Fever of 38.5°C or more, flu-like aches, chills and a tender, erythematous and edematous area of the breast is observed in puerperal mastitis [1]. Women often report of malaise and fatigue as well [5].

• Hemophilia A

  Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious [books.google.com]

• Fever

  Abstract Sporadic puerperal mastitis is an acute cellulitis, characterized by fever and segmental erythema in the breast. Staphylococcus aureus can be cultured in approximately one-half of the cases. [ncbi.nlm.nih.gov]

  Mastitis Clasificación y recursos externos CIE 10 N61 CIE 9 … Wikipedia Español Puerperal fever — Streptococcus pyogenes (red stained spheres) is responsible for most cases of severe puerperal fever. [esacademic.com]

  Clinically, these patients present with a rapid onset of unilateral breast tenderness, redness, fever, and sometimes a thickening or mass. Breast infections can be very aggressive with high fevers developing quickly. [brooksidepress.org]

  There may be fever. It is not possible to distinguish clinically between infectious and non-infectious mastitis. If a breast abscess has developed, there will be a fluctuant tender lump, with overlying erythema. [patient.info]

  Dairy overload with consequent incomplete emptying Nasopharynx infection in the infant primiparity Puerperal mastitis symptoms Patients come to see when they have: 38-39 fever, chills, malaise. Local mastalgia and then generalized. [topdoctors.es]

• Malaise

  Dairy overload with consequent incomplete emptying Nasopharynx infection in the infant primiparity Puerperal mastitis symptoms Patients come to see when they have: 38-39 fever, chills, malaise. Local mastalgia and then generalized. [topdoctors.es]

  Symptoms Puerperal mastitis often starts off as a feeling of malaise. You may complain of body aches and feeling unwell before the pain and soreness of the breast becomes evident. [home-remedies-for-you.com]

  The signs and symptoms may include: Breast tenderness or warmth to the touch General malaise or feeling ill Swelling of the breast Pain or a burning sensation continuously or while breast-feeding Skin redness, often in a wedge-shaped pattern Fever of [wildseedschool.com]

  […] the specimens isolated other bacteria, including Enterobacter cloacae, Pseudomonas picetti, and Haemophilus influenzae. 10 DIAGNOSIS Puerperal mastitis classically presents with the acute onset of maternal fever (100.4 F or higher), chills, myalgia, malaise [glowm.com]

  The presence of mastitis can be diagnosed by tenderness in breast and is associated with malaise and fever. The doctor will advise you antibiotics for Staphylococcus aureus (cephalexin, dicloxacillin, etc.) [beingtheparent.com]

• Breast Engorgement

  Breast engorgement may also contribute to abscess formation, and so nursing should not be discontinued. No ill effects are observed in infants who continue to nurse. [ncbi.nlm.nih.gov]

  Ann Chir Gynaecol Suppl 208: 84, 1994 3 Evans K, Evans R, Simmer K: Effect of the method of breast feeding on breast engorgement, mastitis and infantile colic. [glowm.com]

  Continued nursing is essential to prevent breast engorgement and further blockages. In cases where the infection is acute, the condition is referred to as sporadic acute puerperal mastitis. [home-remedies-for-you.com]

  It should be distinguished from congestive mastitis (breast engorgement) which usually presents on the second or third day of breast-feeding. The complaint in this case is of swollen and tender breasts bilaterally, without fever or erythema. [patient.info]

  Some new mums experience breast engorgement when their milk starts ‘coming in’ a few days after the birth. [medela.com]

• Breast Mass

  The main concern of many women presenting with a breast mass is the likelihood of cancer. Reassuringly, most breast masses are benign. Ultrasonogram demonstrates a hypoechoic mass with smooth, partially lobulated margins typical of a fibroadenoma. [emedicine.medscape.com]

  There may also be a breast mass near the nipple, retraction of the nipple, or discharge. Because breast cancer can also cause these symptoms, it is important to see your doctor if you have any of them. [jamanetwork.com]

  Women will present with a breast mass and no evidence of local or systemic infection. Galactoceles can recur, and often treatment requires removal of the cyst wall. Fibroadenomas can also be confused with a breast mass. [clinicaladvisor.com]

