry University, Coventry, UK
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3
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Selma-Royo M, Calvo-Lerma J, Bäuerl C, Esteban-Torres M, Cabrera-Rubio R, Collado MC. Human milk microbiota: what did we learn in the last 20 years? MICROBIOME RESEARCH REPORTS 2022; 1:19. [PMID: 38046359 PMCID: PMC10688795 DOI: 10.20517/mrr.2022.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 12/05/2023]
Abstract
Human milk (HM) is the gold standard for infant nutrition during the first months of life. Beyond its nutritional components, its complex bioactive composition includes microorganisms, their metabolites, and oligosaccharides, which also contribute to gut colonization and immune system maturation. There is growing evidence of the beneficial effects of bacteria present in HM. However, current research presents limited data on the presence and functions of other organisms. The potential biological impacts on maternal and infant health outcomes, the factors contributing to milk microbes' variations, and the potential functions in the infant's gut remain unclear. This review provides a global overview of milk microbiota, what the actual knowledge is, and what the gaps and challenges are for the next years.
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Affiliation(s)
| | | | | | | | | | - Maria Carmen Collado
- Department of Biotechnology, Institute of Agrochemistry and Food Technology, Spanish National Research Council (IATA-CSIC), Valencia 46980, Spain
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4
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Cullinane M, Scofield L, Murray GL, Payne MS, Bennett CM, Garland SM, Amir LH. Random amplified polymorphic DNA analysis reveals no clear link between Staphylococcus epidermidis and acute mastitis. Aust N Z J Obstet Gynaecol 2022; 62:605-609. [PMID: 35229883 PMCID: PMC9543939 DOI: 10.1111/ajo.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mastitis is commonly experienced by breastfeeding women. While Staphylococcus aureus is usually implicated in infectious mastitis, coagulase‐negative staphylococci (CoNS) are a possible alternative pathogen. This case‐control study examined the role of CoNS in mastitis using isolates cultured from breast milk of 20 women with mastitis and 16 women without mastitis. Gene sequencing determined bacterial species, and random amplified polymorphic DNA (RAPD) analysis investigated strain‐level variation. The majority of CoNS isolates were Staphylococcus epidermidis (182/199; 91%). RAPD analysis identified 33 unique S. epidermidis profiles, with no specific profile associated with mastitis cases.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Lauren Scofield
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
| | - Gerald L Murray
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,Molecular Microbiology Group, Murdoch Children's Research Institute, Melbourne, Victoria, 3052, Australia
| | - Matthew S Payne
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Catherine M Bennett
- Institute of Health Transformation, Deakin University, Melbourne, Victoria, 3125, Australia
| | - Suzanne M Garland
- Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.,Royal Women's Hospital, Melbourne, Victoria, 3052, Australia.,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, 3052, Australia
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5
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Duale A, Singh P, Al Khodor S. Breast Milk: A Meal Worth Having. Front Nutr 2022; 8:800927. [PMID: 35155521 PMCID: PMC8826470 DOI: 10.3389/fnut.2021.800927] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
A mother is gifted with breast milk, the natural source of nutrition for her infant. In addition to the wealth of macro and micro-nutrients, human milk also contains many microorganisms, few of which originate from the mother, while others are acquired from the mouth of the infant and the surroundings. Among these microbes, the most commonly residing bacteria are Staphylococci, Streptococci, Lactobacilli and Bifidobacteria. These microorganisms initiate and help the development of the milk microbiota as well as the microbiota of the gastrointestinal tract in infants, and contribute to developing immune regulatory factors such as cytokines, growth factors, lactoferrin among others. These factors play an important role in reducing the risk of developing chronic diseases like type 2 diabetes, asthma and others later in life. In this review, we will summarize the known benefits of breastfeeding and highlight the role of the breast milk microbiota and its cross-talk with the immune system in breastfed babies during the early years of life.
