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

  Symptoms include high fever, fatigue and a painful, red, swollen and tender area of the breast that makes the condition easy to recognize. [symptoma.com]

  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]

  A number of factors can cause fever—a temperature of 38.0°C (100.4°F) or higher—in the puerperium. Most persistent fevers after childbirth are caused by genital tract infection. [accessmedicine.mhmedical.com]

• 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]

  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]

  Women often report of malaise and fatigue as well. The diagnosis should be made rather easily based on clinical findings. [symptoma.com]

  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]

  […] full musical promo — due out next week — but it's a real treat for anyone who can sympathize with lyrics like these: My boobs are swollen, red and sore / I leak a lot, then I leak some more / Fever's got me down for days / It's what the doctors call malaise [today.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]

  What do engorged breasts feel like? Engorgement can happen in one or both breasts. [medela.com]

  The added breast and nipple pain and soreness from breast engorgement can cause frustration as well. Symptoms of breast engorgement are breast fullness, firmness and nodularities that occur around the nipple or in the breast tissue. [babiesafter35.com]

  Approximately 15 percent of women who do not breast feed develop postpartum fever from breast engorgement. As discussed in Chapter 36 ( Maternal Care During the Puerperium ), the incidence of fever is lower in breast-feeding women. [accessmedicine.mhmedical.com]

  Maternal intravenous fluids and postpartum breast changes: a pilot observational study. Int Breastfeed J 10, 18 (2015). Mangesi L and Dowswell,T. Treatments for breast engorgement during lactation (Review). The Cochrane Library 9, (2010). [medela.jp]

• 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]

  The milk ducts near the nipple become inflamed, causing breast pain. There may also be a breast mass near the nipple, retraction of the nipple, or discharge. [jamanetwork.com]

  Fibroadenomas can also be confused with a breast mass. Typically, they do not become infected. Breast cancer (inflammatory breast cancer) must be considered in atypical presentations or those not responding to initial therapy. [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]

  Cat scratch disease Lupus Commonly Associated Conditions Breast abscess Diagnosis Fever and malaise Nausea ± vomiting Localized breast tenderness, heat, and redness Possible breast mass History Breast tenderness “Hot cords burning in chest wall” Physical [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

  1, 11, 12] Primary skin infections of the breast (cellulitis or abscess) most commonly affect the skin of the lower half of the breast and often recur in women who are overweight, have large breasts, or have poor personal hygiene. [3] Breast masses can [emedicine.medscape.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].

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.