Features Of Mastitis Research Articles

Malignancy mimicking mastitis

Inflammatory breast carcinoma is a rare rapidly progressive form of breast carcinoma. The nature of lesion often mimics inflammatory lesions such as mastitis which leads to the delay in diagnosis and treatment. Here, we report a case of a young lactating female patient who presented with features of mastitis. However, fine-needle aspiration cytology and further histopathological examination of the core biopsy revealed it as carcinoma. The patient was then advised neoadjuvant chemotherapy. Thus, the awareness and recognition of this rare entity, which mimic various inflammatory and nonmalignant causes, are of utmost importance.

A study on traditional practice of squeezing of breasts in newborn care among mothers in a tertiary care centre in Malda, West Bengal, India

Background: Newborn care is culturally and traditionally sensitive in every society. India is a vast country with different communities having their own traditional practices of newborn care. Squeezing of breasts in newborn period is one such unique traditional practice prevalent among population of rural background of West Bengal. This study was conducted to explore the traditional practice of squeezing of neonatal breasts and to highlight its related morbidities following the procedure among newborns.Methods: This was a descriptive, cross-sectional study conducted at triage of Special Newborn Care Unit (SNCU) of Malda Medical College and Hospital among 352 mothers who presented to us with their sick newborns following squeezing of neonatal breasts. After obtaining proper informed consent, mothers were interviewed. The data were collected using pre-designed questionnaires. Statistical analyses of the data were done using SPSS version 21.Results: In the present study, majority (33.52%) of mothers were 18-21 years old and 92.90% were Muslims. Squeezing of neonatal breasts was usually done on 10th day of life (40.34%) and on 4th day of life (27.27%). Local application following squeezing was done with hot turmeric paste (31.25%) and mustard oil (27.56%). Majority of newborns presented with features of mastitis (39.49%), 15.91% with breast abscess and 35.51% with sepsis.Conclusions: This study highlights the harmful aspects of traditional practice of breasts-squeezing among newborns prevalent in rural Bengal. This practice must be condemned by everyone through an integrated approach of proper health education and counseling of mothers and family members.

Idiopathic Granulomatous Mastitis- Challenges of Diagnosis and Treatment

Idiopathic Granulomatous Mastitis (IGM) is a benign breast disease. Owing to its unknown aetiology, rareness,variation of presentation - diagnosis and treatment is still a challenge. This is a retrospective review of clinical presentation and investigation finding of all patients histopathologically diagnosed as IGM from February 2010 to January 2014. Treatment outcome and follow up information were recorded. 6(42%) patient presented with breast abscess, 5(35.7%) patient had features of mastitis without abscess, 3(21.4%) patient had painful firm to hard lump. Diagnosis confirmed by excisional/ incisional biopsy. 9(64%) patients needed more than one surgical intervention. Mean follow up period was 27months. Standardization and optimization of treatment is yet to be achieved.Medicine Today 2016 Vol.28(1): 14-16

Radiological features of mastitis

Objective To describe the radiological features of mastitis. Methods Imaging findings were retrospectively reviewed in 58 women with mastitis,which was confirmed by pathological results.The imaging features were described according to the BI-RADS (breast imaging reporting and data system).All 58 patients had preoperative MRI,while 49 of them were examined with sonograms and 30 with mammograms preoperatively. Results Overall,no remarkable findings were reported on 6 mammography and 2 sonography examinations,but all 58 lesions were identified on MRI in our study.Asymmetrical density (n=16,53.3%) on mammograms and solitary or multiple separated/contiguous hypoechoic mass-like lesions (n=34,69.4%) on ultrasound were the most common signs of mastitis.On enhanced MR images,82.8% (48/58) patients showed non-mass-like enhanced lesions.Multiple,regional enhancement (66.7%,32/48) and separated or contiguous,clumped,rim-like enhancement (63.1%,31/48) were the most common manifestations in non-masslike enhanced lesions.Of the 58 patients,typeⅠand typeⅡtime-signal intensity curve were detected in 48.3% and 50.0% of the patients,respectively.BI-RADS 0 had the highest frequency in reports on mammography (33.3%,10/30),while category 4a was most frequent on sonography (36.7%,18/49) and also on MRI (56.9%,33/58). Conclusion The imaging findings from mammography and US are non-specific for mastitis,therefore,MR can be helpful in the diagnosis,especially in the presence of non-mass-like enhancement that are multiple,regional,separated,or contiguous,clumped,and rim-like. Key words: Mastitis; Mammography; Ultrasonography,mammary; Magnetic resonance imaging

