Non-puerperal Breast Abscesses Research Articles

The challenges of diagnosis and treatment of rare Prevotella-induced breast abscesses: A retrospective cohort study

ObjectiveAlthough the genus Prevotella is part of the general human microbiota, species of this anaerobic gram-negative bacterium have been described as causes of persisting nonpuerperal breast abscesses. Collecting punctate samples and testing these samples for anaerobic bacteria is not part of the common diagnostic workflow in atypical breast abscesses. The causative anaerobic micro-organism can remain unclear and patients can be treated with multiple inadequate antibiotics and/or extensive surgical procedures. The aim of this cohort study of Prevotella induced breast abscesses is to gain more insights into the diagnostic procedures and treatment. MethodsMedical charts of patients with a Prevotella induced breast abscess between 2015 and 2021, were retrospectively reviewed on patient characteristics, diagnostic procedures, treatment and outcome. ResultsTwenty-one patients were included. Six subspecies of Prevotella were determined by culturing. High susceptibility was observed for amoxicillin/clavulanic acid (100%, n = 12). Nine patients (43%) were treated with antibiotics, eight patients (38%) with antibiotics and incision and drainage, and four patients (19%) with only incision and drainage. Recurrence was observed in nine patients (43%), of whom five patients were treated with antibiotics and three patients had surgery. The mean duration of antibiotic administration in patients with recurrence was significantly shorter compared to those without recurrence (5.6 days vs. 19.5 days, p = 0.039). ConclusionSpecific anaerobic culturing should be common practice in atypical breast abscesses to confirm Prevotella species. The high recurrence rate emphasizes the need of further research for optimal treatment. Prolonged duration of antibiotics could be considered and amoxicillin/clavulanic acid seems to be the first choice.

Female tabagism associated mastitis: a case report related to low quality cigarettes consumption in Magé, Rio de Janeiro

Objective: to report a case of periductal mastitis, whose initial presentation has been necrosis of nipple in a client of the Public Unified Health System (SUS) in the city of Magé / Rio de Janeiro. The public healthcare system client had reported prolonged use of cheap cigarettes which she used to smoke and which she could afford. Method: case report qualitative study, anchored in anamnesis and physical examination with emphasis on patient social history and pathophisiology of benign breast mastitis related to tobacco use. Result: According to anamnesis and physical examination, it is suggested that a chronic inflammatory process in breast ducts had occurred. A chronic breast inflammatory process may be linked with toxins eliminated in cigarette combustion, nevertheless an overwhelming patient social vulnerability and issues concerning self-care must be regarded by primary health care nursery. Conclusion: Quitting smoking may imply multifactorial aspects, including willpower, psychiatric and somatic disorders, poverty and little access to healthcare system in Brazil. Body care should have been emphasized concerning medical and nursing management. In Magé, mastitis diagnosis associated with tobacco use has been somewhat frequent, and recurrent non-puerperal breast abscess complicates most cases. Often, poor female patients with low self steem have consumed cheaper cigarettes, perhaps less subject to appropriate quality control.

A study on microbiological profile and risk factors of breast abscess cases attending a tertiary care hospital in Kolkata

INTRODUCTION: Primary breast abscesses occur both in the puerperal and nonpuerperal settings and affect women of all ages. Breast abscesses are a common complication of the postpartum period afflicting 9%–33% of all lactating women. Incision and drainage with postoperative antibiotic drugs has been suggested as the treatment of choice but data regarding the bacteriological profile and antibiotic susceptibility is lacking. AIMS AND OBJECTIVES: To find out the risk factors, bacteriological profile along with antibiotic susceptibility pattern of breast abscess cases. MATERIALS AND METHODS: A total of 136 breast abscess cases were studied over a period of 1 year to identify the risk factors and to isolate the organisms. RESULTS: Among 136 cases 88 (64.7%) were suffering from puerperal breast abscess whereas 48 (35.3%) patients suffered from nonpuerperal breast abscess. Staphylococcus aureus was the predominant pathogen, of which 57.35% showed methicillin resistance. Young age, primiparous, difficulty in lactation came out to be the most important risk factors for development of puerperal breast abscess whereas diabetes mellitus was the predominant risk factor for nonpuerperal breast abscess. DISCUSSION: This is the first study from India in recent past to evaluate the susceptibility patterns of bacterial isolates from breast abscesses as well as risk factors for development of breast abscesses which highlights probably the emergence of community-acquired methicillin-resistant S. aureus as a predominant pathogen of breast abscess cases.

