BREAST INFECTIONS

BREAST INFECTION

FUNGAL- Actinomycosis of

breast

TB OF BREAST

ACUTE BACTERIAL MASTITIS

PERIDUCTAL MASTITIS with/without PERIAREOLAR

ABSCESS

LACTATING BREASTNON_LACTATING

BREAST

ABSCESS

SUPERFICIAL BREAST

INFECTION

LACTATING BREAST

LACTATING BREAST CRITERIA

BREASTINFECTION

PRESENTATION INV. MANAGEMENT

ACUTE BACTERIAL MASTITIS/ LACTATIONAL MASTITIS

• milk stasis

• infections

•Staphylococcus Aureus(from infant, ascending infection )

• signs of acute inflammation• 74% to 95% of cases occur in the first 12 weeks

1. EffectiveMilk removal-proper breastfeeding method-EncourageFrequentbreastfeeding-express breastmilkby hand towards nipple /Heat therapy till milk flows

2. Antibiotic therapy - symptoms severe -a nipple fissure Is visible-symptoms do not improve after 12-24hours of improved milk removal ORAL• dicloxacillin, 250 mg qid

•amoxicillin–clavulanic acid, 875 mg bd

• a first-generation cephalosporin cephalexin, 500 mg qid

•methicillin-resistant S. aureus (MRSA) may necessitate the use of trimethoprim-sulfamethoxazole, 160/800 mg bd 7 days

•clindamycin, or tetracycline depending on the patient's history of infections and the local prevalence of MSRA

3. Symptomatic Treatment-analgesia : diclofenac 50 mg tds-antipyretic : paracetamol 1g bd

CRITERIA

BREAST INFECTION

PRESENTATION INV. MANAGEMENT

BREAST ABSCESS

•fever•Malaise•Breast tenderness•Swelling and erythema•Decreased milk flow•Nipple discharge

•FBC

•CRP

•Diagnostic needle aspiration drainage ,USS guided–pus?cytology, pus C & S

•Milk leucocyte count/bacterial quantification, C & S

•Blood C & S

• Diagnostic breast USS/MMG

1. Admitted to ward (General indications for

admission -obvious sepsis or hemodynamic compromise, immunocompromise (diabetes), rapid & progressive infection, and failure of outpatient antibiotic therapy)

2. Supportive measures:•Fluid –•analgesia : diclofenac 50 mg tds•antipyretic : paracetamol 1g bd

3. Effective milk removal• breastfeeding• pump• heat therapy

4. Antibiotics (oral/IV)10-14 days •dicloxacillin : 500 mg orally four times daily• cephalexin : 500 mg orally three times daily•doxycycline : 100 mg orally twice daily• clindamycin : 300-450 mg orally four times daily

ORAL:•dicloxacillin : 500 mg qid • cephalexin : 500 mg orally tds•doxycycline : 100 mg orally bd• clindamycin : 300-450 mg qid

IV :•oxacillin : 1-2 g intravenously every 4-6 hours

•nafcillin : 1-2 g intravenously every 4-6 hours•cefazolin : 1-2 g intravenously every 8 hours

Breast abscess presents as a hypoechoic fluid collection in the tissue with the absence of vascular signals.

6. Surgery

-repeated aspirations under AB +/- US guidandance -I & D + biopsy of abscess wallHPE

7. Supportive counselling-breastfeeding-encouragement

8. oral AB continued for 10 days post-op

9. TCA 1/52

10.once infection resolves MMG/ USS

•18- to 19 gauge needle•daily aspiration for 5 to 7 days• followed by ultrasound (+/-)

•incision and drainage aspiration fails or large abscesses (>5 cm in diameter)

NON-LACTATING BREAST INFECTION

CRITERIABREAST INFECTION`

PRESENTATION INV. MANAGEMENT

Periductal mastitis/ subareolar abscess

ass. with duct ectasia

-nipple discharge, subareolar mass/ abscess, mammary duct fistula, nipple retraction, repeated incidence

(SAME AS LACTATING)+:

•RBS•AFB

1. Admitted to ward

2. Supportive measures:•Fluid •analgesia : diclofenac 50 mg tds•antipyretic : paracetamol 1g bd

3. Antibiotics-metronidazole 400mg tds

5. Surgery•repeated aspirations under AB +/- US guidandance •I & D + biopsy of abscess wallHPEonce acute phase resolves: Hadfield's operation

6. oral AB continued for 10 days post-op

7. TCA 1/52,once infection resolves MMG/ USS

MAMMARY DUCT FISTULA

RETROAREOLA ABSCESS: ILL-DEFINED, NONCALCIFIED MASSES HIGH-DENSITY, ILL-DEFINED HETEROGENEOUS MASS WITH AN IRREGULAR MARGIN.

CRITERIABREAST INFECTION`

PRESENTATION INV. MANAGEMENT

TB of breasts-nodular, diffuse, sclerosing types

-slow growing-painless mass-tubucle ulcer-multiple sinuses-pulmonary/other tb sites

•FBC•MANTOUX TEST•CRP•CHEST X-RAY•Breast USS•MMG•FNAC

•Culture

1. Admitted to ward

2. Supportive measures:Fluid analgesia : diclofenac 50 mg tds

3. Anti-TB regime6 months of anti-TB therapy •2 months with a 4-drug combination (ethambutol, rifampin, isoniazid, and pyrazinamide) • 4 months with a 2-drug combination (isoniazid and rifampin)-low response,draining fistula: surgical interventiondraining cold abscess or mastectomy with/without axillary clearance

• nodular form : •either hypoechoic with ill-defined margins orcomplex cystic masses

• diffuse:ill-defined hypoechoic masses

• sclerosing breast tb: increased echogenecity of the breast parenchyma often with no definite mass is seen