Breast infections

Breast infections

• 1.
  BREAST INFECTIONS
• 2.
  BREAST INFECTION NON_LACTATING LACTATING BREAST BREAST ACUTE ABSCESS BACTERIAL MASTITIS PERIDUCTAL MASTITIS with/without PERIAREOLAR ABSCESS FUNGAL- Actinomycosis of breast SUPERFICIAL TB OF BREAST BREAST INFECTION
• 3.
  LACTATING BREAST
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  CRITERIA PRESENTATION INV. MANAGEMENT LACTATING BREAST BREAST INFECTION ACUTE BACTERIAL 1. Effective MASTITIS/ • signs of acute Milk removal LACTATIONAL inflammation -proper breast MASTITIS • 74% to 95% of cases feeding method occur in the first 12 -Encourage • milk stasis weeks Frequent breastfeeding • infections -express breastmilk by hand towards nipple / •Staphylococcus Heat therapy till milk Aureus flows (from infant , ascending infection )
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  2. Antibiotic therapy -symptoms severe -a nipple fissure Is visible -symptoms do not improve after 12-24 hours 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
• 6.
  CRITERIA PRESENTATION INV. MANAGEMENT BREAST INFECTION BREAST •fever •FBC 1. Admitted to ward ABSCESS •Malaise (General indications for •Breast tenderness •CRP admission -obvious sepsis or •Swelling and hemodynamic compromise, erythema •Diagnostic needle immunocompromise •Decreased milk aspiration drainage (diabetes), rapid & progressive flow ,USS guided– infection, and failure of •Nipple discharge pus?cytology, pus outpatient antibiotic therapy) C&S 2. Supportive measures: •Milk leucocyte •Fluid – count/bacterial •analgesia : diclofenac 50 mg tds quantification, •antipyretic : paracetamol 1g bd C&S •Blood C & S 3. Effective milk removal • breastfeeding • Diagnostic breast • pump USS/MMG • heat therapy
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  4. Antibiotics (oral/IV)10-14days •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 Breast abscess presents as a hours hypoechoic fluid collection in •nafcillin : 1-2 g intravenously every 4-6 hours the tissue with the absence of •cefazolin : 1-2 g intravenously every 8 hours vascular signals.
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  6. Surgery •18- to19 gauge needle -repeated aspirations under AB +/- US •daily aspiration for 5 to 7 days guidandance • followed by ultrasound (+/-) -I & D + biopsy of abscess wallHPE 7. Supportive counselling -breastfeeding •incision and drainage -encouragement aspiration fails or large abscesses (>5 cm in diameter) 8. oral AB continued for 10 days post-op 9. TCA 1/52 10.once infection resolves MMG/ USS
• 9.
  NON-LACTATING BREAST INFECTION
• 10.
  CRITERIA PRESENTATION INV. MANAGEMENT BREAST INFECTION` Periductal -nipple discharge, (SAME AS 1. Admitted to ward mastitis/ subareolar mass/ LACTATING subareolar abscess, mammary ) 2. Supportive measures: abscess duct fistula, nipple +: •Fluid retraction, repeated •analgesia : diclofenac 50 mg tds ass. with incidence •RBS •antipyretic : paracetamol 1g bd duct ectasia •AFB 3. Antibiotics -metronidazole 400mg tds 5. Surgery •repeated aspirations under AB +/- US guidandance •I & D + biopsy of abscess wallHPE once acute phase resolves: Hadfield's operation 6. oral AB continued for 10 days post-op 7. TCA 1/52,once infection resolves MMG/ USS
• 11.
  MAMMARY DUCT FISTULA RETROAREOLA ABSCESS: ILL-DEFINED, NONCALCIFIED MASSES HIGH-DENSITY, ILL-DEFINED HETEROGENEOUS MASS WITH AN IRREGULAR MARGIN.
• 12.
  CRITERIA PRESENTATION INV. MANAGEMENT BREAST INFECTION` TB of breasts -slow growing •FBC 1. Admitted to ward -nodular, -painless mass •MANTOUX diffuse, -tubucle ulcer TEST 2. Supportive measures: sclerosing -multiple sinuses •CRP Fluid types -pulmonary/other tb •CHEST X- analgesia : diclofenac 50 mg tds sites RAY • nodular form : •Breast USS 3. Anti-TB regime •either hypoechoic with ill- •MMG 6 months of anti-TB therapy defined margins or •FNAC •2 months with a 4-drug combination complex cystic masses (ethambutol, rifampin, isoniazid, and •Culture pyrazinamide) • diffuse: • 4 months with a 2-drug combination ill-defined hypoechoic masses (isoniazid and rifampin) -low response,draining fistula: surgical • sclerosing breast tb: interventiondraining cold abscess or increased echogenecity of the mastectomy with/without axillary breast parenchyma often with clearance no definite mass is seen