Deformation 

Disease code for mkb 10 mastitis. Mastitis is its code, according to the international statistical classification of diseases

Depending on the genesis:

1. Lactation (postpartum).

2. Non-lactation.

Depending on the course of the inflammatory process:

1. Sharp.

2. Chronic.

By the nature of the inflammatory process:

1. Non-purulent:

Serous;

Infiltrative;

2. Purulent:

Abscessing;

Infiltrative-abscessing;

Phlegmonous;

Gangrenous;

Depending on the side of the lesion:

1. Left-sided.

2. Right-sided.

3. Bilateral.

Depending on the location of the abscess in the gland:

1. Subtotal.

2. Subcutaneous.

3. Inbramammary.

4. Retromammary.

By the prevalence of the process:

1. Limited (1 quadrant of the gland).

2. Diffuse (2-3 quadrants of the gland).

3. Total (4 quadrants of the gland).

The main etiological factors:

1. Microtrauma of the nipples of the mammary gland (cracks and excoriation of the nipples, damage to the skin of the gland; especially often develops in lactating primiparous mothers);

2. Lactostasis - stagnation of milk in the mammary gland:

1) Objective reasons:

Stiffness or cracked nipples;

Mastopathy;

Scarring of breast tissue after injuries and operations;

Thin long and convoluted milk ducts;

Other congenital and acquired changes in the mammary gland that interfere with milk flow;

2) Subjective reasons:

Non-compliance with the breastfeeding regimen;

Insufficient or irregular expression of milk after breastfeeding, violation of the pumping technique.

Infection into the mammary gland can penetrate endogenous or exogenous, much more often it is exogenous. The entrance gates are cracks in the nipple (50%), abrasions, eczema of the nipple, small wounds that occur during breastfeeding. At this time, there is no consensus about the direct source of infection, but it is believed that more often the source of infection is a newborn who transmits the infection to the mother during breastfeeding. Endogenous infections most often penetrate the lymphogenous route, but sometimes galactogenic and hematogenous.

In 85% of cases, mastitis is preceded by lactostasis. In most patients, its duration does not exceed 3-4 days. The combination of lactostasis and seeding with pyogenic microflora is the main cause of the onset and progression of mastitis, and lactostasis becomes a "trigger".

With incomplete expression, a significant number of microbial bodies remain in the ducts, causing lactic acid fermentation, milk coagulation and damage to the epithelium of the milk ducts. Curdled milk obturates milk passages, lactostasis occurs.

The amount of microflora that continues to develop in a confined space reaches a "critical level" and inflammation occurs. In parallel with lactostasis, the venous outflow of blood and lymph is disturbed. The swelling of the interstitial tissue increases, compresses the ducts of the adjacent lobules of the gland, which leads to the progression of lactostasis and the inflammatory process.

In 15% of patients with purulent mastitis, nipple cracks occur, which occur due to a discrepancy between excessive negative pressure in the child's oral cavity and the elasticity and extensibility of the nipple tissue. The formation and progression of nipple cracks are caused by: frequent and prolonged contact of the nipple with a bra wet from milk, which causes irritation and maceration of the skin; stiffness and lack of erection of the nipples; non-compliance with the exact time of feeding. As a result of the above, the function of the mammary gland is impaired; women are forced to give up breastfeeding and thorough pumping. Therefore, in order to prevent mastitis, it is necessary to maintain a certain rhythm of feeding and expression.

The development of lactational mastitis is also influenced by: toxicosis of the first or second half of pregnancy, anemia, nephropathy, threats of miscarriage or premature birth.

Sensitization of the organism to various drugs, staphylococcus plays a certain role in the pathogenesis of LM; autoimmune reactions organ-specific antigens (milk and breast tissue). Disturbances in the kallikrein-kinin system of the body play a certain role in the development and course of LM.

In the development of mastitis, the main role is played by Staphylococcus aureus, which in 97% of cases is sown from pus and milk. These strains are characterized by pronounced pathogenicity and resistance to many antibacterial drugs, as well as components of Staphylococcus aureus, such as protein A and teichoic acid, have a significant immunosuppressive effect. In other cases, mastitis can be caused by epidermal staphylococcus, E. coli, streptococcus, enterococcus, Proteus and Pseudomonas aeruginosa.

There is a risk group for developing LM, which includes women with the following pathology:

With a history of purulent-septic diseases;

Suffering from mastopathy;

With anomalies in the development of the mammary glands and nipples;

Those who have undergone breast trauma or surgery;

Prone to cracking of the skin and mucous membranes;

Having a pathological premenstrual syndrome, accompanied by diffuse enlargement and soreness of the mammary glands in the II phase of the menstrual cycle;

With weak labor activity, receiving oxytacin or prostaglandins (in this category, milk comes late and in large quantities);

With the pathology of pregnancy, childbirth and the immediate postpartum period.

The following factors also affect the development of LM:

1. Decrease in immunological reactivity of the organism. Food poor in proteins and carbohydrates reduces the body's resistance to infectious diseases. A pregnant woman's daily diet should include approximately 60-70% of animal proteins. To increase immunological activity, it is necessary to take vitamins A, C, and group B. Pregnant and nursing mothers need good rest and walks in the fresh air (2-3 hours a day, including before bedtime), sleep - at least 10 hours per day. Smoking and drinking alcohol are incompatible with pregnancy and the puerperium. It is necessary to create a favorable environment for the psycho-emotional mood of a woman (pregnant, lactating), which also affects the state of the immune system.

2. Lack of personal hygiene. Pregnant and lactating women need to take a warm shower and change their underwear at least twice a day (morning and evening). The mammary glands need special care. During pregnancy, it is necessary to additionally wash them with water at room temperature, followed by rubbing with a clean terry towel. This helps to harden and increase the resistance of the nipples to mechanical damage that may occur when feeding a baby. From the second half of pregnancy and in the postpartum period, daily 15-20 minute air baths for the mammary glands are useful: in summer - in direct sunlight by an open window, in winter - in combination with small doses of UFO.

3. Excessive negative pressure created in the baby's mouth during feeding is the main cause of cracks in the nipples of the mammary glands. To prevent this complication, it is recommended to periodically gently squeeze the cheek areas of the newborn corners of the mouth with two fingers in time with the sucking movements of the child. You should carefully follow the feeding technique and do not keep the baby at the breast for a long time. If the baby sucks slowly and sluggishly, it is advisable to take short breaks. After feeding, the mammary glands should be washed with warm water without soap, dried with a clean soft towel and left open for 10-15 minutes. Between the bra and the gland halo, it is necessary to put a sterile gauze napkin (or a rolled piece of sterile bandage), which is changed when soaked in milk. When caring for the mammary glands and skin of other parts of the body, do not use lotions, creams, or other products that have a scent.

