Hi Kirsten

Welcome to Lactnet!!

Yes, I have experience of S Pyogenes infections.  When I worked in
private practice in Harare, Zimbabwe, I came across it by accident,
after having asked a doctor to test a mother's milk for Thrush.  The
lab results came back with Staphylococcus (not Strep!) Pyogenes.  It
was so unusual that the lab thought the sample had been contaminated
and requested a repeat test, which came back with the same
result.  Over the course of the next few years I learned to ask for a
milk culture or nipple swab for any of the following Sx:

- sore nipples, where the skin was damaged, pus-filled, and just
wouldn't heal in spite of good positioning and normal Tx for sore nipples
- sore nipples, where the skin was merely slightly inflamed (pink)
but where the pain was extreme and not consistent with the appearance
- breast pain, where there was no overt mastitis, but the pain went
on and on, (normally attributed to Thrush in the ducts)

Bingo!  In all these cases - I eventually "collected" about 14 in all
- the culture came back showing S Pyogenes.  I learned to expect this
diagnosis if everything else had been tried and failed.   The lab
would send back the results with a list of antibiotics to which the
organism was sensitive or resistant.  The doctor would prescribe
appropriately, and would normally offer a second, or third course of
antibiotics if the symptoms hadn't resolved.  I used to follow them
up closely and where pain persisted send the mother back to her
doctor a day _before_ the end of the antibiotic course so that there
would be no break in treatment.  I recall that yes, treatment took a
long time, but did eventually resolve and the mother would be
euphoric.  I want to take my hat off to these mothers for persisting
in breastfeeding through all this pain. Several of them seriously
contemplated quitting because it was so bad and often the doctor
wouldn't believe there was a problem at all at first because there
were no clear visible symptoms.  If this happened, I used to
recommend that the mother obtain a second opinion from another
doctor, who by then had seen it before and was happy to order the lab
work.  The labs got used to identifying S Pyogenes and treating it
became easier over time because the doctors would confer with one
another too.  One of them wanted us to write up a series of case
histories for a journal submission but of course we just didn't get
around to it.

I hope this helps.  Maybe _you_ can be the one to write up this
frustrating situation.  I was told that the organism was Staph
Pyogenes, but I've seen others describe it as Strep Pyogenes.  Maybe
that needs to be clarified too.

There may be more in the archives - I feel sure I've written to
Lactnet about this several times.

Please let us have feedback on your latest case, if you can, so that
we can all learn from it :-)

Pamela Morrison IBCLC
Rustington, Harare






Date:    Thu, 1 Oct 2009 17:18:57 +1000
From:    Kirstin Lock <[log in to unmask]>
Subject: Streptococcus pyogenes

Hi Everyone

This is the first time I have posted having been reading the emails for a
couple of months now.  It has been a fantastic read and very helpful.

We had a woman at our hospital with a streptococcus pyogenes mastitis and
cellutitis, who has been on massive doses on amoxycillin to clear it and it
is very very slowly getting better.  The Professor of Infectious Diseases
actually came up and saw her and said to me later that it can take weeks to
clear up - "we just don't know what's normal!"
I was just wondering if anyone else had encountered this.  She is
breastfeeding well now with lots of milk and baby is thriving.

Thanks in advance

Kirstin
Sydney

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