  IGLM often forms a palpable breast mass that can mimic invasive breast cancer, both on a mammogram and clinical examination. It is important to note that IGLM is a benign condition. [breast-cancer.ca]

  mass History Breast tenderness “Hot cords burning in chest wall” Physical Exam Localized breast induration, redness, and warmth Peau d’orange appearance to overlying skin Diagnostic Tests & Interpretation Mom can check if she produces salty milk from [tipsdiscover.com]

• Mastodynia

  Your doctor may call it mastalgia, mammalgia, mastodynia, or simply breast soreness. Even before you became pregnant you may have experienced changes in your breasts. [momsintofitness.com]

• Large Breast

  Ultrasound-Guided Percutaneous Catheter Drainage of Large Breast Abscesses in Lactating Women: How to Preserve Breastfeeding Safely. Breastfeed Med. 2016 Dec. 11:555-556. [Medline]. Barbosa-Cesnik C, Schwartz K, Foxman B. Lactation mastitis. [emedicine.medscape.com]

• Neglect

  ADVANCES IN KNOWLEDGE: Mastitis is often neglected because of the lack of typical clinical signs and symptoms. [ncbi.nlm.nih.gov]

  A neglected but essential ingredient of breast-feeding. Obstet Gynecol Clin North Am 1987 ; 14 : 623 –33. 19. Schwartz K, d'Arcy HJ, Gillespie B, et al. Factors associated with weaning in the first three months post-partum. (In press). 20. [aje.oxfordjournals.org]

• Meningism

  S. pneumoniae is a leading cause of respiratory tract infections and meningitis in both children and adults. [jmedicalcasereports.biomedcentral.com]

The diagnosis should be made rather easily based on clinical findings [5]. It is important to identify the causative agent, however and cultivation of aspirated samples should be performed, the primary reason being determination of optimal antimicrobial therapy due to the growing issue of antimicrobial resistance, particularly in the setting of MRSA [3].

• Pericardial Effusion

  Effusion & Cardiac Activity. [books.google.com]

• Streptococcus Pneumoniae

  Streptococcus pneumoniae is an extremely rare cause of mastitis. [jmedicalcasereports.biomedcentral.com]

  These include fungi such as Candida albicans, as well as group A beta-hemolytic Streptococcus, Streptococcus pneumoniae, Escherichia coli, and Mycobacterium tuberculosis. 7, 11 Complications One of the most common complications of mastitis is the cessation [aafp.org]

Antimicrobial therapy is the mainstay of puerperal mastitis treatment. For non-MRSA organisms, dicloxacillin (500 mg PO q6h) or cephalexin (500 mg PO q6h) are given in the outpatient setting, whereas nafcillin or oxacillin 2 g IV q4-6h is recommended once patients are admitted [4]. When MRSA is suspected, trimethoprim-sulfamethoxazle (TMP-SMX) is given as a double-strength tablet every 12 hours [4]. Alternative regimens include clindamycin 300 mg PO q6h for outpatients, while intravenous vancomycin 1 gm q12h is recommended in hospital conditions [4]. If an abscess in the breast has developed, surgical drainage or needle aspiration, in addition to antibiotic therapy, is necessary [5]. In addition to antibiotics and surgery, non-steroidal anti-inflammatory drugs (NSAIDs) should be given to reduce the symptoms provoked by inflammation [3].

The prognosis is good with early therapy, but complications may occur, most notable being breast abscess [2], while rare cases have described sepsis as a complication, suggesting the importance of an early diagnosis.

The most important causative agents of puerperal mastitis are Staphylococcus aureus and coagulase-negative staphylococci (CoNS) [1], whereas Streptococcus pyogenes, Escherichia coli, Bacteroides sp., Pseudomonas aeruginosa, Proteus mirabilis and Corynebacterum sp. (rare) are other notable pathogens [4] [7]. Unfortunately, an increased frequency of Methicillin-resistant S. aureus (MRSA) infection has been observed [6].