4. Cracking of the nipple during feeding. For the successful treatment of cracks, it is necessary, first of all, to temporarily stop breastfeeding, to ensure that there is no prolonged contact of milk with the crack. Milk is decanted by hand into a sterile container, the baby is fed from a bottle, through a nipple, in which a small hole is made with a sewing needle hot on a fire. If the hole is made large, the baby may later refuse to breastfeed. When treating nipple cracks, sea buckthorn or rosehip oil, solcoseryl ointment (apply on a sterile gauze napkin and apply to the affected area) are used.

Prevention of lactostasis.

The following measures are related to the prevention of lactostasis:

1. Subject to special medical supervision:

All primiparous;

Women with pathology of pregnancy or childbirth;

Women with anatomical changes in the mammary glands.

2. Do not use tight bandaging of the mammary glands, which is used to stop lactation. (tight bandaging is extremely dangerous, since milk production continues for some time and lactostasis always occurs, and impaired blood circulation in the mammary gland leads to the development of severe purulent forms of mastitis).

3. Wear a cotton or cotton bra (synthetic underwear irritates the nipples and can lead to cracking). The bra should support well, but not squeeze the breast. It must be washed daily (separately from other linen) and put on after ironing with a hot iron.

4. Consider the physiological mechanisms that stimulate milk separation. Early attachment of the newborn to the breast (in the first 30 minutes after birth) activates the release of prolactin into the bloodstream and stimulates milk production.

It is possible to use a circular shower on the mammary gland 20 minutes before feeding.

Observe the correct technology for expressing milk (the manual method is most effective in terms of preventing lactostasis). Particular attention should be paid to expressing milk from the outer quadrants of the gland, where lactostasis and purulent inflammation occur more often.

Differences in the course of the inflammatory process in mastitis from that in acute purulent surgical infection of other localization.

Differences in the course of the inflammatory process in mastitis from that in acute purulent surgical infection of other localization are associated with a postpartum increase in functional activity and features of the anatomical structure of the gland.

Features of the anatomical structure of the mammary gland:

Lobular structure;

A large number of natural cavities (alveoli and sinuses);

Wide network of milk and lymphatic ducts;

An abundance of fatty tissue.

Brief anatomical characteristics of the mammary gland (according to M.G. Prives).

The mammary glands, mammae (Greek mastos), are characteristic devices for feeding newborns in mammals. The mammary glands are derivatives of the sweat glands. Their number depends mainly on the number of babies being born. Monkeys and humans have one pair of glands located on the chest, hence they are also called mammary glands. In a rudimentary form, the mammary gland remains in men for life, while in women, from the beginning of puberty, it increases in size. The mammary gland reaches its greatest development by the end of pregnancy, although lactation occurs already in the postpartum period.

The mammary gland is placed on the fascia of the pectoralis major muscle, with which it is connected by loose connective tissue, which determines its mobility. The base of its gland extends from III to VI ribs, reaching medially to the edge of the sternum. Somewhat downward from the middle of the gland, on its front surface, there is a nipple (papilla mammae), the top of which is pitted by the milky passages that open on it and is surrounded by a pigmented area of \u200b\u200bskin with a areola mammae. The skin of the areola is tuberous due to large glands embedded in it, between which large sebaceous glands lie. In the skin of the areola and nipple there are numerous smooth muscle fibers, which partly run circularly, partly longitudinally along the nipple; the latter, when they are reduced, strains, which facilitates the condition.

The glandular body itself consists of 15-20 lobi glandule mammarial, which radially converge with their tops to the nipple. By the type of its structure, the mammary gland belongs to the complex alveolar-tubular glands. All excretory ducts of one large lobule (lobus) are connected to the lactiferous duct (duktus lactiferus), which goes to the nipple and ends at its top with a small funnel-shaped opening.

Arterial blood supply (according to V.N. Shevkunenko) is carried out from the external milk artery, which is a branch of the axillary artery, as well as the intercostal arteries from the third to the sixth, the internal milk artery, a branch of the subclavian artery. It gives branches to the gland in the third, fourth, fifth intercostal spaces.

Veinspartly accompany the named arteries, partly go under the skin, forming a network with wide loops, which is partly visible through the skin in the form of blue veins.

Lymphatic vessels are of great practical interest in view of the frequent disease of the breast with cancer, the transfers of which are carried out through these vessels.

Brief topographic and anatomical characteristics of the lymphatic system of the mammary gland (according to V.N.Shevkunenko and B.N.Uskov).

Lymphatic system the mammary gland consists of two sections: superficial and deep.

From the lateral parts of the gland, lymph flows through 2-3 large lymphatic vessels passing along the pectoralis major muscle, partially along its lower edge, and flowing into the axillary lymph nodes. These vessels represent the main pathways for lymph drainage from the breast.

At the level of the third rib, these vessels often have a break in the form of one or more lymph nodes lying under the edge of the pectoralis major muscle. In these nodes, cancer metastases most often occur.

There are additional pathways for the outflow of lymph from the breast. So, part of the lymphatic vessels is directed through the thickness of the pectoralis major muscle to the deep axillary nodes located under the pectoralis minor. Part of the lymphatic vessels from the upper parts of the gland is directed, bypassing the subclavian region, to the supraclavicular region and further to the neck.

Lymphatic vessels from the internal parts of the mammary glands are sent to the nodes located behind the sternum along the internal milk artery. From here, the transition of cancer cells to the lymphatic pathways of the pleura and mediastinum is possible. The superficial lymphatic vessels of both mammary glands along their inner edges widely anastomose with each other, as a result of which cross metastases are possible.

Outflow pathways from the breast to the regional lymph nodes (according to B.N. Uskov):

· Axillary nodes;

• pectoral nodes of the pectoralis major and minor;

• chest nodes of the sternum;

· Subclavian nodes;

· Deep cervical nodes;

· Supraclavicular nodes.

In acute mastitis, two stages of the inflammatory process are distinguished: non-purulent (serous and infiltrative forms) and purulent (abscessed, infiltrative-abscessed, phlegmonous and gangrenous forms).

An acute inflammatory process begins with the accumulation of serous exudate in the intercellular spaces and leukocyte infiltration. At this stage, the process is still reversible. However, inflammation is poorly confined and tends to spread to adjacent areas of the breast. LM from serous and infiltrative forms quickly turns into purulent with simultaneous damage to new areas of gland tissue. A purulent inflammatory process is often intramammary, with the capture of two or more quadrants of the gland, often of a protracted course with frequent relapses. Among the purulent forms, infiltrative-abscessing and phlegmonous are more common.