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Affiliation(s)
- Anoud Duale
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
| | - Parul Singh
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Ar-Rayyan, Qatar
| | - Souhaila Al Khodor
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
- *Correspondence: Souhaila Al Khodor
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6
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Marshall J, Ross S, Buchanan P, Gavine A. Providing effective evidence based support for breastfeeding women in primary care. BMJ 2021; 375:e065927. [PMID: 34725097 DOI: 10.1136/bmj-2021-065927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Marshall
- Division of Maternal Health, University of Huddersfield, UK
| | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
| | | | - Anna Gavine
- School of Health Sciences, University of Dundee, UK
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7
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Affiliation(s)
- Lisa H Amir
- Breastfeeding Service, Royal Women's Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Victoria, Australia
| | | | - Jayne R Charlamb
- Division of Breast Health & Breastfeeding Medicine, Department of Obstetrics & Gynecology, SUNY Upstate Medical University, Syracuse, NY, USA
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8
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Moubareck CA. Human Milk Microbiota and Oligosaccharides: A Glimpse into Benefits, Diversity, and Correlations. Nutrients 2021; 13:1123. [PMID: 33805503 PMCID: PMC8067037 DOI: 10.3390/nu13041123] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Human milk represents a cornerstone for growth and development of infants, with extensive array of benefits. In addition to exceptionally nutritive and bioactive components, human milk encompasses a complex community of signature bacteria that helps establish infant gut microbiota, contributes to maturation of infant immune system, and competitively interferes with pathogens. Among bioactive constituents of milk, human milk oligosaccharides (HMOs) are particularly significant. These are non-digestible carbohydrates forming the third largest solid component in human milk. Valuable effects of HMOs include shaping intestinal microbiota, imparting antimicrobial effects, developing intestinal barrier, and modulating immune response. Moreover, recent investigations suggest correlations between HMOs and milk microbiota, with complex links possibly existing with environmental factors, genetics, geographical location, and other factors. In this review, and from a physiological and health implications perspective, milk benefits for newborns and mothers are highlighted. From a microbiological perspective, a focused insight into milk microbiota, including origins, diversity, benefits, and effect of maternal diet is presented. From a metabolic perspective, biochemical, physiological, and genetic significance of HMOs, and their probable relations to milk microbiota, are addressed. Ongoing research into mechanistic processes through which the rich biological assets of milk promote development, shaping of microbiota, and immunity is tackled.
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Affiliation(s)
- Carole Ayoub Moubareck
- College of Natural and Health Sciences, Zayed University, Dubai 19282, United Arab Emirates
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9
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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.
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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
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10
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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.
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11
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Bourdillon K, McCausland T, Jones S. Latch-related nipple pain in breastfeeding women: the impact on breastfeeding outcomes. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjom.2020.28.7.406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Nipple pain is a common issue experienced by breastfeeding mothers and if not resolved, can contribute to early cessation of breastfeeding. Aims To investigate mothers experiences of nipple pain, the solutions used to manage their issues, and the perceived impact on breastfeeding outcomes with particular focus on latch-related nipple pain with no clear underlying cause (LRNP). Methods Data was collected via an online survey of UK-based women (n=1084). Findings LRNP was the most common issue as experienced by 52% of mothers surveyed. Various solutions were utilised to try to manage LRNP. Use of Highly Purified Anhydrous (HPA) Lanolin to manage LRNP was associated with a substantial increase in breastfeeding duration (average 33.2 weeks compared to 26.5 weeks for those who didn't report using HPA Lanolin). Discussion HPA Lanolin is a key solution used by mothers in the management of latch-related nipple pain and one which they perceive as having a significant positive effect on the physical symptoms and pain associated with nipple trauma. Use of HPA Lanolin was also associated with a substantial increase in breastfeeding duration which ultimately aids women in meeting their personal breastfeeding goals and improves overall breastfeeding rates.
