Yes, we certainly have this syndrome of intense sharp shooting pains while nursing. There are several reasons for it, such as vasospasm, oversupply, nipple dermatitis, and what I call dysbiosis rather than a subacute mastitis.
Many mothers in the USA are treated for yeast in these situations, but clinically I don't find that these women have a simple yeast infection. Often it starts with exposure to the baby's oral candidiasis, which I believe changes the behavior of the coag neg staph that resides  in all lactating breasts. I notice that the women with the worst cases develop  biofilm on their nipples, a white crusty material that comes from the coag neg staph. I believe that the Spanish researchers are calling this an infection from coag neg staph, but since the bacteria are commensal in the lactating breast, I think of it more as a dysbiosis or imbalance of bacteria, much like bacterial vaginosis or travelers' diarrhea.
It is tough to treat. There does not appear to be a pure lactobacillus salivarius attainable in the USA. IT is found in many probiotic mixes but not by itself.  I am skeptical as to whether just taking a probiotic by itself will prevent this problem. I have been having moms take probiotics for years to prevent this and it does not seem to help.
We need a lot more research on this topic because it is a huge clinical issue.
Anne



Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes
President of The Milk Mob,  A Gang of Breastfeeding and Human Lactation Educators
www.themilkmob.org


Date:    Tue, 27 Jan 2015 10:21:57 +0100
From:    Carmela Baeza <[log in to unmask]>
Subject: Subacute mastitis

​Here I go again...
Sorry to go on about this, but it is a really big problem, lots of mothers spending a lot of money and not getting any real help.

SUBACUTE MASTITIS

The term subacute mastitis I have only found referring to bovine mastits EXCEPT in papers written by Arroyo et al (the Spanish lactobacilli group).
They say "subacute mastitis in lactating women is caused by coagulase-negative Staphylococcus (epidermidis), Streptococcus viridans/mitis and some species of Corynebacterium. These women have local pain, more or less intense, like stabbing needles, cramps or burning, with no visible inflamation and no systemic symptoms. They do not state how long "subacute"
means... I undestand it´s longer than acute and shorter than chronic, but they define no timeline.
They then go on to state that subacute mastitis should be treated with lactobacilli. They also state that there are two clinical trials that back up this statement; the clinical trials are their own, and the women enrolled in those two clinical trials had acute mastitis symptoms.

Carrera M, Arroyo R et al Lactancia materna y mastitis. Tratamiento empírico basado en la sintomatología y los agentes etiológicos. Acta Pediatr Esp. 2012;70(6):255-61.

Subacute mastitis has become an epidemic in Spain. Every woman with shooting pains is receiving (or rather, spending money on) lactobacilli.
With or without previous milk culture, and usually almost always regarless of the result of the culture. SOme women are now being advised to take lactobacilli DURING PREGNANCY to prevent breast problems.

QUESTION: does subacute mastitis of the lactating breast exist in any other country other than Spain? Are you living a probiotic campaign that is not supported by much actual research?


TIA,
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.amazon.es/Amar-con-los-brazos-abiertos/dp/8426904688/ref=sr_1_1?s=books&ie=UTF8&qid=1420813499&sr=1-1&keywords=amar+con+los+brazos+abiertos
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