In 10% of cases, LM has an erased (latent) course, which is due to prolonged antibiotic therapy in abscessed or infiltrative-abscessed forms.

In some cases, as a local manifestation of the body's autosensitization to organ-specific antigens (milk and inflamed tissue of the gland), breast gangrene develops. Then the inflammatory process is especially malignant, with extensive skin necrosis and rapid spread to the cellular tissue of the chest.

Purulent mastitis is always accompanied by regional lymphadenitis.

The clinical picture of acute purulent mastitis (LM) depends on the form of the inflammatory process. The following forms are distinguished: 1) serous (initial); 2) infiltrative; 3) abscess; 4) infiltrative-abscess; 5) phlegmonous; 6) gangrenous.

Serous The (initial) form is widespread in surgical practice. This form is characterized by the formation of an inflammatory exudate without any focal changes in the tissues of the gland. The disease begins acutely with the appearance of pain, a feeling of heaviness in the mammary gland, chills, an increase in body temperature to 38 ° C and above. Objectively: the gland is increased in volume, there is a slight hyperemia of the skin in the area of \u200b\u200binflammation. Palpation in the area of \u200b\u200bhyperemia is painful. The amount of expressed milk has been reduced. In the blood there is moderate leukocytosis and increased ESR. The microscope shows accumulations of leukocytes around the blood vessels. With a favorable course of the disease, the serous form can take on an abortive character; with inadequate and ineffective treatment, this form progresses with the development of the following phases and complications.

Infiltrative the form of mastitis is a continuation of the first and may be its brief manifestation. Usually it proceeds according to the aseptic option, and with inadequate treatment it turns into various purulent complications. With this form, patients present the same complaints as with serous, the above symptoms persist, but in the tissues of the gland a painful infiltration is determined without clear boundaries, areas of softening and fluctuations. High body temperature and chills in both serous and infiltrative forms are caused by lactostasis, in which milk, which has a pyrogenic effect, is absorbed into the blood through the damaged milk ducts. When carrying out desensitizing therapy and stopping lactostasis, in most patients the temperature drops to 37.5 ° C. In the absence of treatment and inadequate therapy, serous and infiltrative forms of mastitis turn into purulent after 3-4 days.

Abscessing the form is characterized by the appearance of a focus of softening and melting with the formation of a delimited purulent cavity. With this form, the state of health of patients worsens, general and local symptoms become more pronounced, intoxication increases; body temperature above 38 ° C; increased edema and hyperemia of the skin of the mammary gland. Objectively: a sharply painful infiltrate (abscess) delimited by a pyogenic capsule is palpated in the mammary gland; in 50% of patients, it occupies more than one quadrant; in 60% - the abscess is located inbramammary, less often - subareolar or subcutaneous; 99% have a positive fluctuation symptom; often in the center of the infiltrate there is a softening site.

Infiltrative - abscessing the form of mastitis is more severe than the abscessed form. It is characterized by: an increase in body temperature up to 38 ° C and above, pronounced hyperemia, edema, independent and palpation pain; in the tissues of the gland, a dense infiltrate is determined, consisting of many small abscesses of various sizes according to the type of "honeycomb" (therefore, the symptom of fluctuation is positive in 5% of cases). In 50%, the infiltrate occupies no more than two quadrants of the gland and is located intramammary.

Phlegmonous the form is characterized by a deterioration in the general condition and pronounced signs of intoxication. Pain in the mammary gland increases, weakness increases, appetite decreases, the skin becomes pale, body temperature ranges from 38 ° C (in 80% of patients) and more than 39 ° C (in 20%). Objectively: the mammary gland is sharply increased in volume, edematous, sharp hyperemia of the skin, in places with a cyanotic shade; the nipple is often retracted. On palpation, the gland is tense, sharply painful, the tissues are pasty, in 70% of patients, the symptom of fluctuation is positive. In 60% of patients, 3-4 quadrants are immediately involved in the inflammatory process. In the clinical analysis of blood: the number of leukocytes is increased, the hemoglobin of the blood is decreased, the shift of the blood formula to the left. In the clinical analysis of urine, albuminuria is noted, the presence of granular casts.

When gangrenous the form of the patient's condition is defined as extremely severe, there is extensive necrosis of the skin and deep-lying tissues. This form is more common in patients who seek medical help late. The purulent process proceeds with a rapid fusion of tissues and spread to the cellular spaces of the chest and is accompanied by a pronounced systemic inflammatory reaction. In most patients, the temperature is above 39 ° C. General and local symptoms of the disease are pronounced, fluctuation is determined in 100% of cases.

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MASTITIS honey.
Mastitis is an inflammation of the breast. Prevailing age
Mastitis of newborns occurs in the first days of life as a result of infection of hyperplastic glandular elements
Postpartum Mastitis - During Breastfeeding
Periductal mastitis (plasmacytic) - more often during menopause.
Prevailing gender
Mostly women are ill
Juvenile mastitis - in adolescents of both sexes during puberty.

Classification

With the flow
Acute: serous, purulent (phlegmonous, gangrenous, abscessing: subareolar, intramammary, retromammary)
Chronic: purulent, non-purulent
By localization - intracanalicular (galactophoritis), periductal (plasmacytic), infiltrative, diffuse.

Etiology

Lactation (see)
Carcinomatous
Bacterial (streptococci, staphylococci, pneumococci, gonococci, often in combination with other coccal flora, Escherichia coli, Proteus).

Risk factors

Lactation period: violation of the outflow of milk through the milk ducts, cracked nipples and areola, improper care of the nipples, violations of personal hygiene
Purulent diseases of the skin of the mammary gland
Mammary cancer
Diabetes
Rheumatoid arthritis
Silicone / Paraffin Breast Implants
Taking glucocorticoids
Removal of breast tumor followed by X-ray therapy
Long-term smoking experience.

Pathomorphology

Squamous metaplasia of the epithelium of the mammary glands
Intraductal hyperplasia of the epithelium
Fat necrosis
Dilation of the ducts of the mammary glands.

Clinical picture

Acute serous mastitis (may progress with the development of purulent mastitis)
Sudden start
Fever (up to 39-40 ° C)
Severe pain in the mammary gland
The gland is enlarged, tense, the skin over the focus is hyperemic, on palpation - a painful infiltrate with indistinct boundaries
Lymphangitis, regional lymphadenitis.
Acute purulent phlegmonous mastitis
Severe general condition, fever
The mammary gland is sharply enlarged, painful, pasty, the infiltrate without sharp boundaries occupies almost the entire gland, the skin over the infiltrate is hyperemic, has a bluish tint
Lymphangitis.
Acute purulent abscessing mastitis
Fever, chills
Pain in the gland
Mammary gland: reddening of the skin over the lesion, retraction of the nipple and skin of the mammary gland, sharp pain on palpation, softening of the infiltrate with the formation of an abscess
Regional lymphadenitis.