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Affiliation(s)
| | - Tom McCausland
- Department of innovation and NPD, Lansinoh Laboratories, Leeds
| | - Stephanie Jones
- Department of innovation and NPD, Lansinoh Laboratories, Leeds
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12
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Moossavi S, Fehr K, Derakhshani H, Sbihi H, Robertson B, Bode L, Brook J, Turvey SE, Moraes TJ, Becker AB, Mandhane PJ, Sears MR, Khafipour E, Subbarao P, Azad MB. Human milk fungi: environmental determinants and inter-kingdom associations with milk bacteria in the CHILD Cohort Study. BMC Microbiol 2020; 20:146. [PMID: 32503420 PMCID: PMC7275434 DOI: 10.1186/s12866-020-01829-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Fungi constitute an important yet frequently neglected component of the human microbiota with a possible role in health and disease. Fungi and bacteria colonise the infant gastrointestinal tract in parallel, yet most infant microbiome studies have ignored fungi. Milk is a source of diverse and viable bacteria, but few studies have assessed the diversity of fungi in human milk. Results Here we profiled mycobiota in milk from 271 mothers in the CHILD birth cohort and detected fungi in 58 (21.4%). Samples containing detectable fungi were dominated by Candida, Alternaria, and Rhodotorula, and had lower concentrations of two human milk oligosaccharides (disialyllacto-N-tetraose and lacto-N-hexaose). The presence of milk fungi was associated with multiple outdoor environmental features (city, population density, and season), maternal atopy, and early-life antibiotic exposure. In addition, despite a strong positive correlation between bacterial and fungal richness, there was a co-exclusion pattern between the most abundant fungus (Candida) and most of the core bacterial genera. Conclusion We profiled human milk mycobiota in a well-characterised cohort of mother-infant dyads and provide evidence of possible host-environment interactions in fungal inoculation. Further research is required to establish the role of breastfeeding in delivering fungi to the developing infant, and to assess the health impact of the milk microbiota in its entirety, including both bacterial and fungal components.
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Affiliation(s)
- Shirin Moossavi
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada.,Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kelsey Fehr
- Children's Hospital Research Institute of Manitoba, Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada
| | | | - Hind Sbihi
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Robertson
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, CA, USA
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence (MOMI CORE), University of California San Diego, La Jolla, CA, USA
| | - Jeffrey Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Theo J Moraes
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Allan B Becker
- Children's Hospital Research Institute of Manitoba, Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ehsan Khafipour
- Children's Hospital Research Institute of Manitoba, Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada.,Department of Animal Science, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada. .,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
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13
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Emerging Perspectives on Pain Management by Modulation of TRP Channels and ANO1. Int J Mol Sci 2019; 20:ijms20143411. [PMID: 31336748 PMCID: PMC6678529 DOI: 10.3390/ijms20143411] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022] Open
Abstract
Receptor-type ion channels are critical for detection of noxious stimuli in primary sensory neurons. Transient receptor potential (TRP) channels mediate pain sensations and promote a variety of neuronal signals that elicit secondary neural functions (such as calcitonin gene-related peptide [CGRP] secretion), which are important for physiological functions throughout the body. In this review, we focus on the involvement of TRP channels in sensing acute pain, inflammatory pain, headache, migraine, pain due to fungal infections, and osteo-inflammation. Furthermore, action potentials mediated via interactions between TRP channels and the chloride channel, anoctamin 1 (ANO1), can also generate strong pain sensations in primary sensory neurons. Thus, we also discuss mechanisms that enhance neuronal excitation and are dependent on ANO1, and consider modulation of pain sensation from the perspective of both cation and anion dynamics.
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14
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Waldman RA, Finch J, Grant-Kels JM, Whitaker-Worth D. Skin diseases of the breast and nipple: Inflammatory and infectious diseases. J Am Acad Dermatol 2019; 80:1483-1494. [PMID: 30452953 DOI: 10.1016/j.jaad.2018.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 10/27/2022]
Abstract
Certain dermatologic conditions are unique to the breast and nipple, whereas others may incidentally involve these structures. All require a nuanced approach to diagnosis and treatment because of the functional, sexual, and aesthetic importance of this area. The lactating patient requires special management because certain treatment options are contraindicated. All dermatologic conditions involving the breast and nipple require careful evaluation because malignancy of the breast can be mistaken for a benign condition or may trigger the development of certain dermatologic conditions. The second article in this continuing medical education series reviews common and uncommon inflammatory and infectious conditions of the breast and nipple and provides insight into both the diagnosis and the treatment of this heterogeneous group of diseases. For the purposes of this article, these conditions are divided into 4 distinct categories: 1) dermatitis; 2) radiation-induced changes; 3) mastitis; and 4) miscellaneous dermatologic conditions of the breast and nipple.
