Please help me with this case:
I have been working with this mother since June. First baby, being
breastfed and breast milk fed exclusively since birth. DOB 2-11-06,
birth wt. 9lbs 7oz, wt. now 20+ lbs. Baby first presented to me with
apparent "thrush" spots in his mouth, mother had deep "shooting" breast
pain, bilateral. Both had been treated with Nystatin in another state
before moving here. She claimed that they were both resistant to it. I
saw a baby with excellent latch, normal oral anatomy, good growth,
approp. Stooling and urination. Mother had normal nipple-areolae,
easily expressed mature milk, slightly pinkish nipple skin which she
claimed was normal for her.
Here's where it gets unusual. I had the pediatrician prescribe
fluconazole for baby and Gyn for mother, exactly as Hale recommends. He
says for unusually difficult cases it may need 3 - 4 weeks of treatment.
She got better. (Remember: she had previously had two of these in
another state.) Now two months later they have both resumed infections.
I had her see her FP physician who sent her to the breast surgeon.....
I calmed her down, and suggested (since we could not get any more
fluconazole) gentian violet and gave her instructions per Jack Newman. I
went with her to the surgeon and he agreed that there was probably not a
reason to see him. He sent a sample of the milk to the lab (a good
idea, actually). One week later now, and she is still having symptoms
(baby seems o.k. right now with gentian violet) pathology comes back
with NO candida or any other fungal infection.
Anybody out there have a new direction for me to turn? This is the most
dedicated mother you will ever find. The obstacles she has over come
are unreal (for example she is pumping in a bathroom at work b/c she is
a waitress). But I am running out of ideas.
Please Email me privately,
THANKS WISE ONES!!!
Lizabeth J. Berkeley, MPH, CHES, IBCLC
Department of OB-Gyn
Texas Tech Health Sciences Center
4800 Alberta Ave.
El Paso, TX 79905
(915) 545-6990 X261
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