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Date: | Wed, 18 Oct 2006 08:41:06 EDT |
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Candida albicans seems to rear its ugly head frequently enough that one
would think we would have a better grasp of how to diagnose and handle it. There
seems to be more questions than answers. C albicans easily colonizes
stratified squamous epithelial cells lining the gastrointestinal and genitourinary
tracks. Portions of the lining of the milk ducts are also composed of such
cells. Under the right circumstances could these also be vulnerable to fungal
invasion? Ductal infections in dairy cattle and goats has been reported with C
albicans isolated from milk samples of dairy cows with mastitis or subclinical
mastitis. Could ductal colonization or infection occur in humans when the
breast becomes susceptible through subclinical mastitis if the ductal lining is
inflamed? Opening of the tight junctions between luminal epithelial cells
from milk stasis could also increase the areas for colonization by pathogens.
Ultrasound imaging of the breasts has shown dilitation of the milk ducts
followed by narrowing and a backflow of milk that was not removed. Could this
backflow carry pathogens deeper into the smaller collecting ducts and ductules?
C albicans is capable of changing its form into filamentous forms that
readily penetrate tissues.
Finding and culturing C albicans in milk is difficult since the lactoferrin
in the milk inhibits yeast growth in vitro often resulting in false-negative
test results. A new laboratory technique uses the addition of iron to
counteract the action of lactoferrin and reduces the chances of false negative
results, providing a more accurate means of detecting and confirming the presence
of C albicans in human milk. Some of the deep breast pain and shooting or
stabbing pains that mothers describe could also be from bacterial infections.
I don't think we should dismiss the possibility of fungal invasion of milk
ducts quite yet.
Marsha Walker, RN, IBCLC
Weston, MA
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