Acute mastitis is an infection of the breast. Occurs with predilection in young women, in circumstances of the lactation. Acute mastitis occur because of a lack of local hygiene of breast or infant glossitis (inflammatory lesions of the tongue).
Incriminated pathogens in the etiology of this disorder are usually staphylococci and streptococci.
The gateway is the nipple, which presents a suprainfected fissure. The germs reach the nipple ducts (channels carrying the milk secretion of mammary lobes and open to the nipple) where they trigger an inflammatory process which is the initial stage of a mastitis.
Clinically, acute mastitis take various forms. The most common form is acute abscess of the breast. Another clinical form of acute mastitis of the breast is the wooden phlegmon with a swollen mammary gland. Also you can meet a form of fulminant mastitis (diffuse phlegmon of the breast) when the collection stage is missing.
The onset is usually insidious but may be sudden with fever and chills. Mammary gland is enlarged, painful in a specific area. Superjacent skin (located above) are hot and congested (red).
In the next days will appear a collection (breast abscess) which is located in the area with maximum fluctuation (signs that are seen by palpation and at palpation feels like a liquid).
Regarding the evolution of acute mastitis, if untreated progress to spontaneous fistulising at the wall of formed abscess. Incomplete evacuation of pus lead to relapse. After healing, normal breast tissue is replaced by scar tissue that will subsequently cause the development of local sequelae as fibrous nodules, vicious scarring or retraction of the nipple .
Treatment of acute mastitis. It is very important the prophylactic treatment which is based on rigorous rules of hygiene, both before and after breast-feeding (nipple should be washed with soap and water before and after child feeding).
If there are any cracks in the nipple they should be followed carefully and treated with topical antiseptic solutions. Breast pump will be used to avoid stasis.
If the infection has started it is necessary to stop breastfeeding and apply compresses with antiseptic solution and take antibiotics.
When the collection is formed it must be evacuated by incision followed by drainage of abscess cavity.
Bibliography: 1. Braunwald's Heart Disease; 2. Harrison's Principles of Internal Medicine; 3. European Society of Cardiology - Clinical Practice Guidelines.