On 4/3/04 10:27 AM, "Automatic digest processor"
<[log in to unmask]> wrote:
> WE had a mom of twins in our practice last year who had a bad case of
> thrush, or so we thought. We suggested many options and she tried nearly
> everything. She was on diflucan for over 6 weeks, and was also sent to a
> dermatoligist to rule out a bacterial problem. This Dr. sent her to a
> speciaist at Johns Hopkins and he advised her to wean, as she was just
> giving the babies the thrush and continuing the cycle. His advice was that
> some moms just don't get over yeast until they wean. Well mom called today,
> the babies have been weanened for 1 year, she still has milk in her breasts
> and is still experiencing pain in her breasts to the point that she doesn't
> want her husband to touch her nipples. Her DR. has assured her that she
> doesn't still have yeast I'm wondering if anyone has any new ideas for this
> mom?
> Peg Merill, IBCLC
It is not often known that breast pain is a common phenomenon in
non-lactating women (and one would therefore also expect a reasonable, and
probably even greater, incidence in lactating women). It is reported that
mastalgia affects up to 70% of women at sometime in their lives and
constitutes about 50% of referrals to breast clinics (and is divided into
cyclical and non-cyclical pain). In 15% the pain is sufficient to severely
affect lifestyle and requires treatment. There are several drug treatments
(evening primrose oil, Danazol, Bromocriptine and tamoxifan as well as
anti-inflammatories, depending on cause). They have found that women with
both cyclical and non-cyclical mastalgia sometimes have reduced levels of
certain fatty acids (PUFAs) which can be improved through diet and
supplementation. Pathology is very rarely associated with breast pain but
should be excluded none the less. I would recommend she be referred to a
breast clinic where all the options can be considered.
In lactating women these aspects are also important to consider, along with
all the other possible differential diagnoses (eg: vasosapasm, referred pain
from the back, fibromyalgia, chest wall pain, trauma, infection and feeding
difficulties). In my opinion thrush is not as common as it is believed to be
and should not always be the diagnosis we jump to first.
On this note there is a new study being undertaken on thrush and nipple pain
(sorry if this has already been posted, I donšt always catch up with all the
digests). A preliminary report from the study has been published last year:
Graves, S., Wright, W., Harman, R., & bailey, S. 2003. Painful nipples in
nursing mother's: Fungal or staphylococcal? Aust Family Physician 32(7)
570-571.
In short, 28 mothers with nipple pain and 23 control mothers were recruited.
The mothers with nipple (tender) pain would have been considered to have
"thrush" just based on clinical diagnoses. Swabs were taken from the nipples
of both groups along with breastmilk cultures and swabs were taken from the
mothers nares and vagina and the babies orophaynyx.
Of the symptom group 57% nipple swabs were +ve for S. aureus and and also
48% of breastmilk cultures. The control group had no positive cultures from
either source. 42% of case group had S.aureus in their nares and 26% of the
control group (not statistically different). Two babies of infected mothers
had S.aureus in the nares whereas 10 babies whose mothers nipples were
infected did not, concluding that the risk of the baby of acquiring S.aureus
colonisation from the infected mother was low (15%). Four babies had candida
albicans in their orophayrx but three of them were control babies, therefore
a baby with Candida did not correlate with a mother having breast thrush.
Their conclusions were that breastfeeding mothers with tender nipples were
unlikely to have thrush but may be be positive for staph aureus. They are
conducting a much bigger trial at present, involving treatment with
antifungals, some of the results were presented at an ABA conference
recently. I was not present and haven't seen the conference proceedings.
Perhaps someone else was there that knows?, what I have "heard" sounded very
interesting. I will try to get hold of a copy of the proceedings or similar
to let you know what they have been finding.
Cathy Fetherston
Perth, Western Australia
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