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Affiliation(s)
- Reid A Waldman
- University of Connecticut Health Center Dermatology Department, University of Connecticut, Farmington, Connecticut
| | - Justin Finch
- University of Connecticut Health Center Dermatology Department, University of Connecticut, Farmington, Connecticut
| | - Jane M Grant-Kels
- University of Connecticut Health Center Dermatology Department, University of Connecticut, Farmington, Connecticut
| | - Diane Whitaker-Worth
- University of Connecticut Health Center Dermatology Department, University of Connecticut, Farmington, Connecticut.
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15
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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
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16
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Lv X, Feng R, Zhai J. A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial. BMJ Open 2019; 9:e025526. [PMID: 30918032 PMCID: PMC6475339 DOI: 10.1136/bmjopen-2018-025526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Nipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast growth factor (aFGF) plays an important role in wound healing. However, current evidence on the efficacy and safety of mupirocin plus aFGF for nipple fissure and nipple pain in breastfeeding women is inconclusive due to the lack of well-designed randomised controlled trials on this topic. The purpose of this study is to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women. METHODS AND ANALYSIS This study is a randomised, double-blind, single-centre, parallel-group clinical trial. A total of 120 breastfeeding women with nipple fissure and nipple pain will be randomly assigned to either mupirocin plus aFGF group or mupirocin plus placebo group according to a computer-generated random allocation sequence. The treatment period lasts 14 days. The primary outcome is nipple pain intensity measured by the Visual Analogue Scale on day 14 during the treatment period. Secondary outcome measures include time to complete nipple pain relief, changes in the Nipple Trauma Score, time to complete healing of nipple trauma, quality of life measured by the Maternal Postpartum Quality of Life (MAPP-QOL) Questionnaire, the frequency of breast feeding, the rate of breastfeeding discontinuation, weight change in infants and adverse events. ETHICS AND DISSEMINATION The study has gained approval from the Ethics Review Committee of Tianjin Central Hospital of Gynaecology Obstetrics on 22 January 2018 (approval no. 2018KY001). We plan to publish our research findings in a peer-reviewed academic journal and disseminate these findings in international conferences. This study has been registered with the Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER ChiCTR1800017248.
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Affiliation(s)
- Xiaofang Lv
- Galactophore Department, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Rui Feng
- Galactophore Department, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jingbo Zhai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Maruyama K, Takayama Y, Sugisawa E, Yamanoi Y, Yokawa T, Kondo T, Ishibashi KI, Sahoo BR, Takemura N, Mori Y, Kanemaru H, Kumagai Y, Martino MM, Yoshioka Y, Nishijo H, Tanaka H, Sasaki A, Ohno N, Iwakura Y, Moriyama Y, Nomura M, Akira S, Tominaga M. The ATP Transporter VNUT Mediates Induction of Dectin-1-Triggered Candida Nociception. iScience 2018; 6:306-318. [PMID: 30240621 PMCID: PMC6137711 DOI: 10.1016/j.isci.2018.08.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/02/2022] Open
Abstract
Candida albicans infection can cause skin, vulvar, or oral pain. Despite the obvious algesic activity of C. albicans, the molecular mechanisms of fungal nociception remain largely unknown. Here we show that the C. albicans-specific signaling pathway led to severe mechanical allodynia. We discovered that C. albicans-derived β-glucan stimulated nociceptors depending on Dectin-1, and two pathways in inflammatory pain. The major pathway operates via the Dectin-1-mediated ATP-P2X3/P2X2/3 axis through intercellular relationships between keratinocytes and primary sensory neurons, which depends on the ATP transporter vesicular nucleotide transporter (VNUT). The other pathway operates via the Dectin-1-mediated PLC-TRPV1/TRPA1 axis in primary sensory neurons. Intriguingly, C. albicans-derived β-glucan has the ability to enhance histamine-independent pruritus, and VNUT inhibitor clodronate can be used to treat unpleasant feelings induced by β-glucan. Collectively, this is the first report to indicate that Dectin-1 and VNUT mediated innate sensory mechanisms that detect fungal infection. β-Glucan-induced pain is abolished in Dectin-1- and TRPV1/TRPA1-deficient mice β-–Glucan stimulates nociceptors via Dectin-1-PLC axis, activating neurons β-Glucan-induced allodynia is dependent on extracellular ATP and VNUT VNUT inhibitor clodronate can be used to treat β-glucan-induced allodynia
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Affiliation(s)
- Kenta Maruyama
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan.