Neonatal Mastitis: A Clinico-Microbiological Study

OBJECTIVE: Neonatal breast hypertrophy is a common phenomenon in term infants, superadded infection can lead to mastitis and that can progress to breast abscess with short and long term detrimental effects. Our effort is to study the prevalence, risk factors, the current microbial profile and sensitivity pattern in these infections in order to suggest an optimal treatment plan for these patients. DESIGN: Case series. SETTING: Hospital based study conducted in Kashmir on the native population. DURATION: 2011 to 2013. MATERIALS AND METHODS: 32 neonates with features of mastitis or abscess were included in the study. Demographic and clinical data, laboratory work-up were recorded for all these patients in a patient form. Gram stain of the purulent nipple discharge or pus obtained on drainage was done and the specimens were culture plated. Antibiotic sensitivity was determined by disk diffusion and categorized by current Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: Most babies were full term, the age range was 6-48 days. Peak incidence for mastitis was in the 2nd week and for abscess in the 4th week. The ratio of male: female was 1:2 in the entire group, there was greater preponderance of female involvement with increasing age. Massage for expression of secretions a common practice in the study population had been done in 15 patients, especially in male babies. The babies were generally well and associated skin pustulosis was common. Laboratory workup showed polymorphonuclear leucocytosis and CRP positivity. Gram staining showed gram positive cocci in 13 patients and gram negative rods in 1 patient. Culture revealed Staphylococcus aureus in 18, E.col in 2, klebsiella in 1 patient and was sterile in 2 patients. Most strains of Staphylococcus aureus were resistant to macrolides and penicillins. Fifteen were methicillin sensitive and 3 were resistant but were sensitive to amikacin, ofloxacin and vancomycin. Gram negative rods were sensitive to, aminoglycosides, chloramphenicol, quinolones, piperacillin-tazobactum and cefoperazone-sulbactum, but were resistant to cephalosporins including third generation cephalosporins. Treatment with oral antibiotic was not successful. Patients responded well to open drainage via a stab incision away from the breast mound; 4 patients were managed by repeated needle aspirations. IV antibiotics were prescribed in all patients for 2-5 days, followed by oral continuation therapy of 7-14 days. CONCLUSIONS: From our study, we can conclude that parental counseling to avoid massage, and early treatment for pustulosis is important to prevent mastitis. Intravenous antibiotics should be used for this condition guided by gram stain or culture sensitivity once available. Empirically a drug with good anti-staph cover may be instituted till appropriate reports are available. Incision drainage gives uniformly good results, though; multiple sittings of needle drainage may obviate the need for incision drainage. Therapy can be shifted to oral drugs once clinical improvement is seen.

Neonatal mastitis: a clinico-microbiological study.

Neonatal breast hypertrophy is a common phenomenon in term infants, superadded infection can lead to mastitis and that can progress to breast abscess with short and long term detrimental effects. Our effort is to study the prevalence, risk factors, the current microbial profile and sensitivity pattern in these infections in order to suggest an optimal treatment plan for these patients. Case series. Hospital based study conducted in Kashmir on the native population. 2011 to 2013. 32 neonates with features of mastitis or abscess were included in the study. Demographic and clinical data, laboratory work-up were recorded for all these patients in a patient form. Gram stain of the purulent nipple discharge or pus obtained on drainage was done and the specimens were culture plated. Antibiotic sensitivity was determined by disk diffusion and categorized by current Clinical and Laboratory Standards Institute (CLSI) guidelines. Most babies were full term, the age range was 6-48 days. Peak incidence for mastitis was in the 2nd week and for abscess in the 4th week. The ratio of male: female was 1:2 in the entire group, there was greater preponderance of female involvement with increasing age. Massage for expression of secretions a common practice in the study population had been done in 15 patients, especially in male babies. The babies were generally well and associated skin pustulosis was common. Laboratory workup showed polymorphonuclear leucocytosis and CRP positivity. Gram staining showed gram positive cocci in 13 patients and gram negative rods in 1 patient. Culture revealed Staphylococcus aureus in 18, E.col in 2, klebsiella in 1 patient and was sterile in 2 patients. Most strains of Staphylococcus aureus were resistant to macrolides and penicillins. Fifteen were methicillin sensitive and 3 were resistant but were sensitive to amikacin, ofloxacin and vancomycin. Gram negative rods were sensitive to, aminoglycosides, chloramphenicol, quinolones, piperacillin-tazobactum and cefoperazone-sulbactum, but were resistant to cephalosporins including third generation cephalosporins. Treatment with oral antibiotic was not successful. Patients responded well to open drainage via a stab incision away from the breast mound; 4 patients were managed by repeated needle aspirations. IV antibiotics were prescribed in all patients for 2-5 days, followed by oral continuation therapy of 7-14 days. From our study, we can conclude that parental counseling to avoid massage, and early treatment for pustulosis is important to prevent mastitis. Intravenous antibiotics should be used for this condition guided by gram stain or culture sensitivity once available. Empirically a drug with good anti-staph cover may be instituted till appropriate reports are available. Incision drainage gives uniformly good results, though; multiple sittings of needle drainage may obviate the need for incision drainage. Therapy can be shifted to oral drugs once clinical improvement is seen.

Recurrent Late-Onset Group B Streptococcus Sepsis in a Preterm Infant Acquired by Expressed Breastmilk Transmission: A Case Report

Group B Streptococcus is a known cause of neonatal sepsis, being more common in the early period by maternal genital tract transmission and less so in the late neonatal period, ascribed to intestinal colonization or horizontal transmission. Although breastmilk transmission of Group B Streptococcus has rarely been reported in the past, most cases are of patients nursed on the mother's breast and less commonly in expressed breastmilk-fed infants. This case describes a preterm infant (born at a gestational age of 24 weeks 6 days) in the neonatal intensive care unit who acquired recurrent late-onset sepsis with Group B Streptococcus with the mother's expressed breastmilk culture growing the same organism that was later matched to the infant's isolate. The mother had presented with features of mastitis only during the second episode of sepsis and was then treated with oral antibiotics. The infant was fed on formula feeds after the second incidence and remained healthy, being discharged on a regular follow-up plan at 39 weeks corrected gestational age.

Die Bedeutung der Mammographie in der Diagnostik und Therapie einer nicht puerperalen Mastitis

Circumscribed or diffuse non-puerperal mastitis is usually associated with local signs of inflammation. In two-thirds of these cases it is possible to demonstrate the radiological features of mastitis. Mammography is an important diagnostic procedure in the demonstration of acute mastitis and its differentiation from an inflammatory carcinoma; it is also valuable in the control of treatment. The success of intensive antibiotic therapy with recovery of normal appearances in the chest can be observed objectively by mammography. In distinguishing mastitis from an inflammatory carcinoma, radiological evidence of regression under the influence of antibiotics is evidence in favour of mastitis.