Denise asks, "Kathleen and Pamela that is really interesting about a really
nasty
infection causing this too. .... Pamela did you swab the nipple or culture
the milk in the cases you dealt with?"

Not myself, no.  I ask the mother to see her doctor (GP) and request a
nipple swab/culture of the milk, then follow up with the doctor or the mom
to find out what the results were, and for my own interest, what Abx have
been prescribed.  Sometimes the doctor will prescribe first, and then
change the Abx when the results come back from the lab.  Sometimes a second
course is necessary too.  Very, very occasionally the doctor has been
reluctant to get the lab-work done, in which case I suggest that the mom
seek a second opinion (and lab test) from another doctor.

The first case was identified almost by accident.  The mom had what looked
like nipple Thrush, but I wasn't sure, so I sent her off to her GP who did
a swab and the lab sent back this "mistake" message.  The test was
repeated, with the same result.  After that I had about 8 or 9 cases which
I shared with another GP (my client, her patient), and then there were
more, here and there.  It's got to the point now where I wonder how many
cases of apparent Thrush are really S Pyogenes.  It can cause breast pain
too - sharp, needle-like pain which just goes on and on and the cause can't
be identified - until the milk is cultured and there it is!

Pamela Morrison IBCLC, Zimbabwe
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