| | - Yasunori Takayama
- Thermal Biology group, Exploratory Research Center on Life and Living Systems National Institutes of Natural Sciences, Okazaki Aichi 444-8787, Japan; Division of Cell Signaling, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi 444-8787, Japan; Department of Physiological Sciences, the Graduate University for Advanced Studies, Aichi 444-8787, Japan
| | - Erika Sugisawa
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Yu Yamanoi
- Thermal Biology group, Exploratory Research Center on Life and Living Systems National Institutes of Natural Sciences, Okazaki Aichi 444-8787, Japan; Division of Cell Signaling, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi 444-8787, Japan; Department of Physiological Sciences, the Graduate University for Advanced Studies, Aichi 444-8787, Japan; Research Laboratory, Ikedamohando Co., Ltd., 2-16-16 Iwamoto-cho, Chiyoda-ku, Tokyo 101-0032, Japan
| | - Takashi Yokawa
- BioView Corporation, 2-16-16 Iwamoto-cho, Chiyoda-ku, Tokyo 101-0032, Japan
| | - Takeshi Kondo
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Ken-Ichi Ishibashi
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Bikash Ranjan Sahoo
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Naoki Takemura
- Department of Mucosal Immunology, School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan
| | - Yuki Mori
- Laboratory of Biofunctional Imaging, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Hisashi Kanemaru
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Yutaro Kumagai
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan; Biotechnology Research Institute for Drug Discovery National Institute of Advanced Industrial Science and Technology Central 5-41, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Mikaël M Martino
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan; European Molecular Biology Laboratory Australia, Australian Regenerative Medicine Institute, Innovation Walk, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Yoshichika Yoshioka
- Laboratory of Biofunctional Imaging, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Hisao Nishijo
- System Emotional Science (Physiology), Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Hiroki Tanaka
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Atsushi Sasaki
- Research Unit/Neuroscience Sohyaku, Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, 1000, Kamoshida-cho, Aoba-ku, Yokohama 227-0033, Japan
| | - Naohito Ohno
- Laboratory for Immunopharmacology of Microbial Products, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Yoichiro Iwakura
- Research Institute for Biomedical Sciences, Tokyo University of Science, 2669 Yamazaki, Noda, Chiba 278-0022, Japan
| | - Yoshinori Moriyama
- Department of Membrane Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8530, Japan
| | - Masatoshi Nomura
- Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shizuo Akira
- Laboratory of Host Defense, Osaka University, Osaka 565-0871, Japan; WPI Immunology Frontier Research Center (IFReC), Osaka University, Osaka 565-0871, Japan
| | - Makoto Tominaga
- Thermal Biology group, Exploratory Research Center on Life and Living Systems National Institutes of Natural Sciences, Okazaki Aichi 444-8787, Japan; Division of Cell Signaling, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi 444-8787, Japan; Department of Physiological Sciences, the Graduate University for Advanced Studies, Aichi 444-8787, Japan; Institute for Environmental and Gender Specific Medicine, Juntendo University, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
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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.
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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
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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.