AB200. 235. A comparative analysis of the pathophysiology of puerperal vs. nonpuerperal breast abscess

Background: Breast abscess (BA) is a poorly understood condition, with significant health and psychological sequelae. Demographic factors and best treatment practice remains controversial; although it is believed that there is a significant pathophysiological difference between puerperal breast abscess (PBA) and nonpuerperal breast abscess (NPBA). The aim of this study was to understand the characteristics of the disease population, their treatment and outcomes.

Ultrasound-guided drainage of breast abscesses: results in 151 patients

The aim of this paper is to describe the efficacy of ultrasound-guided drainage of breast abscesses with special attention to the risk of recurrence and the need for surgical treatment in a consecutive patient population. 151 patients, 89 with puerperal and 62 with non-puerperal breast abscesses, were treated with ultrasound-guided drainage, by needle or catheter under local anaesthesia. Follow-up punctures were performed at 2 or 3 day intervals until the clinical condition and ultrasound findings had improved. All patients were treated with oral antibiotics. Mammography was performed to search for underlying cancer. 86 (97%) out of 89 patients with puerperal abscesses and 50 (81%) out of 62 with non-puerperal abscesses recovered after the first round of ultrasound-guided drainage. One patient in each group had recurrence in loco but recovered after further ultrasound-guided drainage. 13 patients, 11 with non-puerperal and two with puerperal abscesses, underwent surgical excision of the abscess cavity or fistulas. Breastfeeding continued and 117 patients were treated as outpatients. The median number of follow up examinations in the ultrasound-department was four (range 1-10) for the group of patients with puerperal abscess and three (range 1-7) in the group of patients with non-puerperal abscess. The corresponding figure for the median number of punctures was for both groups one (range 1-6 and 1-4). There were no reports of newly diagnosed breast cancer in the 2 year follow-up period. This study supports the use of ultrasound-guided drainage in puerperal and non-puerperal breast abscesses. The method is less invasive than traditional surgery and has a high rate of success.

Chronic recurrent subareolar breast abscess: incidence and treatment

Abstract Background Chronic recurrent subareolar breast abscesses (SBAs) are a distinct entity of non-puerperal breast abscesses. They are located in the retroareolar or periareolar area and occur as a result of obstruction of the lactiferous ducts by squamous metaplasia. Unfamiliarity with this entity often leads to inadequate treatment, and recurrences frequently appear with extended fistulas. For this reason, the incidence of and the treatment for SBAs were analysed retrospectively. Methods In two clinics all patients with non-puerperal breast abscesses were analysed during a 6-year period. Results Some 98 patients were included (in the same period 35 patients were treated for puerperal breast abscesses). In 85 patients a total of 204 SBAs occurred (the largest study known). The remaining 13 patients had other non-puerperal breast abscesses such as cystic breast disease, inflammatory breast carcinoma and fat necrosis. If treatment of the SBA did not include excising the ductus lactiferus, the recurrence rate was 72 per cent. If the ductus lactiferus was excised, the recurrence rate was 37 per cent. Conclusion If a patient presents with a non-puerperal breast abscess in a subareolar location, the first diagnosis to consider should be (chronic recurrent) SBA. Smoking appears to be an important precipitating factor. In a recurrent SBA most frequently anaerobic micro-organisms are cultured. The primary treatment of SBA may comprise only incision and drainage. However, this should be followed by excision of the affected ductus lactiferus, including a part of the mamilla. If the affected ductus is not sufficiently excised, the SBA is destined to become a problematic chronic recurrent abscess.

Ascessual breast cancer and non-puerperal breast abscesses: Diagnosis and follow-up with mammography, B-mode and color Doppler ultrasonography

Ascessual breast cancer and non-puerperal breast abscesses: Diagnosis and follow-up with mammography, B-mode and color Doppler ultrasonography

Nonpuerperal Breast Infection

Objective: We undertook a microbiological study of purulent specimens from women with symptomatic breast abscesses. Methods: Fifty-one purulent samples were collected in 2 periods (December 1991–April 1992 and January 1994–June 1994) from nonpuerperal breast abscesses in 44 patients attending our hospital. Results: One of the most frequently isolated microorganisms was Proteus mirabilis (9 patients, 20.4%), present as a pure culture in all but 1 specimen (isolated together with Peptostreptococcus spp.). Staphylococcus aureus was isolated in 10 specimens, 6 of which were post-tumorectomy abscesses. Polymicrobial anaerobic flora were isolated in 11 specimens (21.5%); Staphylococcus epidermidis in 4 (8%); and Streptococcus milleri, Alcaligenes sp., and mixed aerobic-anaerobic flora in 1 specimen each. The 7 remaining samples (13.7%) were negative bacteriological cultures. Conclusions: We draw attention to the frequent isolation of P. mirabilis in recurrent and torpid breast abscesses in 4 women in whom surgery was necessary in addition to antibiotic treatment.