Overall prevalence of puerperal mastitis ranges between 10% in the United States, 15-20% in Australia and up to 24% in Finnish women [1] [2]. Risk factors associated with mastitis are nipple damage, maternal fatigue, milk stasis, history of mastitis, use of an antifungal nipple cream and an increased frequency of breastfeeding [2]. Some studies have determined that African American women are at a higher risk for the development of a breast abscess, as are obese women and cigarette smokers [7].

Bacterial colonization of the breast and its connective tissue is the principal event in the pathogenesis of puerperal mastitis. Presumably, milk stasis, nipple damage and other factors promote invasion of microbial organisms into the breast, leading to acute inflammation and the appearance of symptoms.

Complete emptying of the breast, optimization of breastfeeding techniques and a reduction in breastfeeding frequency (< 10 times per week) are strategies that can reduce the risk for mastitis [2] [5], but so far, neither of the mentioned strategies have been confirmed in large-scale studies [3].

Puerperal (or lactation) mastitis is a term that describes inflammation of the interlobular connective tissue within the mammary gland during puerperium - the first 6 weeks postpartum [1]. Most common causes are Staphylococcus aureus, coagulase-negative staphylococci (CoNS) and other bacterial pathogens, but microbial invasion may not be the cause in all cases [2]. Approximately 10-25% of women develop puerperal mastitis in different parts of the world and risk factors include nipple damage, milk stasis, previous history of mastitis and an increased breastfeeding frequency [2]. Clinical signs are fever, chills, fatigue, and the presence of a tender, edematous, erythematous area of the breast that is inflamed and painful [1]. The diagnosis is made on clinical grounds and cultivation of aspirated breast fluid should be performed to identify the causative agent [3]. Antibiotics are the mainstay of therapy, but it is imperative to conduct antimicrobial susceptibility testing, to initiate optimal treatment and to avoid the risk of resistance [4]. Mastitis does not pose a risk for the infant and breastfeeding should not be ceased during the infection [5], but it is important to recognize the condition early on and treat it appropriately, as breast abscesses (but also sepsis) can occur.

Puerperal mastitis is a term that describes inflammation of breast tissue in the first 6 weeks after delivery (known as the puerperium). In most cases, bacterial organisms such as Staphylococcus aureus cause an infection that leads to inflammation. Approximately 10% of women in the United States develop puerperal mastitis, while somewhat higher rates (15-25%) have been observed in Australia and Finland. Various risk factors have been described - nipple damage, milk stasis, previous history of mastitis and increased breastfeeding frequency, all promoting colonization of breast tissue with bacteria. Symptoms include high fever, fatigue and a painful, red, swollen and tender area of the breast that makes the condition easy to recognize. Nevertheless, it is necessary to identify the organism responsible for the infection, in order to determine optimal antibiotic therapy, the mainstay of treatment. In rare cases, breast abscesses and even sepsis can ensue, which is why early recognition of the infection is vital. Preventive strategies such as complete emptying of the breast, reduced breastfeeding frequency and correction of breastfeeding techniques have been proposed, but their true effects are yet to be confirmed.

1. Amir LH, Forster DA, Lumley J, McLachlan H. A descriptive study of mastitis in Australian breastfeeding women: incidence and determinants. BMC Public Health. 2007;7:62.
2. Foxman B, D'Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002;155:103-114.
3. Bharat A, Gao F, Aft RL, et al. Predictors of primary breast abscesses and recurrence. World J Surg. 2009;33(12):2582-2586.
4. Schoenfeld EM, McKay MP. Mastitis and methicillin-resistant Staphylococcus aureus (MRSA): the calm before the storm? J Emerg Med. 2010;38(4):e31-34.
5. Spencer JP. Management of mastitis in breastfeeding women. Am Fam Physician. 2008;78(6):727-731.
6. Gilbert DN, Chambers HF, Eliopoulos GN, Saag MS. The Sanford Guide to Antimicrobial Therapy 2015. 45th ed. Antimicrobial Therapy, Inc, Sperryville, VA; 2015.
7. Cusack L, Brennan M. Lactational mastitis and breast abscess - diagnosis and management in general practice. Aust Fam Physician. 2011;40(12):976-979.