*Hi,*
Marsha, I have to say I do not agree that subacute mastitis is either a
defined condition or that it should be treated with probiotics. There is no
eviendece whatsoever at this time.
In the literature, the term "subacute mastitis" has NOT been defined. The
group that proposed this term (a group from Spain) gives at least four
different definitions... That is, not even the very people who put forth
this term can define it. Here are their definitions, plus one from another
group of authors:
* “Local pain, more or less intense, needle-like or cramps, or burning
sensation, without redness or viosible inflamation (or very slight) and no
geenral symptoms." *
M. Carrera, R. Arroyo, P. Mediano, L. Fernández, M. Marín, J.M. Rodríguez.
Lactancia materna y mastitis. Tratamiento empírico basado en la
sintomatología y los agentes etiológicos. *Acta Pediatr Esp*. 2012; 70(6):
255-261
*“Needle-like, burning pain and engorgement." *
Esther Jiménez, Javier de Andrés, Marina Manrique, Pablo Pareja-Tobes,
Raquel Tobes, Juan F. Martínez-Blanch, Francisco M. Codoñer, Daniel
Ramón, Leónides
Fernández, and Juan M. Rodríguez. Metagenomic Analysis of Milk of Healthy
and Mastitis-Suffering Women. *Journal of Human Lactation* 2015, Vol. 31(3)
406 –415
*“Breast inflamation and other local symptoms (engorgement, burning
needle-like pain, reduced milk secretion." *
Leónides Fernández, Nivia Cárdenas, Rebeca Arroyo, Susana Manzano, Esther
Jiménez, Virginia Martín, Juan Miguel Rodríguez. Prevention of Infectious
Mastitis by Oral Administration of Lactobacillus salivarius PS2 During Late
Pregnancy. *Clinical Infectious Diseases*, Volume 62, Issue 5, 1 March
2016, Pages 568–573, https://doi.org/10.1093/cid/civ974
*“Painful nipples and/or shooting breast pain." *
Jiménez E, Arroyo R, Cárdenas N, Marín M, Serrano P, Fernández L, Rodríguez
JM. Mammary candidiasis: A medical condition without scientific evidence?
PLoS One. 2017 Jul 13;12(7):e0181071. doi: 10.1371/journal.pone.0181071.
eCollection 2017.
*In this article, subacute mastitis is named four times, without any
definition, and grouping it with subclinical mastitis (which is a
completely different entity). *
Pilar Mediano, Leonides Fernández, Esther Jiménez, Rebeca Arroyo, Irene
Espinosa-Martos, Juan M. Rodríguez and María Marín. Microbial Diversity in
Milk of Women With Mastitis: Potential Role of Coagulase-Negative
Staphylococci, Viridans Group Streptococci, and Corynebacteria*. Journal of
Human Lactation* 2017, 1 –10 DOI: 10.1177/0890334417692968
*“Breast engorgement and fever.”*
Shriram H. Patel, Yati H. Vaidya, Reena J. Patel, Ramesh J. Pandit,
Chaitanya G. Joshi & Anju P. Kunjadiya. Culture independent assessment of
human milk microbial community in lactational mastitis. *Scientific Reports*,
volume 7, Article number: 7804 (2017). doi:10.1038/s41598-017-08451-7
I believe the term subacute mastitis does not help...
Subacute refers to the duration of a certain condition and simply means
that it has lasted longer than an acute condition and not enough to be
chronic (where chronic has been defined in part of the literature as a
condition lasting more than three weeks, and in other medical texts as
lasting more than three months). So we really don´t know what subacute
means durationwise.
About mastitis, the suffix "-itis" means either inflammation or infection.
If we are talking about a certain type of pain, calling it mastitis is just
adding confusion. If what the mother describes is breast PAIN (shooting,
needles, burning, etc) but there is no outward sign of
inflammation/infection (either local or general) then we should call it
MASTALGIA, that is, breast pain.
The hypothesis that shooting breast pain is caused by biofilms is, as of
today, only a hypothesis. It has not been proven and neither has the
efficacy of probiotics (besides, the studies that are out there are mostly
funded by the probiotic industry - the largest one had funds from
Fun-C-Foods, a consortium of which Danon is part).
About the case for candidas, please review the CASTLE study, in my opinion
the best one out there (it is longitudinal, among other things, and has a
beautiful clinical design). They find that the symptoms "burning nipple
pain plus shooting breast pain" have a statistically significant link to
candidas on the nipple/milk/baby´s mouth. In my experience, if a mother
feels this type of pain, and when I look at her nipple it is pinkish, and
there is usually a history of antibiotics or corticoid treatment (in mother
or baby), then treating with antifungal cream, and in some few cases also
oral antifungals, the pain resolves. This does NOT mean that all shooting
or burning is candida, but sometimes it is, you just have to look for all
the clues.
Anyway, long lasting mastalgia, or chronic breast pain, can have maaaany
causes (as we all know) and is often multifactorial (traumatized nipple,
unergonomic breeastfeeding positions due to the pain that lead to muscular
contractions which bring more pain and reduce blood flow to the nipple;
fear of pain and all the emotional issues that stem from that and that can
worsen the pain, etc etc. It takes detective work, a very detailed history
taking, a good look at mother, baby and a feed. I think this is a beautiful
part of our work!!!
Hugs,
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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