Enzymatically active Peptostreptococcus magnus: association with site of infection.

Fifty-four strains of Peptostreptococcus magnus (11 were recovered from abdominal infections, 18 were from nonpuerperal breast abscesses, and 21 were from diabetic foot infections; the type strain and three other strains were from the American Type Culture Collection, Rockville, Md.) and the type strain of Peptostreptococcus micros were tested for their ability to produce various enzymes, including catalase, hippurate hydrolase, serine dehydratase, threonine dehydratase, collagenase, gelatinase, alkaline phosphatase, and esterase C4. The data were analyzed by cluster analysis. The results showed that all but one strain could be assigned to either of two distinct, valid clusters. The first cluster of 11 strains was composed of strains that were relatively inactive, having produced one or two of the eight strain-dependent enzymes. The second was a large cluster of strains (n = 43) that were considerably more active, all having produced at least three enzymes; the vast majority of strains (89%) produced four or more enzymes. The unclustered strain produced one enzyme that was different from that produced by the strains in the first cluster. The chi 2 test of homogeneity applied to the clustering solution indicated that greater enzyme activity was significantly associated with the site of infection (P less than 0.001). The more enzymatically active P. magnus strains were recovered significantly more often from nonpuerperal breast abscesses and diabetic foot infections than they were from abdominal infections. These results may provide insight into the nature of certain polymicrobial soft tissue infections and suggest that (i) P. magnus may participate more in nonpuerperal breast and diabetic foot infections than in abdominal infections and that (ii) peptostreptococcal production of proteolytic enzymes may have an important adjunctive effect on the pathogenesis of certain soft tissue infections.

Anaerobic Pathogenesis: Collagenase Production by Peptostreptococcus magnus and Its Relationship to Site of Infection

Fifty isolates of Peptostreptococcus magnus from intraabdominal sepsis, nonpuerperal breast abscess, and diabetic foot infections were examined for collagenase activity using bovine type I collagen. Collagenase production was detected in a higher percentage of strains from nonpuerperal breast and diabetic foot specimens (P less than .001). This enzyme may be responsible for P. magnus playing a more central role in the pathogenesis of nonpuerperal breast abscess and diabetic foot disease than in intraabdominal sepsis.

Mobiluncus species and other anaerobic bacteria in non-puerperal breast abscesses

Samples of 109 breast masses were cultured aerobically and anaerobically for Mobiluncus spp. using selective and non-selective media. Two of the 103 evaluable samples were sterile and 57 (55%) yielded facultative bacteria only. The remaining 44 (43%) contained anaerobic growth alone or mixed infections. Seven (16%) of the 44 samples with anaerobes, six from women and one from a man, yielded Mobiluncus spp. Six were identified as Mobiluncus curtisii and one as Mobiluncus mulieris. There were two types of breast abscesses: one with Staphylococcus aureus predominating and one with anaerobes predominating. Most of the anaerobes belonged to the normal vaginal flora, but some were members of the normal oral flora. These results support the hypothesis that breast infections with these anaerobes result from sexual activities.

A prospective study of the microflora of nonpuerperal breast abscess.

The majority of reports concerning nonpuerperal breast abscess (NPBA) identify aerobic and facultative bacterial isolates as the predominant flora in this disease. In the present study, fine-needle aspiration was performed in 29 women with NPBA; 12 (41%) of the patients had a history of chronic NPBA. The mean age of patients was 39.2 years. The aspirated material was cultured both anaerobically and aerobically. A total of 108 bacterial strains were recovered from 32 specimens; two specimens yielded no bacterial growth. A mean of 3.6 different bacteria were recovered from each culture-positive specimen. Anaerobic recovery outweighed aerobic-facultative recovery by a factor of 2:1. Significantly, 37 strains (five aerobes and 32 anaerobes) were harvested only from enriched broth subcultured for four to 14 days after initial culture processing. Coagulase-negative staphylococci (60% of total aerobes) and peptostreptococci (47% of total anaerobes) were the predominant bacterial isolates. These findings indicate that NPBA is due to a mixed flora with a major anaerobic component. Furthermore, the results suggest that routine cultures often overlook the involvement of anaerobes in these infections.

Microbiology of non-puerperal breast abscesses.

Microbiology of non-puerperal breast abscesses.

Mobiluncus spp: pathogenic role in non-puerperal breast abscess.

Mobiluncus spp: pathogenic role in non-puerperal breast abscess.