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Acute mastitis
What is acute mastitis?
Acute mastitis is an acute purulent infection of the mammary gland, commonly occurring in women during the postpartum breastfeeding period, especially more frequently seen in primiparous women. It usually occurs within three months after delivery, particularly in the third and fourth weeks postpartum. Therefore, it can also be referred to as postpartum mastitis or lactational mastitis. The main causes are due to bacterial invasion, stagnation of milk, and a decrease in the body's immune function. The primary pathogens are generally Staphylococcus aureus, with occasional cases involving Streptococcus. In such instances, it is recommended to conduct a routine blood test for the mammary gland and an ultrasound to determine the severity of the mastitis.
What are the symptoms of acute mastitis?
During the onset of acute mastitis, symptoms often include high fever and chills, and the affected breast may enlarge and become firm, with throbbing pain that becomes more apparent during breastfeeding. This is usually accompanied by an increase in local skin temperature, redness and swelling, and tenderness. If the area softens over a short period, an abscess may have formed. If the infection is not controlled, it can lead to systemic infection or sepsis. Patients often have swollen lymph nodes, and blood tests show elevated neutrophil counts in white blood cells.
Does acute mastitis have lumps?
Mastitis involves inflammation, and severe cases can lead to inflammatory lumps. Generally, we use breast ultrasonography for diagnosis and differentiation. If the ultrasonography report indicates a cystic formation, it is typically considered to be caused by the accumulation of milk. At this point, ceasing breastfeeding and seeking massage from a professional or a loved one to clear the accumulated milk can be curative. If the ultrasonography report shows an inflammatory hard lump or a solid mass, we recommend stopping breastfeeding and starting anti-inflammatory symptomatic treatment. If the lump shows signs of shrinking, continue the anti-inflammatory symptomatic treatment. However, if there is no change in the inflammatory lump, surgical treatment is recommended to remove the inflamed mass.
Treatment methods for acute mastitis
The treatment methods for acute mastitis start with stopping breastfeeding. For those with mild symptoms or less severe conditions, breastfeeding can continue, but it is not advisable to breastfeed from the affected breast. Instead, a breast pump can be used to express the milk. Secondly, the breast can be supported with a bra. Thirdly, for local redness and swelling, hot compresses can be applied, or ichthyol ointment can be used topically, as well as Levonorgestrel topical application. If blood tests show elevated levels, systemic antibiotics should be used, with the choice of penicillins and cephalosporins for symptomatic treatment. If an ultrasound shows an abscess formation, it is recommended to perform an abscess incision and drainage procedure, or, if it's deeper, a thick needle can be used for aspiration to draw out the abscess.
How to reduce fever in acute mastitis
For fever in acute mastitis, it is first recommended to obtain a complete blood test to check if white blood cells and neutrophils are elevated. Of course, there are basic conservative methods and medication treatments for fever reduction. The conservative approach includes drinking plenty of water, preferably warm. Secondly, local application of magnesium sulfate can be used, with concentrations ranging from 33%-50%. During hot weather, it can be applied directly as a wet compress on the inflamed breast. It is important to thoroughly clean the breast, especially the nipple, before breastfeeding to prevent the baby from ingesting magnesium sulfate, which can cause diarrhea in infants. Thirdly, if the blood test shows an increase in white blood cells and neutrophils, intravenous antibiotics are used, commonly referred to by people as anti-inflammatory injections. Using antibacterial medications at this time can rapidly reduce fever. The fourth method is to temporarily use fever-reducing medications, which, along with magnesium sulfate, are available at pharmacies. However, for antibiotics, it is best to go to a hospital.
Does acute mastitis require infusion?
In cases of acute mastitis, the specific situation must be considered. If it is a simple case of acute mastitis without a significant abscess, without particularly high white blood cell counts, and without pronounced fever, then it is not necessarily required to administer IV fluids. Local applications of magnesium sulfate compresses can be used, and in colder weather, these can be heated for a warm compress. Alternatively, traditional Chinese medicine such as Jin Huang powder can be applied externally and is often sufficient to resolve the issue. However, if the acute mastitis is accompanied by an increase in neutrophilic leukocytes, which requires verification through blood tests, and systemic symptoms such as fever and pain, then antibiotic treatment is necessary, typically administered through IV or orally, though IV is often faster. When acute mastitis is complicated by a breast abscess, not only is IV treatment needed, but also procedures for abscess drainage or incision and drainage. Currently, many minimally invasive methods for draining abscesses and other treatments are employed.
Is hot compress effective for acute mastitis?
An important factor in acute mastitis is the accumulation of milk during breastfeeding, which leads to mastitis. Applying heat can be somewhat effective, as it helps to unblock the milk, thus further alleviating and controlling the symptoms of mastitis. However, heat application is mainly used in the initial stage of mastitis. If the condition progresses further, with more apparent systemic symptoms or pus formation, then heat application is not very effective. Further anti-infection treatment and, if necessary, incision and drainage surgery are needed to control the condition.
Acute mastitis is caused by what?
Mastitis is generally considered to be caused by the accumulation of milk, which occurs during breastfeeding when the posture or unintentional actions by the child cause damage to the milk ducts, leading to an accumulation of milk within them. Since milk serves as an excellent culture medium, this can lead to bacterial infection. The second point is that if there are cracks or fissures on the nipple, bacteria can infect in reverse, leading to significant infections by Staphylococcus aureus, which can also cause mastitis. The third point concerns a weakened immune system, for example due to mental stress or lack of sleep. These are the main causes of acute mastitis.
The causes of acute mastitis
The first cause is milk stasis, which occurs when, due to incorrect positioning during nursing or breastfeeding, a child inadvertently causes the milk ducts to close, leading to a significant accumulation of milk within these ducts. The milk inside the ducts provides an excellent medium for bacterial growth. The second cause is bacterial invasion, mainly through cracks and fissures in the nipple. Bacteria enter the milk ducts through these fissures or breaks, causing inflammation. The third cause is a decrease in the body's immune function, for example due to severe mental stress or lack of sleep. All of these are the primary causes of acute mastitis.
Can you breastfeed with a fever from acute mastitis?
For acute mastitis with fever, it is generally recommended to stop breastfeeding. For mild symptoms and less severe cases, breastfeeding is possible. However, do not breastfeed from the breast that is affected with redness, swelling, heat, and pain; instead, use a breast pump to extract the milk. For more severe symptoms or if an abscess has formed, breastfeeding must be discontinued. Further, a breast ultrasound should be performed to determine whether the issue is cystic or inflammatory. A complete blood count is also recommended to view the extent of the infection. If the count exceeds 10,000, intravenous antibiotics are necessary, and topical Levofloxacin can be applied locally. If the count is below 10,000, oral anti-inflammatory medications can be taken to treat the symptoms. (Please use medications under the guidance of a doctor.)