I thought I would chime in on this conversation. I have been using the term mammary dysbiosis rather than subacute mastitis. We have many microbial communities in our bodies, and often we end up with dysbiosis in those regions, such as bacterial vaginosis of the vagina, traveler's diarrhea as a manifestation of gut dysbiosis. Diverticulitis is also created from a dysbiosis of the gut, in the setting of diverticuli.

Chronic bronchitis and chronic sinusitis are also syndromes that are due to dysbiosis.

Like Marsha Walker explained, the dairy industry is extremely vigilant regarding subacute mastitis, described as 'high somatic cell counts'. If the somatic cell counts are high, the milk is considered poorer quality and it is not worth as much per lb of milk.

As a Wisconsinite, many of my office staff and patients are farmers, so we talk about the similarities between cows and humans often. This syndrome of  mammary dysbiosis has also been documented in goats, pigs, mice, etc.

I have been treating this for years. I think exposure to candida in the baby's mouth triggers this, and I find that women who take fluconazole for these symptoms of burning/sharp/deep pain etc can improve about 40-80%. When I do milk cultures on women who have been on fluconazole, they lack the normal coagulase neg staph that should be present. I think fluconazole works because it is antibacterial. The vast majority of women will grow coag neg staph, it is a commensal organism in the breastmilk, but it is also the pathogen I treat when pain is not resolving with all other typical measures.

I virtually never grow out yeast in women who have never been on antifungals. Yeast is an easy organism to grow. The Castle study had to use molecular techniques rather than simple cultures to find yeast. I don’t' have any trouble culturing yeast from all other parts of the body, and I don't find it in breastmilk, so I really don't think it is there.

The other issue regarding the Castle study is that one goal was to determine if breast pain is due to staph aureus vs candida. I would say neither, it is due to most often due to coag neg staph, that has changed its behavior to become a biofilm former (the white film seen on the nipples of women with lots of pain). That is my most common finding, and clinically, when I treat it, the pain resolves.

I have never found probiotics to be effective for breast pain or mastitis. Because of the cost, I no longer have mothers purchase lactobacillus salivarius or lactobacillus fermentum. More recent studies do NOT show that oral probiotics populate breastmilk.  Perhaps at some point in the future we can figure out a way to alter the population of probiotics in breastmilk.  Right now I don't think we have an answer with current products available in the USA, that I am aware of.



Anne 





Anne Eglash MD, IBCLC, FABM

Clinical Professor, Department of Family and Community Medicine

University of Wisconsin School of Medicine and Public Health

Medical Director, UW Lactation Services

Medical Director, Mothers Milk Bank of the Western Great Lakes

Founder and President of The Milk Mob, dedicated to building Breastfeeding Knowledgeable Medical Systems and Communities http://www.themilkmob.org













Date:    Wed, 28 Mar 2018 09:26:44 -0400

From:    Marsha Walker <[log in to unmask]>

Subject: Subacute mastitis



Subacute mastitis is a well known and unwelcome visitor in the dairy industry. It has also been recognized and defined in humans. The bacterial diversity in the breastmilk differs between mothers with acute and subacute mastitis (Patel et al.  Sci Rep <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552812/#>. 2017; 7: 7804.) Probiotic therapy for any type of mastitis is in its infancy and has been explored in a number of studies and countries. While it may not yet be ready for prime time, it hovers as a potential addition to our choices of interventions.



Marsha Walker, RN, IBCLC

Weston, MA





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End of LACTNET Digest - 27 Mar 2018 to 28 Mar 2018 (#2018-84)

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