Sorry to keep going, this topic has created a LOT of unnecessary
difficulties in Spain... I would not wish it on any other breastfeeding
community.

The Patel el al study you note, Marsha, says that subacute mastitis is
BREAST ENGORGEMENT AND FEVER.

They then say:
"Jimenez *et al*. 2015, carried out metagenomic shotgun sequencing of
breast milk sample collected from 10 women with mastitis (5 from subacute
mastitis and 5 from acute mastitis and 10 healthy-controls. Similarly to
the results obtained from culture dependent studies, *Staphylococcus* (*S*.
*aureus* in acute and *S*. *epidermidis* in subacute mastitis)... "

However in the Jimenez study, subacute mastitis is defined as "shooting
needle-like pain and engorgement".

Therefore, these studies are giving the same name to two different clinical
presentations!! In fact, they are comparing microbiological results from
two different conditions, not the same one! These are not valid results,
they muddle issues.


Subacute mastitis is well defined in the dairy industry... However, cows
cannot tell us whether they feel pain or whether it is shooting  burning or
needle-like. Therefore  the definitions in dairy industry cannot be based
on these symptoms. So, whatever subacute mastitis means in the dairy
industry (which I do not know, I have not researched it) it can't be
automatically translated into human pathology.

I think that the terms we use must be helpful and clarifying. Using the
term subacute mastitis for humans is not, at least at this point...

For the last few years here, women with just about any type of breast pain,
even with just low milk supply, have been tagged as having subacute
mastitis (since there are so many definitions that any difficulty can be a
subacute mastitis). Their milk has been cultured, and since something
always grows, they are treated with antibiotics (although no one really
knows what is normal and what is not in a milk culture). They are also
treated with probiotics.

So, we have a lot of breastfeeding women waking around with unnecessary
milk cultures, antibiotics, probiotics, less money in their pockets and
unresolved breastfeeding issues (because why look at a baby's latch when
you can dish out a few pills?).

I hope this helps you understand why I am so insistent on this topic!

Hugs from Madrid
Kika






-------------------------------------------
Date:    Wed, 28 Mar 2018 09:26:44 -0400
From:    Marsha Walker <[log in to unmask]>
Subject: Subacute mastitis

Subacute mastitis is a well known and unwelcome visitor in the dairy
industry. It has also been recognized and defined in humans. The bacterial
diversity in the breastmilk differs between mothers with acute and subacute
mastitis (Patel et al.  Sci Rep
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552812/#>. 2017; 7: 7804.)
Probiotic therapy for any type of mastitis is in its infancy and has been
explored in a number of studies and countries. While it may not yet be
ready for prime time, it hovers as a potential addition to our choices of
interventions.

Marsha Walker, RN, IBCLC
Weston, MA

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