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Subject:
From:
Cathy Fetherston <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 23 Nov 2010 08:47:56 +0800
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Hi Marrianne

If your mum has had so many multiple epsiodes of mastitis that have been
accompanied by systemic as well as local symptoms this is highly indicative
of a chronic untreated infection

You mention she has had nipple and skin swabs taken, but you dont mention
milk culture and sensitivity - even these do not always return a positive
result as you cannot be assured you have expressed milk from the affected
area - but they are worth trying and should be taken mid stream, at the time
of her symptoms, prior to taking any antibiotics.

You dont mention what antibiotics she has used to treat the problem, a
common scenario is that ABs are taken when the episode occurs, if the
pathogen is not sensitive (or is resistant) to the AB prescribed you will
see an easing or resolution of the symptoms but the underlying infection
will remain to return either days or weeks after the course is completed.
This can go on indefinately. I had one pt come to see me at 12 months, she
had had a bout of mastitis every 3-4 weeks over that year, always treated
with what turned out to be the incorrect AB. Milk cultures revealed she had
a resisent form of Strep B.

Questions to ask - did she have nipple trauma immediately post partum, was
there strep B on her high vaginal swab? any other peripartum infections in
either her or her baby? Babies can often "re-infect" their mothers if they
carry potential pathogens in their nose or oro-pharynx. It is often worth
while to take another maternal oro-pharynx and vaginal swab and an infant
nasal swab if milk cultures come back negative. More recently the literature
is showing even microbes generally considered to be normal skin flora such
as CNS and Strep viridans appear to the causative organism.

If still nothing comes up as being positive I have found a long term low
dose of a broad spectrum antibiotic such as 250mg cephalexin twice a day for
the term of the lactation works well, this is controversial in light of the
emergence of resisent pathogens and may not be well received by some
doctors.

If she does wean from that breast, I would think antibiotic coverage for
the period of involution would be important. Complete involution is often
very difficult to attain during established lactation anyway and the lack of
flow of milk through the breast will also make her highly susceptible to
further episodes

There are other possibilities to consider - eg: an undiagnosed immune
deficincy
eg:

Fetherston, C.M. Lai, C.T. & Hartmann, P.E. 2008. Recurrent blocked ducts in
a woman with immunoglobulin A deficiency: A case history. *Breastfeeding
Medicine* 3(4):261-264.



and sometimes, unfortunately,  its just a
mystery.................................



regards

Cathy Fethertson PhD IBCLC

Perth, Western Australia


>She doesn’t really feel it coming up, but in no time her breast is bright
red and painful and she feels terrible >herself.
>They quickly follow eachother up, hardly leaving time for mom to recoup.
>After the 12th time, I went to the hospital with her to the radiologist for
an ultrasound, hoping we would be able >to find something. Result: nothing
found, not even a single cyst.
>Ab doesn’t seem to do anything: healing shows no difference with or without
ab

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