Hi wise people of the list,
I am trying to get things straight about mastitis, but there are several
places where I keep getting stuck. I will set it out for you and I´d love
to read what you all think...
1. ACUTE MASTITIS
(what we usually refer to when we simply say mastitis): the "typical"
mastitis, red and/or painful area of the breast, accompanied by fever and
flu-like symptoms. The revised ABM protocol is very clear about its
diagnosis and treatment. However, I have a question. There is a 2010 study
by a Spanish group in Clin Infect Dis.
<http://www.ncbi.nlm.nih.gov/pubmed/?term=lactocillus+fermentum+and+mastitis>
2010
Jun 15;50(12):1551-8* Arroyo et al Treatment of infectious mastitis during
lactation: antibiotics versus oral administration of Lactobacilli isolated
from breast milk*
<http://www.ncbi.nlm.nih.gov/pubmed?term=Arroyo%20R%5BAuthor%5D&cauthor=true&cauthor_uid=20455694>
done with 352 women, in which the authors state "In conclusion, the results
obtained in this study suggest that L. salivarius and L. fermentum can be
used as an effective alternative to antibiotics for the treatment of
mastitis". This same group of investigators has several other papers with
similar conclusions, although the study groups are smaller.
QUESTION 1: Do any of you know if these studies have been replicated by any
other groups? Do any of you have serious experience using lactobacilli for
the actual TREATMENT of acute mastitis, instead of antibiotics?
2. SUBCLINICAL MASTITIS
Subclinical mastitis, defined as raised milk sodium/potassium (Na/K) in the
absence of clinical symptoms. Therefore, I would not know one of my clients
has subclinical mastitis unless I did a milk analysis. When would I do
this, if ever? I´ve read it is associated with poor infant weight gain and
increased risk of mother-to-child HIV transmission. I have no HIV mothers
in my practice.
QUESTION 2: Would subclinical mastitis be a cause of FTT in the child of a
healthy mother? Should I be looking out for it?
3. SUBACUTE MASTITIS
The term subacute mastitis I have only found referring to bovine mastits
EXCEPT in papers written by Arroyo et al (the Spanish lactobacilli group).
They say "subacute mastitis in lactating women is caused by
coagulase-negative
*Staphylococcus* *(epidermidis)*, *Streptococcus* *viridans/mitis and some
species of* *Corynebacterium*. These women have local pain, more or less
intense, like stabbing needles, cramps or burning, with no visible
inflamation and no systemic symptoms. They do not state how long "subacute"
means... I undestand it´s longer than acute and shorter than chronic, but
they define no timeline.
They then go on to state that subacute mastitis should be treated with
lactobacilli. They also state that there are two clinical trials that back
up this statemnt; the clinical trials are their own, and the women enrolled
in those two clinical trials had acute mastitis symptoms.
Carrera M, Arroyo R et al Lactancia materna y mastitis. Tratamiento
empírico basado en la sintomatología y los agentes etiológicos. Acta
Pediatr Esp. 2012;70(6):255-61.
Subacute mastitis has become an epidemic in Spain. Every woman with
shooting pains is receiving (or rather, spending money on) lactobacilli.
With or without previous milk culture, and usually almost always regarless
of the result of the culture.
QUESTION 3: does subacute mastitis of the lactating breast exist in any
country besides Spain?
4. CHRONIC MASTITIS
In the literature, it is usually not associated to lactation but to other,
systemic causes in the non-lactating woman. However, in Spain the term
chronic mastitis is sadly used when referring to chronic breast pain, or
chronic mastalgia. This is terrible because by adding the "mastitis"
suffix, healthcare professionlas will think infection every time, when they
should be keeping their minds also open for non-infections causes of
chronic mastalgia.
5. CHRONIC BREAST PAIN
Here is one of my main battles right now. Opening other healthcare workers´
minds to new ideas about the etiology of chronic mastalgia. It used to be
all candidosis to be treated with diflucan. According to Arroyo et al, it´s
all S epidermidis to be treated with lactobacilli. According to Witt et al
(Breastfeeding Med vol 9 nº1 2014), it is S aureus... But I am soooo tired
of having moms come to the clinic with continued mastalgia after two months
of probiotics and several rounds of ciprofloxacin. Nobody checks baby´s
latch, nobody checks mom´s position, her chest, neck and back muscles,
nobody gives her emotional support...
QUESTION 4: does anyone have a nice protocol for the diagnosis and
management of chronic breast pain that I can translate and pass around in
this country of mine? Anne Englash? Lisa Amir?
Thank you for your patience.
Kika
--
Carmela Baeza, IBCLC, MD
www.centroraices.com
http://www.facebook.com/Consulta.Lactancia.Raices
<http://www.facebook.com/pages/Centro-de-Atenci%C3%B3n-a-la-Familia-Ra%C3%ADces/274415189309122>
Autora de "Amar con los Brazos Abiertos"
http://www.amazon.es/Amar-con-los-brazos-abiertos/dp/8426904688/ref=sr_1_1?s=books&ie=UTF8&qid=1420813499&sr=1-1&keywords=amar+con+los+brazos+abiertos
<http://www.ediciones-encuentro.es/libro/amar-con-los-brazos-abiertos.html>
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