Laboratory research

Leukocytosis, increased ESR
A bacteriological study is needed to determine the sensitivity of microorganisms to antibiotics.

Special studies

Ultrasound
Mammography (breast cancer cannot be completely ruled out)
Thermal imaging research
Breast biopsy.

Differential diagnosis

Carcinoma (inflammatory stage)
Infiltrative breast cancer
Tuberculosis (may be associated with HIV infection)
Actinomycosis
Sarcoid
Syphilis
Hydatid cyst
Sebaceous cyst.

Treatment:

Conservative therapy
Isolation of mother and child from other mothers and newborns
Stopping breastfeeding with the development of purulent mastitis
Dressing for hanging the mammary gland
Dry heat to the affected mammary gland
Expression of milk from the affected gland to reduce engorgement
If expression is not possible, bromocriptine is prescribed to suppress lactation at 0.005 g 2 r / day for 4-8 days
Antimicrobial therapy: erythromycin 250-500 mg 4 r / day, cephalexin 500 mg 2 r / day, cefaclor 250 mg 3 r / day, amoxicillin-clavulanate (augmentin) 250 mg 3 r / day, clindamycin 300 mg 3 r / day (with suspicion of anaerobic microflora)
NSAIDs
Retromammary novocaine blockade.

Surgery

Aspiration of contents under ultrasound guidance
Lancing and draining the abscess with careful separation of all bridges
Operating incisions
With subareolar abscess - along the edge of the areola
Intramammary abscess - radial
Retromammary - along the submammary fold
With a small size of an abscess, it is possible to excision it with adjacent inflammatory modified tissues by the type of sectoral resection with active drainage of the wound with a double-lumen tube and suturing tightly
Opening of all fistulous passages
With the progression of the process - removal of the gland (mastectomy).

Complications

Fistula formation
Sepsis
Subpectoral phlegmon.
The course and prognosis are favorable
Full recovery occurs within 8-10 days with adequate drainage
After operations, scars remain, disfiguring and deforming the mammary gland.

Prevention

Thorough care of the mammary glands
Maintaining feeding hygiene
Using emollient creams
Expressing milk.

Synonyms

Mastitis
see also

ICD

N61 Inflammatory diseases of the breast

Handbook of diseases. 2012 .

Synonyms:

See what "MASTIT" is in other dictionaries:

    Mastitis - ICD 10 N61.61. ICD 9 611.0611.0 DiseasesDB ... Wikipedia

    MASTITIS - (breast) inflammation of the mammary gland. Mastitis usually occurs as a result of the penetration (through the cracked nipples) of pyogenic microbes into the mammary gland. Most often it occurs in lactating women and pregnant women With mastitis, it suddenly rises ... ... Brief Encyclopedia of Household

    mastitis - Breastfeeding Dictionary of Russian synonyms. mastitis n. breastfed Dictionary of Russian synonyms. Context 5.0 Informatics. 2012. mastitis ... Synonym dictionary

    MASTITIS - MASTITIS, breast, mastitis, mammitis, mas tadenitis (from the Greek mastos female breast), inflammation of the breast. Distinguish between acute and hron. inflammatory processes. Acute inflammation of the breast can occur at all periods of life, but more often ... ... Big medical encyclopedia

    mastitis - a, m. mastite mastos breast, nipple. Inflammation of the mammary gland. Krysin 1998. Lex. Michelson 1866: mastitis; BASS 1: suits / t ... Historical Dictionary of Russian Gallicisms

    mastitis - MASTIT, colloquial. decrease breast ... Dictionary-thesaurus of synonyms for Russian speech

    MASTITIS - (from the Greek mastos nipple breast) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection penetrating through cracked nipples; occurs more often in the postpartum period ... Big Encyclopedic Dictionary

    MASTITIS - MASTIT, ah, husband. Inflammation of the breast. | adj. venerable, oh, oh. Ozhegov's Explanatory Dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Ozhegov's Explanatory Dictionary

    Mastitis - (from the Greek mastos nipple, breast) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection penetrating through cracked nipples; occurs more often in the postpartum period. ... Illustrated Encyclopedic Dictionary

    Mastitis - I Mastitis (mastitis; Greek mastos breast + itis; synonym breast) inflammation of the parenchyma and interstitial tissue of the mammary gland. Distinguish between acute and chronic mastitis. Depending on the functional state of the mammary gland (Breast) (presence of ... Medical encyclopedia

    MASTITIS - (breast), acute or chronic inflammation of the mammary gland, usually associated with its infection during lactation. MASTITIS IN HUMAN Mastitis usually occurs in women, although occasionally cystic breast disease occurs in men. Sharp ... ... Collier's Encyclopedia

Books

  • Acute purulent lactation mastitis, A. P. Chadaev, A. A. Zverev. The book covers the issues of etiology and pathogenesis, clinic, prevention and treatment of acute purulent lactational mastitis, as well as the principles of surgical treatment depending on various forms ...

Mastitis in newborns is an inflammation of the mammary gland in a baby one month after birth. This process also occurs in older children, but more often in newborns due to the peculiarities of the structure and functioning of the mammary gland. Any inflammatory process in such a baby threatens with serious complications and generalization of inflammation, which is why the problem of mastitis is so important for timely diagnosis.

ICD-10 code

P39.0 Neonatal infectious mastitis

Epidemiology

The epidemiology of mastitis in newborns is such that about 65% of all babies in the first month of life suffer from physiological mastopathy, and about 30% of cases are complicated by purulent mastitis. The death rate from purulent mastitis is 1 in 10 cases of the disease, which is an incredibly large figure, despite the availability of new modern methods of treatment. About 92% of mastitis cases are primary, caused by exogenous entry of the pathogen through cracks or scratches in the nipple. Such data allow you to prevent the disease by simple conversations with parents about the rules of caring for a child, which will reduce the amount of mastitis.

Causes of mastitis in newborns

Mom is the first person who notices any changes in the health of her baby. Mastitis develops very quickly in such a child, so it is sometimes difficult to pinpoint the exact cause. But you definitely need to know about all possible factors that affect the development of mastitis, so that it is the mother who can prevent their development.

