The physician was correct, this is an intraductal bacterial infection. I treat 6-8 of these each month with good success with antibiotics.
She needs a breastmilk culture, these are usually due to staph epidermitis, sometimes staph aureus. The literature is now pretty clear that thrush does not grow in breastmilk cultures from women with this syndrome.
When the baby has thrush and mom is exposed, it appears there may be a biofilm situation, with the yeast somehow causing an imbalance of the staph epidermitis that is already there. That is my current theory anyway, based on Delgado's work in Spain. The theory works well for me, since treating with antibiotics seems to help resolve the pain. Fluconazole tends to help about 40%-60% of the pain.
 From my experience, these women need 6-8 weeks of antibiotics.
Good luck,
Anne

Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)



Date:    Mon, 31 Oct 2011 18:23:21 -0400
From:    Isabella Mendoza<[log in to unmask]>
Subject: new case: persistent candida?

For all of you who helped me with the "block" feeding issue with mom and terrible oversupply, I saw her today again and she is MUCH happier!  After reading all about block feeding here from all of you, and reading the 2007 journal article from IBJ, we discussed at length and she began last week.  It seems baby is much less gassy, hardly no spit-up, doesn't resist the breast, mother said baby's stool is not as "explosive".  Thank you all so much.

Now for a new one: This mother has given me permission to post.  41 year old 7 pregnancies 5 vaginal the last 2 c/s. This delivery was at 34 weeks due to severe preclamsia.  Baby in NICU for one week. On ventalator 2 days. She nursed all other children with no major issues or pain for 6 to 9 months depending on child.

Unsure whether this is actually candida:
Onset of deep, double sided, shooting pain was 8/17/2011 when baby was 2mo. At check up Dr. noticed Thrush in babys mouth however baby also had ear infection. Dr. explained that antibotic will hamper thrush treatment so he prescribed nystatin only.  Pedi Dr. also recommended mother be treated simotaneously. Mother's doctor gave her one pill of fluconazole 150mg. At follow up two weeks later, baby was given Fluconazole for one week orally.  She tried gentian violet at some point before she called me.

Initially Ob Dr. was reluctant to comply and prescribed fluconazole for 7 days at 150 mg After that ob Dr felt the pain was bacterial and  instead prescribed antibiotic for 3 days. A slight improvement for a couple of day but then the intensity of pain was so severe that she begged the Ob Dr. to prescribe 200 mg of fluconazole.  He did initially, 18 pills then an additional 14. The only improvement to report is that pain is most severe in the morning after first feeding.  Throughout the days other feeding the pain is minimal and seems to respond to ibuprofen or Tylenol.

The pain is deep in the breast and intense. Currently the right breast hurts more and requires icing.  The pain feels like burning stabbing pain as if "my breast are being pealed with a peeler".

So far I have given this mother advice to get herself and baby treated simultaneously with fluconazole (as I first saw her after the baby's diagnosis at 2 mo) for at least 14 days, even as long as 28, as Toxnet and Hale mention.  I also gave her Dr. Newman's candida protocol including the diet and APNO cream recipe to take to a compounding pharmacy.  She has not been completely compliant, as her diet is heavily yeasty and full of white-flour, and compounding pharmacies are hard to find around here.  She is now thinking about the food and other environmental recommendations.

She says she still has pain and now her fluconazole is gone.
Any other ideas?

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