I have an interesting case I wanted to run it by the "collective" Here is the
background:
Second time mom had "mastitis" at 11/2 wk postpartum. She described fevers,
redness, tenderness at breast, spoke to WIC counselor who rec warm soaks and
lots of nursing...sx improved in 3 days. At 4 wks pp again with same sx
"mastitis" this time tx'd with Keflex 7 day course ordered, mom completed 3
days and stopped as sx resolved. Baby nursing very well entire course since
delivery, no lumps ever felt. At 8 wks c/o sudden onset painful nursing,
large cracks in nipples, sees above WIC counselor again, dx with thrush-using
Gentian Violet for 3 days--and here is where I am consulted. Thrush in babys
mouth is gone, but baby still with vaginal discharge and yeasty-diaper rash.
Mom with vaginal discharge, rash she describes as prickly like the diaper
rash on her breasts esp under nipples. Severe cracked and oozing nipples.
She describes this as if "someone took a knife and slit under the nipples all
around. very deep and very sore" there is some active drainage per mom.
She had been using bactroban now to mycatracin without much improv. Nursing
is too painful as is pumping, she is hand expressing for now. I seen/talked
to her on saturday and observed a non engorged breast, no lumps, some red
prickly rash on breasts concentrated under nipple, deep fissure at and
around base of nipple, no dc but gentian violet on, extremely tender.
Here is what I did/think...any more suggestions?
1-nystatin cream for baby
2-Jacks APNO for mom
3-diflucan for both-strict instructions to complete 14 days
4-cultured nipple drainage -will treat with antibiotics pending some results.
My thinking is definate yeast...but is there some "low grade" mastitis also?
perhaps a low dose 6 wk course of antibiotics? then there will be more
yeast? Help!
STUMPED!
Cheryl Parrott RN, BSN
Kokomo IN
Mom to Lexie 2 yrs old and Rachel-angel baby
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