The mammary glands in a newborn child have their own anatomical and physiological characteristics. The mammary gland consists of glandular tissue, loose connective tissue, and milk ducts. In newborns, it lies on a large "fat pad", which consists of connective tissue, which has a loose structure. The milk ducts themselves are not very developed, but they have a slight branching in the radial direction. Under the influence of mother's hormones, the synthesis of myocytes and connective tissue cells may be activated just before childbirth, which, some time after birth, gives clinical manifestations of physiological engorgement of the mammary glands. This process is considered normal and is not accompanied by inflammation. A small amount of secretion, colostrum, may even be released from the nipple, which is also not a pathology. But often parents, out of inexperience or simply through negligence, injure the gland or try to somehow treat engorgement, squeezing out a secret. This is often the main cause of mastitis, as the primary complication of physiological mastopathy.

The pathogenesis of the development of the inflammatory process lies in the fact that at the slightest cracks in the nipple or on the halo, bacteria that are on the surface of the skin enter the gland tissue. This leads to the activation of the immune defense and leukocytes are activated in this place where bacteria enter. After this, an active immune response begins and the inflammatory process causes symptoms. But the peculiarity of the structure of the mammary gland of newborns is a large amount of loose connective tissue, which in turn allows the inflammatory process to instantly spread further with rapid damage to other tissues. Such features of the pathogenesis of the development of mastitis lead to the early appearance of complications, which must be taken into account in timely diagnosis.

Another common cause of mastitis in newborns is improper skin care of the baby. This group of reasons includes not only insufficient hygiene measures, but also excessive care. This term means that often mothers massage the child incorrectly, or try to wash it thoroughly by rubbing the skin with a washcloth. These are all additional factors of trauma, and as a consequence - the entrance gate for infection. Therefore, a healthy newborn child does not need such activities, a light bathing in water without rubbing is enough.

The cause of mastitis can be not only a local inflammatory reaction, but also a systemic one. For example, a child with a sore throat or otitis media that is not diagnosed in time may have the spread of the infection by the lymphogenous or hematogenous route. At the same time, against the background of a weakened immunity or in premature babies, there may be a generalization of the infection with the development of mastitis secondary to angina.

Speaking about the causes of mastitis in newborns, it is necessary to highlight the main etiological factors in children of this age. The cause is more often streptococci, staphylococci, enterococci. This is important not only for diagnostic purposes, but also for the choice of treatment tactics.

The causes of mastitis in a newborn are pathogenic bacteria that cause inflammation. To date, the etiological significance in the development of mastitis are group B streptococci (which are a common cause of mastitis in newborns), group C (they are the cause of sepsis in newborns). Since the 80s, the number of diseases, pyogenic infections caused by coagulase-negative strains of staphylococci St. epidermidis, St. saprophiticus, St. hemoliticus, St.xylosus, that is, the species composition of staphylococci changes. Therefore, the division of staphylococci into "pathogenic" and "non-pathogenic" today is conditional. The pathogenic effect of staphylococci is explained by their ability to release toxins (lethal toxin, enterotoxin, necrotoxin, hemotoxin, leucocidin) and aggression enzymes (coagulase, fibrinolysin, hyaluronidase), which greatly facilitate the spread of the pathogen in the tissues of the infant's body. In addition, most pathogenic strains secrete penicillinase, cephalosporinase, which destroy penicillins, cephalosporins in conventional therapeutic doses.

Further, next to staphylococcal infection, which occurs in newborns in 45-50% of mastitis and other skin infections, the proportion of gram-negative flora increases. Outbreaks begin to appear caused by Escherichia coli, Klebsiella, Serration, Proteus, Pseudomonas aeruginosa (in 30-68%), their association. Gram-negative opportunistic flora has a pronounced biological plasticity, which allows them to adapt to different ecological niches. Some of them: Escherichia coli, Klebsiela, Proteus, Enterobacter are representatives of normal human microflora, others serration, pseudomonas are mainly found in the environment. They can cause in newborns various pathological processes in addition to mastitis omphalitis, enteritis, pneumonia, conjunctivitis, meningitis, sepsis. Of particular danger are hospital strains that form in hospitals as a result of the wide, often irrational use of broad-spectrum antibiotics. As a result, strains with high resistance to antibiotics and disinfectants are formed.

Another feature of the etiological flora of mastitis is the presence of pathogenic factors in bacteria (enterotoxigenicity, adhesiveness), enzymes of aggression (proteases, DNAases), hemolytic activity, which enhance their pathogenic potential. A feature is their resistance to the external environment (their ability to stay and reproduce for a long time in the external environment at low temperatures). Humid places are especially favorable for them: toilets, sinks, soap dishes, brushes for washing hands, and resuscitation equipment. All this contributes to their widespread distribution in a hospital setting and is a risk factor for the development of mastitis in a child when it is infected in the hospital.

Thus, the cause of the development of mastitis in newborns is bacteria that can represent the normal flora of the child or can be infected with them from the external environment. But in this case, a prerequisite for the development of inflammation in the baby's mammary gland is the presence of an incoming gate for infection. This can be a scratch or damage to the skin of the mammary gland, a crack in the nipple during physiological engorgement, which allows the pathogen to get under the skin and contributes to the further development of the inflammatory process.

The causes of mastitis in newborns are directly related to external factors, so proper care of the baby during this period is very important.

Risk factors

Risk factors for developing mastitis:

  1. a premature baby has a reduced protective function of the immune system, which allows the purulent process to spread faster;
  2. physiological engorgement of the mammary glands may be a prerequisite for the development of mastitis;
  3. trauma to the skin of the breast or nipple;
  4. previous operations in a child with a long hospital stay and contact with the hospital flora;
  5. unfavorable obstetric history: prolonged infertility, somatic diseases, extragenital pathology;
  6. pathological course of pregnancy, threat of termination, urogenital diseases, ARVI, exacerbation of chronic foci, prolonged hypoxia;
  7. pathological course of childbirth, premature labor, prolonged anhydrous period, obstetric interventions, t in childbirth;
  8. the need for resuscitation and intensive care, mechanical ventilation, intubation, catheterization of the great vessels, th food;
  9. artificial feeding from the first days.

Thus, mastitis can develop in an absolutely healthy baby without signs of pathology after birth, and the main factor in this case is infection with the bacterial flora.

Pathogenesis

The pathogenesis of the formation of inflammation of the mammary gland in a newborn child is based on the features of the development of the gland in children after birth. After birth, every child's organs and systems adapt to the conditions of the external environment. One of these states of adaptation of a child is a sexual crisis. The emergence of a hormonal crisis is due to the action of the mother's estrogenic hormones, which, starting from the 7th month of gestation, pass from mother to fetus in utero.

