BREAST INFECTIONS
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