Kika, indeed subacute and subclinical mastitis have definitions all over
the place with many contradicting each other! Even the same authors change
definitions of subacute mastitis in subsequent papers. We could look at the
different pathogens that are associated with subacute and acute mastitis
(S. aureus with acute mastitis and S. epidermidis and Strep viridans with
subacute mastitis). S. aureus produces toxins that lead to a strong
inflammatory response, are rapidly absorbed into systemic circulation, and
lead to the flu-like symptoms. Bacteria responsible for subacute mastitis
to not produce toxins but form thick biofilms in the ducts, impeding milk
flow through the ducts, and leading to needle-like pain from pressure on
the inflamed lumen. We could also look at changes in the milk
microenvironment with an elevated Na/K ratio and an increase in
inflammatory markers. One study showed that up to 25% of breastmilk samples
collected during the first month postpartum and 10% thereafter presented
with biological features of subacute mastitis (Tuaillon et al. Pediatr Res
2017;81:556-564. So I guess that we could look at what we see clinically,
delve into what has been published and come up with acute mastitis as
showing breast redness, fever, pain, and malaise and subacute mastitis
possibly showing erythema, burning sensation, sharp needling pain,
bacterial culprit, and changes in the milk microenvironment. We also have a
growing number of papers exploring the use of specific probiotic strains
that may be useful, especially during the subacute phase to help restore a
better breast microbiome that can fight off pathogenic invaders more
effectively.

Marsha Walker, RN, IBCLC
Weston, MA

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