One of the manifestations of a sexual crisis is a symmetrical swelling of the mammary glands, which appears on days 2-4 of a child's life, and reaches a maximum value up to 6-7 days. This phenomenon is observed in both girls and boys. The mammary glands, as a rule, are slightly enlarged, sometimes they swell to the size of a walnut. The skin above them strains, may become hyperemic. When pressed, a whitish fluid resembling colostrum is released from the glands. Against this background, mastitis mainly develops. For this, a prerequisite for the inflammation process must be the penetration of pathogenic bacteria into the breast tissue. Only this implies further development against the background of physiological mastopathy - mastitis.

Susceptibility to infections in newborns is high, which is predetermined by the anatomical and physiological characteristics of the newborn's skin and their reduced immunological reactivity, imperfection of the nonspecific defense system:

  1. Low phagocytic activity of leukocytes, complement activity, low lysozyme levels impair the penetration of the epithelial-endothelial barrier defense
  2. Specific protection is provided by the humoral and cellular link of immunity, which also has its own characteristics that contribute to the development of mastitis in newborns:
    1. low synthesis of own Ig G, secretory Ig A;
    2. the predominance of the synthesis of Ig M macroglobulin, which, due to its structure, does not have sufficient protective properties;
    3. low cytotoxic activity of T-lymphocytes, insufficiency of the cellular link.

Symptoms of mastitis in newborns

The first signs of mastitis in a newborn may appear against the background of physiological mastopathy. Then there is a violation of the general condition of the child, moodiness or even severe anxiety. After a few hours, you can see the already objective symptoms of mastitis. The gland itself increases significantly in size, the skin above it becomes red or even tinged with blue. If you taste a baby's breast, he will react instantly, as this is accompanied by severe pain. If an abscess has formed, then you can feel how pus moves under the fingers during palpation - a symptom of fluctuation. This process is usually one-sided. Discharge can also be from the nipple on the affected side in the form of green or yellow pus. These are the main symptoms that indicate a local inflammatory process. They develop very quickly, sometimes over several hours. But it is not always possible to detect such changes. Sometimes the first symptom may be a significant increase in body temperature. Then the child screams, sometimes there may be convulsions against the background of this.

Mastitis in newborn girls and boys is equally common and the symptoms do not differ either. But the stages of the inflammatory process are distinguished, which differ in manifestations. The dynamics of the stages can not always be traced in newborns, since the process quickly moves from one to another.

Serous mastitis is an inflammation characterized by initial changes in breast tissue and the accumulation of serous secretions. This stage is characterized by the initial manifestations of the disease in the form of a violation of the general condition and swelling of the gland. There may not yet be a change in skin color, but body temperature may rise.

The infiltrative stage occurs when an active immune response in the tissue of the gland is accompanied by infiltration and the formation of a diffuse focus. This is already manifested by skin redness, pain, high body temperature. Further, the foci of infiltration merge and the number of dead leukocytes forms pus, which leads to the next stage.

Purulent mastitis of a newborn is characterized by an extreme degree of severity of symptoms against the background of a massive infectious process, which can easily spread to tissues located deeper.

Forms

The types of mastitis are classified according to the stages, which is sometimes difficult to distinguish due to the rapid dynamics in such children. Therefore, the main task of the mother is the timely immediate appeal to the doctor if there are symptoms of redness or enlargement of one gland with a violation of the general condition of the child.

Symptoms of mastitis in a newborn depend on the stage of the disease. There are several types of breast inflammation.

  1. According to the clinical course.
    1. Acute:
      1. stage of serous inflammation;
      2. infiltrative (phlegmonous) form;
      3. stage of abscess formation;
      4. gangrenous.
    2. Chronic:
      1. nonspecific;
      2. specific.
  2. By localization:
    1. Subareolar
    2. Antemamar (premamar).
    3. Intramamar:
      1. parenchymal
      2. interstitial.
    4. Retromamarium.
    5. Panmastitis.

In newborns, one mammary gland is often involved in the process and all at once, so we are talking about panmastitis. The first signs of the disease are manifested by local symptoms. The onset of the disease is usually acute. In most cases, the disease begins with the appearance of hardening of the mammary gland, rapidly increasing pain. The pain is intense, can be pulsating in nature, does not radiate, increases with palpation of the gland. This inflammatory process causes an early rise in body temperature to high numbers (39-40). As a result of the inflammatory process, weakness, anxiety of the baby, and a shrill cry develop. Further, there is a pronounced hyperemia and fluctuation of the skin over the site of inflammation. The general condition is disturbed, intoxication syndrome is expressed, appetite is reduced, sluggish sucking. Going through successive stages of the disease, at the stage of formation of a gangrenous or phlegmonous process, the child's condition can be significantly aggravated. The body temperature rises rapidly, which cannot be reduced. The child begins to refuse food, he may constantly sleep or, on the contrary, screams. The skin may show a dark gray or blue color of the inflammatory process, which can show through the thin skin of the child. The inflammatory process spreads very quickly and the child's condition can worsen in a few hours. Therefore, purulent mastitis in a newborn occurs most often when the process quickly passes from the serous stage to the stage of purulent inflammation. This plays a huge role in the treatment and choice of tactics at every stage of the disease.

Complications and consequences

Complications of mastitis can be generalization of the infection with the development of sepsis literally in a matter of hours, so it is simply necessary to start treatment immediately after the diagnosis is made. The consequence of the operation may be a violation of lactation in the future, if it is a girl, but such consequences are not comparable to the health of the baby. The prognosis can be very serious, therefore it is necessary to prevent such a pathology.

Diagnosis of mastitis in newborns

Diagnosis of mastitis is not difficult, even by its external characteristics. First you need to listen to all the complaints of the mother and find out how the symptoms developed. The benefit of mastitis is evidenced by a high body temperature, an acute onset of the disease, a violation of the child's condition.

On examination, the diagnostic signs of pathology are very simple - an enlarged hyperemic mammary gland is visible, sometimes the local temperature can be increased. On palpation, it can be noted that the child begins to scream and fluctuations or uneven consistency can be felt due to the accumulation of pus.

As a rule, the diagnosis is not in doubt in the presence of such objective symptoms. Complementary testing for a newborn baby can be challenging. Therefore, if the child was healthy before, then they are limited to general clinical analyzes. Changes may be characteristic of severe bacterial infection with high leukocytosis and increased ESR. But the absence of changes in the blood test does not exclude acute bacterial inflammation, since due to the immaturity of the immune system, there may not be a pronounced reaction.

Instrumental diagnostics of mastitis is not often used, since there is no need for a pronounced clinic. Therefore, only for the purpose of differential diagnosis, ultrasound examination can be performed.

Thermography: zones with local temperature rise are formed.

