Candida albicans seems to rear its ugly head frequently enough that one  
would think we would have a better grasp of how to diagnose and handle it. There  
seems to be more questions than answers. C albicans easily colonizes  
stratified squamous epithelial cells lining the gastrointestinal and  genitourinary 
tracks. Portions of the lining of the milk ducts are also composed  of such 
cells. Under the right circumstances could these also be vulnerable to  fungal 
invasion? Ductal infections in dairy cattle and goats has been reported  with C 
albicans isolated from milk samples of dairy cows with mastitis or  subclinical 
mastitis. Could ductal colonization or infection occur in humans  when the 
breast becomes susceptible through subclinical mastitis if the ductal  lining is 
inflamed? Opening of the tight junctions between luminal epithelial  cells 
from milk stasis could also increase the areas for colonization by  pathogens. 
 
Ultrasound imaging of the breasts has shown dilitation of the milk ducts  
followed by narrowing and a backflow of milk that was not removed. Could this  
backflow carry pathogens deeper into the smaller collecting ducts and ductules?  
C albicans is capable of changing its form into filamentous forms that 
readily  penetrate tissues.
 
Finding and culturing C albicans in milk is difficult since the  lactoferrin 
in the milk inhibits yeast growth in vitro often resulting in  false-negative 
test results. A new laboratory technique uses the addition of  iron to 
counteract the action of lactoferrin and reduces the chances of false  negative 
results, providing a more accurate means of detecting and confirming  the presence 
of C albicans in human milk. Some of the deep breast pain and  shooting or 
stabbing pains that mothers describe could also be from bacterial  infections.
 
I don't think we should dismiss the possibility of fungal invasion of milk  
ducts quite yet.
 
Marsha Walker, RN, IBCLC
Weston, MA

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