Its nice to back on Lactnet after such a long time and I couldn't resist a reply to Rachel's comments on the CMT, Oh that mastitis diagnosis in women was so easy but it is true that there is a lot to be learned from mastitis in the dairy industry which has spent many years and a great deal of money investigating the problem of mastitis (in cows that is) The California Mastitis Test (CMT) has been around for about 50 years, and is still widely used mainly as a test for subclinical mastitis (a term we have unfortunately inappropriately applied to women with high sodium concentrations in breastmilk). Somatic cells in milk (leucocytes, macrophage and epithelial cells from the secretory tissue) in cows are associated with clinical, subclinical mastitis and reduced milk production. It uses a four compartment paddle and blue reagent to test a sample of milk from each quarter (of the udder) for somatic cells and can help producers to easily identify cows that probably have mastitis infections, and also provides an estimate of the severity of those probable infections. In general, as CMT reactions increase, the likelihood of recovering pathogenic bacteria increases. The CMT is good at detecting infections in quarters that have Somatic Cell Counts (SCC) > 500,000 cells/ml but studies have shown that infected quarters may be missed when the cell count is lower. The rate of false negatives ranges from 8 to 43% depending on the score used as a threshold for infection. It does have its limitations. More sophisticated equipment that actually counts the number of leukocytes in a sample of milk do exist now. Although the CMT doesn't actually measure bacteria there is an association between high SSC and infections, eg: a recent (2006) study published in the Journal of Dairy Science concluded that CMT score of ™2 corresponding to ™800,000 somatic cells is the best cut-off to correctly identify S. aureus intramammary infections in low yielding dairy cows in Tanzania. Thomsen's work (in women) in 1983/84 tried to use this premise of relating leukocyte counts to bacteria counts in milk to differentiate between infective inflammation, non infective inflammation and milk stasis but it wasn't quite as straightforward as it theoretically should have been and 20 years on we are still not much further ahead........... regards Cathy Fetherston RM PhD IBCLC Perth Western Australia > > Date: Wed, 13 Jun 2007 21:06:08 +0200 > From: Rachel Myr <[log in to unmask]> > Subject: California Mastitis Test > > Since I mostly work with people I only recently became aware of a test kit > by this name available in farm supply stores, for checking the number of > white blood cells in cow's milk. It involves taking a small amount of fresh > milk and mixing it with a reagent which causes color change. The color > varies with the concentration of white cells. For farmers it means they can > check quickly whether a cow's production passes the test to go to the dairy. > > If this test or something like it could be used in humans, imagine how much > simpler it would be to make the differential diagnosis between engorgement > and mastitis. Does anyone out there know anything about it? > I have also heard unconfirmed rumors that there are tests to determine which > bacterium is to blame, but since the ones in the test are the common > pathogens for bovine mastitis, it wouldn't work for women unless they were > cross-infected from a cow. > > Rachel Myr > Kristiansand, Norway, and walking distance from the feed supply store where > I can get these kits quite reasonably :-) > > ***********************************************