An invasive study with a biopsy of the site of inflammation and laboratory examination of exudate, determination of the sensitivity of microflora to antibiotics is one of the most specific methods for further conservative diagnosis. This allows you to accurately determine the pathogen and, if necessary, prescribe those antibacterial drugs to which the pathogen is precisely sensitive.

Differential diagnosis

Differential diagnosis of mastitis in newborns should primarily be carried out with physiological mastopathy. Physiological "mastitis" is characterized by a symmetrical enlargement of the gland to a small size. There is no discoloration of the skin and it is not a concern for the child. At the same time, the baby's appetite is saved, sleep is not disturbed, he gains enough weight, the stool is normal, and there are no signs of intoxication. And with purulent mastopathy, the symptoms are the opposite.

Mastitis also needs to be differentiated from erysipelas of the skin caused by hemolytic streptococcus. Erysipelas is an inflammation of the skin with clear boundaries of the process and a gradual onset of the disease. It causes a gradual and moderate rise in body temperature without other general symptoms. The child's appetite and sleep is usually preserved, in contrast to mastitis.

Treatment of mastitis in newborns

Treatment of mastitis is complex - it is imperative that such young children use surgery and massive antibacterial therapy.

Treatment tactics depend on the stage of the disease and the spread of the inflammatory process. At the initial stages of the disease, serous and infiltrative, complex conservative therapy is carried out; when an abscess and a purulent focus are formed, surgical intervention is performed.

Conservative treatment.

  1. Mode: bed; for the baby's mammary gland, it is necessary to provide it with the minimum conditions for trauma with the help of a suspensor, which should hold the gland, and not squeeze it.
  2. Locally chill an ice pack through gauze onto the affected gland for 20 minutes every 1-1.5 hours.
  3. Retromamar novocaine blockade: 70-80ml of 0.25-0.5% solution of novocaine + antibiotic in newborns is rarely carried out due to the complexity of the technique.
  4. Antibiotic therapy according to modern principles of its conduct and after bacterial analysis and flora sensitivity studies.
  5. Stimulation of the body's defenses: the introduction of antistaphylococcal J-globulin, immunomodulators, autohemotherapy.
  6. Gland massage.

Treatment of mastitis in a newborn with medication involves the use of two broad-spectrum antibiotics. For this purpose, you can use the following preparations:

  1. Ampicillin is an antibiotic from the aminopenicillin group that acts on most microorganisms that can cause skin inflammation and mastitis in newborns. The drug destroys the bacterial wall and neutralizes the cell membrane, disrupting its reproduction. The dosage of the drug for infants is at least 45 milligrams per kilogram of the child's body weight. The course of treatment is at least one week. Method of application - in the form of a suspension, dividing the daily dose into three doses. Side effects can be in the form of allergic reactions, as well as diarrhea due to the effect of newborns on the intestines. Precautions - do not use if you have a history of allergies to this group of drugs.
  2. Amikacin is an aminoglycoside antibiotic widely used in combination with ampicillin to treat mastitis. The mechanism of action of the drug is associated with disruption of the ribosomes and disruption of the inclusion of amino acids in the RNA chain. This leads to the death of the bacterial cell. For newborns with mastitis, it is advisable to use one antibacterial drug in the oral form, and the other in the parenteral form. Therefore, the recommended route of administration of this drug is intramuscular or intravenous. The dosage is 15 milligrams per kilogram in two divided doses. Side effects can be systemic or skin allergic reactions.
  3. Cefodox is a third-generation oral cephalosporin that does not die in the presence of bacteria that contain lactamases. The drug is well absorbed when taken internally and is immediately divided into fractions, circulating through the blood throughout the day. This allows you to maintain the required concentration of the drug in the inflammation focus, given that other antibiotics can poorly accumulate in the breast tissue during mastitis. The mechanism of action of the drug is to activate enzymes that contribute to the destruction of the bacterial wall and the release of bacterial endotoxin (violation of the synthesis of polysaccharides in the cell wall of the microorganism). This ensures the death of the pathogen during mastitis and prevents the development of further infection. The dosage is 10 mg / kg per day, divided into one or two doses. It is possible to combine the use of cefodox with a parenteral antibiotic from the group of macrolides or aminoglycosides, and in severe cases, with fluoroquinolones.
  4. Paracetamol is a drug used in the treatment of mastitis to reduce fever in a newborn. The main mechanism of action of paracetamol is inhibition of the synthesis of prostaglandins. These substances potentiate the inflammatory response through the synthesis of inflammatory substances. The drug blocks the release of these substances and reduces fever and other symptoms of inflammation. Also, in addition to lowering body temperature, paracetamol has an analgesic effect. For newborns, this is the only drug that can be used from the first days. Best used as a syrup. The dosage is 10-15 milligrams per kilogram of body weight at a time. You can repeat the reception at least 4 hours after the last time. The syrup is available in a dose of 120 milligrams in five milliliters, which is further calculated by body weight. Side effects from the gastrointestinal tract in the form of dyspeptic disorders, erosions and ulcers of the stomach and duodenum, may be bleeding and perforation.

Of the antibacterial agents, at least two, and sometimes three antibiotics are used, one of which must be administered intravenously.

Local treatment of mastitis is carried out depending on the phase of the inflammatory process against the background of general conservative therapy. In phase I phase of inflammation, preference should be given to multicomponent water-soluble ointments based on polyethylene oxide levosin, levomekol, oflokain. They simultaneously have antibacterial, dehydrating and analgesic effects, and due to the presence of such a component as methyluracil in their composition, they contribute to the activation of the reparative process. In the presence of areas of necrosis that were not removed during surgery, proteolytic enzymes are used. In the regeneration phase, it is advisable to use aqueous solutions of antiseptics dioxidine, chlorhexidine, furacilin.

An obligatory element of the treatment of mastitis in newborns is surgical treatment, since the accumulation of pus in such a baby quickly spreads and the disease will not be resolved without surgery. Immediately after the diagnosis is made, the child is immediately admitted to the pediatric surgical department. An operation is performed urgently under general anesthesia. The scope of the operation consists in making incisions on the skin of the affected area of \u200b\u200bthe mammary gland in a checkerboard pattern. There can be a large number of them, depending on the volume of the affected gland. The incisions are made in such a way that they are located on the verge of healthy and affected skin. Further, drainages are installed, through which such an area is actively washed. Then the drains are left for a better outflow of pus. Dressings need to be done several times a day after the operation, and the mother should monitor this. Feeding such a baby continues normally with breast milk, which provides better protection for the baby. In addition, symptomatic therapy is also used.

For drainage, preference should be given to active methods of flow-flushing, vacuum aspiration. Methods of improved surgical treatment of a purulent wound, which are used to reduce the number of microorganisms in it, should use physiotherapeutic treatment:

  • treatment of the wound with a pulsating stream of liquid;
  • vacuum wound treatment;
  • processing by laser beams;
  • sonication.

