Kika,

I have been treating subacute mastitis for 25 years. I often interchange subacute mastitis with mammary dysbiosis, but subacute mastitis seems more relevant to women who have a low grade degree of mastitis, with a patch of redness, mild discomfort in that region, no fever, no engorgement.

Mammary dysbiosis, based on my professional opinion and experience only, is characterized by breast pain and sometimes nipple pain, that is worse after nursing, associated with a deep achy, sharp pain, often accompanied by recurrent plugs, occasionally stringy milk, biofilm on the nipples, breast tenderness, and sometimes vasospasm. The vasospasm does not occur when pain is at its worst, which is how I distinguish it from primary vasospasm.

The breast is very tender on palpation, especially inferiorly, and manual expression is very uncomfortable. There is often a subtle ring of redness and swelling, no dermatitis, circumferentially at the base of the nipple. I think for many women the infection dwells in the retroareolar regions, in the lactiferous sinuses (and yes, based on our favorite breast surgeon's own eyes, Dr Mitchell, there ARE lactiferous sinuses!).

The dx is sort of a diagnosis of exclusion, similar to the dx of bacterial vaginosis, because the offending bacteria is typically normal flora. One needs to rule out hyperlactation, vasospasm, latch or pump trauma, and low supply first before making the dx.

The cultures are usually just + for coag neg staph, and often is resistant to oxacillin. Sometimes I see this with gr B strep, staph aureus. The worst, most resistant cases occur when the nursing child has strep throat. It seems that once gr A beta hemolytic strep gets in the breast, it is so, so hard to get rid of the mammary dysbiosis from this bacteria. 

I also see some of the worst cases in mothers who are just pumping in the NICU, where aggressive coag neg staph lurks.

My belief is that the vast majority of 'yeast' or 'chronic yeast' is due to mammary dysbiosis.



This diagnosis makes sense in the context of what is around us. In the dairy industry, this is one of the top problems that farmers try to avoid. Bacterial overgrowth in milk decreases the value of their milk, so they work hard doing the things that we also suggest such as full 'bag stripping' (I live in the #1 dairy state in the USA). They find it very hard to get rid of this problem if it develops in dairy cows so they dry off or cull the cow (send to market) if it develops. IF they dry the cow, they then treat with antibiotics, then re-impregnate. IF it comes back again during lactation, off to market.

IN addition we, as physicians, deal with dysbiosis in several organ systems, such as sinusitis, chronic otitis media with effusion, chronic bronchitis, diverticulitis, travelers diarrhea, chronic cystitis in cath'd patients, chronic prostatitis, acne, etc. IT makes sense that a probiotic approach ought to be helpful, but so far I am not impressed with the use of l. fermentum or l. salivarius in getting rid of this infection. Perhaps I don't have access or knowledge of the most effective ones, but the ones I have used have not helped. I have found some herbs and homeopathy to be helpful, and of course antibiotics.

I would love to get your opinion on this, from your experience.

Anne





Anne Eglash MD, IBCLC, FABM

Clinical Professor, Dept of Family and Community Medicine

University of Wisconsin School of Medicine and Public Health

Director, UW Lactation Services

Medical Director, Mothers Milk Bank of the Western Great Lakes

Founder and President of The Milk Mob, www.themilkmob.org







Date:    Tue, 24 Jul 2018 14:27:35 +0200

From:    Kika Baeza <[log in to unmask]>

Subject: Subacute mastitis



Hi Marsha,



I am very interested about your view on the definition of subacute mastitis, as it is described differently in different studies... there is no consensus. How do you define it?



Thanks, this is a very controversial topic in my area!

Kika





--

Dra. Carmela Baeza

Médico de Familia

Consultora Certificada en Lactancia Materna IBCLC 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.ediciones-encuentro.es/libro/amar-con-los-brazos-abiertos.html







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