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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
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20
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Cullinane M, Amir LH. In Response to "Microbial Diversity in Milk of Women With Mastitis: Potential Role of Coagulase-Negative Staphylococci, Viridans Group Streptococci, and Corynebacteria". J Hum Lact 2017; 33:815-816. [PMID: 28817362 DOI: 10.1177/0890334417726058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Multiple Approaches Detect the Presence of Fungi in Human Breastmilk Samples from Healthy Mothers. Sci Rep 2017; 7:13016. [PMID: 29026146 PMCID: PMC5638952 DOI: 10.1038/s41598-017-13270-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/21/2017] [Indexed: 12/11/2022] Open
Abstract
Human breastmilk contains a variety of bacteria that are transmitted to the infant and have been suggested to contribute to gut microbiota development and immune maturation. However, the characterization of fungal organisms in milk from healthy mothers is currently unknown although their presence has been reported in the infant gut and also in milk from other mammals. Breastmilk samples from healthy lactating mothers (n = 65) within 1 month after birth were analyzed. Fungal presence was assessed by different techniques, including microscopy, growth and identification of cultured isolates, fungal load estimation by qPCR, and fungal composition using 28S rRNA gene high-throughput sequencing. In addition, milk macronutrients and human somatic cells were quantified by spectrophotometry and cytometry. qPCR data showed that 89% of samples had detectable levels of fungal DNA, at an estimated median load of 3,5 × 105 cells/ml, potentially including both viable and non-viable fungi. Using different culture media, 33 strains were isolated and identified, confirming the presence of viable fungal species. Pyrosequencing results showed that the most common genera were Malassezia (44%), followed by Candida (19%) and Saccharomyces (12%). Yeast cells were observed by fluorescence microscopy. Future work should study the origin of these fungi and their potential contribution to infant health.
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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".
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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
- * E-mail:
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24
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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.
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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.
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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
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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.
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Cullinane M, Amir LH, Donath SM, Garland SM, Tabrizi SN, Payne MS, Bennett CM. Determinants of mastitis in women in the CASTLE study: a cohort study. BMC FAMILY PRACTICE 2015; 16:181. [PMID: 26674724 PMCID: PMC4681172 DOI: 10.1186/s12875-015-0396-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/09/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mastitis is an acute, debilitating condition that occurs in approximately 20 % of breastfeeding women who experience a red, painful breast with fever. This paper describes the factors correlated with mastitis and investigates the presence of Staphylococcus aureus in women who participated in the CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study. The CASTLE study was a prospective cohort study which recruited nulliparous women in late pregnancy in two maternity hospitals in Melbourne, Australia in 2009-2011. METHODS Women completed questionnaires at recruitment and six time-points in the first eight weeks postpartum. Postpartum questionnaires asked about incidences of mastitis, nipple damage, milk supply, expressing practices and breastfeeding problems. Nasal and nipple swabs were collected from mothers and babies, as well as breast milk samples. All samples were cultured for S. aureus. "Time at risk" of mastitis was defined as days between birth and first occurrence of mastitis (for women who developed mastitis) and days between birth and the last study time-point (for women who did not develop mastitis). Risk factors for incidence of mastitis occurring during the time at risk (Incident Rate Ratios [IRR]) were investigated using a discrete version of the multivariable proportional hazards regression model. RESULTS Twenty percent (70/346) of participants developed mastitis. Women had an increased risk of developing mastitis if they reported nipple damage (IRR 2.17, 95 % CI 1.21, 3.91), over-supply of breast milk (IRR 2.60, 95 % CI 1.58, 4.29), nipple shield use (IRR 2.93, 95 % CI 1.72, 5.01) or expressing several times a day (IRR 1.64, 95 % CI 1.01, 2.68). The presence of S. aureus on the nipple (IRR 1.72, 95 % CI 1.04, 2.85) or in milk (IRR 1.78, 95 % CI 1.08, 2.92) also increased the risk of developing mastitis. CONCLUSIONS Nipple damage, over-supply of breast milk, use of nipple shields and the presence of S. aureus on the nipple or in breast milk increased the mastitis risk in our prospective cohort study sample. Reducing nipple damage may help reduce maternal breast infections.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, Australia.
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, VIC, 3000, 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.
| | - Suzanne M Garland
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, VIC, 3052, Australia. .,Women's Centre for Infectious Diseases, Royal Women's Hospital, Parkville, VIC, 3052, Australia. .,University of Melbourne Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, VIC, 3052, Australia.
| | - Matthew S Payne
- School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.
| | - Catherine M Bennett
- Centre for Population Health Research, Deakin University, Burwood, VIC, 3125, Australia.