Vitamins and physiotherapy treatment can be carried out at the stage of convalescence, when it is necessary to support the baby's defenses.

Alternative treatment, herbal treatment and homeopathic remedies for mastitis are not used, since such a disease in the neonatal period has fatal consequences that develop rapidly. Traditional methods do not have such a property of rapid elimination of pus, therefore they are not recommended for use by doctors.

], ,

Inflammation in the mammary gland due to milk stagnation. A factor predisposing to the development of mastitis is nipple cracks.

Laser therapy for lactation mastitis is carried out to eliminate lactostasis and local inflammation. The tactics of treatment are determined by the form of the disease: with serous mastitis, direct laser irradiation of the breast is permissible; in the presence of purulent complications, accompanied by intoxication, fever and the presence of pus in milk expressed from the affected breast, direct laser irradiation is recommended to delimit the purulent process, which facilitates subsequent surgical intervention in the required volume.

In this case, the main therapeutic measures provide for a parallel effect on the immunocompetent organs and zones: the projection zone of the thymus, blood irradiation according to the supravenous technique in the projection of the ulnar and axillary vessels, axillary lymph nodes on the affected side.

As the acute inflammatory phenomena decrease: symptoms of intoxication, the temperature drops to normal or subfebrile values, and the tension in the mammary gland decreases, direct laser irradiation of the affected mammary gland is permissible: first in the peripheral regions, and in subsequent sessions - in the projection of the inflammation focus.

It should be recalled that during the entire period of the disease, milk from the affected mammary gland is expressed and the child is not given, and during antibiotic therapy, the child is transferred to artificial feeding during the entire period of taking antibiotics. In both types of mastitis, treatment is supplemented by irradiation of the receptor zones positioned in the projection of the outer surface of the forearm, the dorsum of the hand, the outer and front surface of the lower leg, the anterior chest wall, paravertebral zones of the spine in the projection Th1-Th7, and the collar zone.

It should be emphasized that laser irradiation of the breast has a positive effect on the quality of milk and cannot be regarded as a reason for restrictions in feeding the baby.

Modes of irradiation of treatment zones in the treatment of lactational mastitis

Irradiation area Emitter Power frequency Hz Exposure, min Nozzle
ULOK of the ulnar vessel, Fig. 116, item. "2" BIK 15-20 mW - 6-8 KNS-Up, No. 4
Breast area, fig. 116, item. "4" BI-1 6-8 watts 80-150 6-10 LONO, M1
Axillary lymph nodes, Fig. 116, item. "1" BI-1 2 watts 300-600 2 KNS-Up, No. 4
Thymus projection, Fig. 116, item. "3" BIM 35 watts 150 2 -
Spine, Th1-Th5, fig. 116, item. "five" BIM 20 watts 150-300 2-4 -
Collar area, Fig. 120, item. "1" BIK 10-15 mW - 8-10 KNS-Up, No. 4
Receptor zone BIM 20 watts 150 4 -

Figure: 116. Zones of radiation in the treatment of lactational mastitis. Legend: pos. "1" - projection of the axillary neurovascular bundle, pos. "2" - ulnar vessels, pos. "3" - thymus projection, pos. "4" - the mammary gland, the estimated area of \u200b\u200blactostasis, pos. "5" - the zone of segmental innervation of the breast.

The duration of the course of treatment is determined by positive dynamics. A regularity was noted: the earlier the treatment with the laser therapy method is started, the shorter the course duration. Treatment from the first day of illness determines the duration of the course within 3 procedures. At the beginning of the course of treatment on the 3rd day and later, the duration of the course is 8-10 procedures or more.

The choice of therapeutic tactics depends on the stage of development of the disease and involves the solution of the following tasks: maintaining or stopping lactation, fighting the causative agent of the disease, sanitizing purulent foci (in case of their formation). Patients with postpartum inflammation of the mammary glands are advised to temporarily stop breastfeeding the baby. Milk secretion is suppressed only in a small number of patients in the presence of certain indications: rapid progression of inflammation with the transition to the infiltrative phase within 1-3 days with adequate therapy, recurrence of purulent mastitis after surgery, phlegmonous and gangrenous forms, postoperative antibiotic resistance, decompensation from the side other organs and systems.
Before the transition of inflammation to a purulent form, the basis of treatment is antibacterial drugs, selected taking into account the sensitivity of the infectious agent. In addition to etiotropic therapy, pathogenetic and symptomatic agents are used that contribute to a faster recovery and prevent complications. Usually, in the treatment of the lactational form of mastitis, the following are used:
Antibiotics.The course of antibiotic therapy is prescribed immediately after the diagnosis is made and corrected according to the results of bacteriological examination data. Synthetic penicillins, cephalosporins, aminoglycosides, combined preparations, nitroimidazole derivatives are used.
Antifungal agents.Modern antibacterial drugs with a wide spectrum of action, along with pathogens, destroy the natural microflora. Therefore, antifungal drugs are indicated for the prevention of superinfection, dysbiosis and candidiasis.
Means for improving immunity.Immunomodulators, immunocorrectors, vitamin and mineral complexes are used to stimulate non-specific protection. To increase the specific reactivity, staphylococcal toxoid, anti-staphylococcal plasma and gamma globulin are used.
Antihistamines.Taking several antibiotics against the background of altered tissue reactivity often provokes allergic reactions, for the prevention of which drugs with an antihistamine effect are prescribed, and in more severe cases, glucocorticoids.
Infusion therapy.Starting with the infiltrative form of mastitis, the introduction of synthetic colloidal solutions, formulations based on dextrans, and protein preparations is shown. Medicines of these groups can correct metabolic disorders, maintain the functions of the main body systems.
Identification of purulent inflammation is a direct indication for surgical debridement of the pathological focus. Taking into account the form of the inflammatory process, the mastitis is opened and drained or an abscess punctured with subsequent drainage. Correctly performed surgical intervention allows you to stop the spread of the inflammatory process, preserve the parenchyma of the breast as much as possible, and provide an optimal cosmetic result. After the operation, the patient is prescribed a complex drug therapy.
The scheme of combined treatment of mastitis arising in the lactation period provides for the active use of physiotherapy methods. Patients with serous inflammation are shown ultrasound, ultraviolet irradiation, oil-ointment dressings with camphor or vaseline oil, balsamic liniment, butadiene ointment. With the transition of the disease to the infiltrative stage, heat loads increase. After intervention for lactational purulent mastitis, subthermal doses of UHF, suberythemal and weakly erythemal doses of UHF are recommended.

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