I have seen pus in milk from women who merely had severe mastitis with no
abscess present.  I've also seen it in situations where an abscess occurred.
In women, as  in herd animals, the presence of clumps of debris in the milk
is a sign of infection.  Not everyone with mastitis will see this phenomenon
(unless they pump, perhaps), but when it appears, it can appear as stringy,
or mucus-y.  We have a photo in the Breastfeeding Atlas of a clump of milk
sitting in the basket of a mesh tea strainer.  The mother had florid
mastitis and was pumping bloody milk with lots of clots of milk.  We poured
her milk though the tea strainer so I could take a photo of this effect.
Kay Hoover's case study in the Atlas of a mom with a MRSA infection shows a
photo of the
husband (who was a physician) pulling a plug of congealed milk through a
skin lesion on the side of the woman's breast where the skin had broken down
from the infection.  The lesion was oozing blood and both liquid and solid
milk.  When I've seen clumpy milk, it both floats and sinks and is quite
visable.  However, after the milk sits for a while, the clumps tend to
reabsorb.

Ruth Lawrence in earlier editions (beginning in 1983) of Breastfeeding:  A
Guide for the Medical Profession alludes to a case where an infant developed
illness after nursing from a mom with mastitis caused by bilateral strep.
This case is mentioned in other papers, but Lawrence is the ref
generally cited when other authors discusssed the risk.
For instance, I found a 1988 paper:  K Ogle and S Davis,
Mastitis in Lactating Women, J Fam Pract 1988; 26(2):139-144 that states
that infants generally can nurse during mastitis, "The exception to this
rule is when bilateral mastitis is noted.  Lawrence cites a case in which an
infant infected with streptococcal disease at birth was treated with
antibiotics.  Six weeks later, the mother developed bilateral mastitis and
the infant became ill.  Cultures of both the infant and the breast milk grew
out Streptococcus organisms."

 I looked in the current ed. of Lawrence's
book and there is no specific mention of this case, however, she states (on
pg 283)  "Nursing can be maintained when the breast is surgically drained as
long as the incision and drainage tube are sufficiently far from the areola
so that they are not involved in feeding.  In any event, the breast should
be manually drained of milk frequently to maintain the milk supply until
feeding can resume (sufficient healing usually occurs in 4 days).  The
infant can continue to feed on the unaffected side.  The infant should
always be monitored for infection, and simultaneous therapy should be
intitiated, especially with staphylococcal or streptococcal disease."

Some years after Lawrence describes her case the following paper appeared.
M Rench and C Baker, Group B streptococcal Breast Abscess in a Mother and
Mastitis in her Infant, Obstet Gynecol 1989; 73(5): 875-77 and 89-5.  The
abstract for this article states:

"Group B streptococcus is a common cause of postpartum infection, but breast
abscess in a lactating woman has not been reported.  Seven days postpartum,
a woman developed mastitis resuling from type Ib/c group B streptococcus.
She was treated with oral antibiotics for 1 week with apparent resolution.
Breastfeeding was continued, but at reduced frequency on the affected side.
Two days later, local and systemic symptoms recurred, and a large breast
abscess was surgically drained.  Five days into the mother's intial episode
of mastitis, her infant developed type Ib/c group B streptococcal mastitis,
requiring hospitalization and parenteral antibiotic therapy.  It is likely
that the pathogenesis of infection in theis mother-infant pair was circular,
and that either the early abscess formation during the mother's first
clinical infection and /or milk stasis due to decreased frequency of
breastfeeding resulted in transient gourp B streptococcal bacteremia, with
seeding of breast tissue in the newborn."

The article cited above has an interesting bibliography that goes back to
some of the articles that reference acute puerperal mastitis epidemics in
newborn nurseries in the 1950's.  I keep meaning to look at some of these
studies, but don't have them on hand.  In many of the papers I do have on
file concern
ing abscess, what is remarkable is the number of organisims that can be
involved.  Some
are quite nasty.

I have managed mothers who preferred to pump and dump during the acute
drainage phase of abscess, and I've had moms who kept nursing on the
affected side throughout (for one reason or another -- esp. when they
couldn't pump well or the pump flange sat on top of the wound).  I've never
seen a case of an infant getting ill from this practice, but I think
Lawrence's caution that the infant should be monitored is prudent, given the
lit.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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