Mammary candidiasis: A medical condition without scientific evidence?

Esther Jiménez,Rebeca Arroyo,Juan M Rodríguez,María Marín,Nivia Cárdenas,Pilar Serrano,Leonides Fernández,Hauke Smidt

doi:10.1371/journal.pone.0181071

Esther Jiménez, Rebeca Arroyo + Show 6 more

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https://doi.org/10.1371/journal.pone.0181071

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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”.

Highlights

Lactation is probably the only bodily function for which modern medicine has almost no training, protocol or scientifically-acquired knowledge
The objective of this work was to elucidate the actual etiology of 529 cases of sore nipples and/or painful breastfeeding, initially diagnosed as “ductal or mammary candidiasis”, by using a great variety of microscopy techniques, as well as culture-dependent and–independent identification methods applied to milk, nipple swabs and nipple biopsy samples
Mean [95% confidence interval (CI)] concentration of yeast in milk samples obtained by manual expression was about 2.16 [1.69; 2.63] colony-forming unit (CFU)/mL while in those collected by women using a pump was about 3.84 [3.59; 4.10] CFU/mL (P

Summary

Introduction

Lactation is probably the only bodily function for which modern medicine has almost no training, protocol or scientifically-acquired knowledge. In the absence of fever or flu-like symptoms, the onset of sore burning, painful nipples or radiating or “shooting” pain into the axilla in breastfeeding women has traditionally been diagnosed and treated as “ductal or mammary candidiasis” by many physicians, midwives and lactation consultants [4,5,6,7,8,9] Such diagnosis is made in virtually all cases by visual assessment of the breast, without supporting laboratory findings and ignoring that the evidence of a potential association Candida-painful breastfeeding is largely anecdotal [10,11]. Studies directed to and systematically investigate the presence or absence of Candida cells and/or DNA in a large collection of milk samples from women with these symptoms are very scarce

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