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Payne MS, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Amir LH. Detection of Candida spp. in the vagina of a cohort of nulliparous pregnant women by culture and molecular methods: Is there an association between maternal vaginal and infant oral colonisation? Aust N Z J Obstet Gynaecol 2015; 56:179-84. [PMID: 26437337 DOI: 10.1111/ajo.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/31/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Most studies describing vaginal Candida spp. in pregnancy focus on symptomatic vaginitis, rather than asymptomatic colonisation, and solely utilise microbiological culture. The extent to which asymptomatic vaginal carriage may represent a reservoir for infant oral colonisation has been highly debated. MATERIALS AND METHODS This study formed part of the Candida and Staphylococcus Transmission Longitudinal Evaluation (CASTLE) study, in Melbourne, Australia, from 2009 to 2011 and used culture and molecular methods to examine vaginal swabs collected late in the third trimester of pregnancy for Candida spp. Oral swabs from infants were also examined using culture methods. RESULTS Overall, 80 of 356 (22%) women were positive for Candida spp; the majority being Candida albicans (83%). Candida glabrata and other Candida spp. were also identified, but in much lower numbers. Molecular analysis identified numerous positive samples not detected by culture, including 13 cases of C. albicans. In addition, some positive samples only recorded to genus level by culture were accurately identified as either C. albicans or C. glabrata following molecular analyses. Eighteen infants recorded positive Candida spp. cultures, predominantly C. albicans. However, there were only four (25%) mother/infant dyads where C. albicans was detected. CONCLUSIONS This study provides valuable data on asymptomatic colonisation rates of Candida spp. within an asymptomatic population of women late in pregnancy. The utilisation of molecular methods improved the rate of detection and provided a more accurate means for identification of non-albicans Candida spp. The low mother/infant colonisation rate suggests that non-maternal sources are likely involved in determining infant oral colonisation status.
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Affiliation(s)
- Matthew S Payne
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia.,Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,School of Women's and Infants' Health, University of Western Australia, Subiaco, Western Australia, Australia
| | - Meabh Cullinane
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sepehr N Tabrizi
- Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
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Cooklin AR, Amir LH, Jarman J, Cullinane M, Donath SM. Maternal Physical Health Symptoms in the First 8 Weeks Postpartum Among Primiparous Australian Women. Birth 2015; 42:254-60. [PMID: 26088503 DOI: 10.1111/birt.12168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe prospectively the extent, onset, and persistence of maternal physical health symptoms (cesarean delivery pain, perineal pain, back pain, constipation, hemorrhoids, urinary incontinence, bowel incontinence, and fatigue) in the first 8 weeks postpartum. METHODS A prospective cohort of 229 primiparous women was recruited antenatally from a public and a private maternity hospital, Melbourne, Australia, between 2009 and 2011. Data were collected by self-report questionnaires at weeks 1, 2, 3, 4, and 8. Main outcome measures were a checklist of maternal health symptoms and a standardized assessment of fatigue symptoms. RESULTS Birth-related pain was common at week 1 (n = 80/88, 91% cesarean delivery pain; n = 92/125, 74% perineal pain), and still present for one in five women who had a cesarean birth (n = 17, 18%) at week 8. Back pain was reported by approximately half the sample at each study interval, with 25 percent (n = 48) reporting a later onset at week 2 or beyond. Fatigue was not relieved between 4 and 8 weeks. CONCLUSIONS Women experience significant morbidity in the early weeks postpartum, the extent of which may have been underestimated in previous research relying on retrospective recall. Findings contribute to the growing body of evidence that supports early identification, treatment, and support for women's physical health problems in the postpartum.
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Affiliation(s)
- Amanda R Cooklin
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Jennifer Jarman
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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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.
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Affiliation(s)
- Lisa H Amir
- 1 Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University , Melbourne, Australia
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31
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Abstract
BACKGROUND Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage. SUBJECTS AND METHODS A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study. RESULTS After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage. CONCLUSIONS Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
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Affiliation(s)
- Miranda L Buck
- 1 Mother and Child Health Research, La Trobe University , Melbourne, Victoria, Australia
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32
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Nutrition and nurture in infancy and childhood. Abstracts of the Fourth International Interdisciplinary Conference Organized by Maternal & Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire. June 10-12, 2013. Cumbria, United Kingdom. MATERNAL & CHILD NUTRITION 2013; 9 Suppl 3:1-57. [PMID: 24152183 PMCID: PMC7158222 DOI: 10.1111/mcn.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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