BREAST INFECTION NON_LACTATING LACTATING BREAST BREAST ACUTE ABSCESS BACTERIAL MASTITIS PERIDUCTAL MASTITISwith/without PERIAREOLAR ABSCESS FUNGAL- Actinomycosis of breast SUPERFICIAL TB OF BREAST BREAST INFECTION
CRITERIA PRESENTATION INV. MANAGEMENT LACTATING BREASTBREASTINFECTIONACUTE BACTERIAL 1. EffectiveMASTITIS/ • signs of acute Milk removalLACTATIONAL inflammation -proper breastMASTITIS • 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 milkAureus flows(from infant, ascendinginfection )
2. Antibiotic therapy- symptoms severe-a nipple fissure Is visible-symptoms do not improve after 12-24hours of improved milk removalORAL• dicloxacillin, 250 mg qid•amoxicillin–clavulanic acid, 875 mg bd• a first-generation cephalosporincephalexin, 500 mg qid•methicillin-resistant S. aureus (MRSA) maynecessitate the use of trimethoprim-sulfamethoxazole, 160/800 mg bd 7 days•clindamycin, or tetracycline depending onthe patients history of infections and thelocal prevalence of MSRA3. Symptomatic Treatment-analgesia : diclofenac 50 mg tds-antipyretic : paracetamol 1g bd
CRITERIA PRESENTATION INV. MANAGEMENTBREASTINFECTIONBREAST •fever •FBC 1. Admitted to wardABSCESS •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
4. Antibiotics (oral/IV)10-14 days •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 4-6Breast abscess presents as a hourshypoechoic fluid collection in •nafcillin : 1-2 g intravenously every 4-6 hoursthe tissue with the absence of •cefazolin : 1-2 g intravenously every 8 hoursvascular signals.
6. Surgery•18- to 19 gauge needle -repeated aspirations under AB +/- US•daily aspiration for 5 to 7 days guidandance• followed by ultrasound (+/-) -I & D + biopsy of abscess wallHPE 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
CRITERIA PRESENTATION INV. MANAGEMENTBREASTINFECTION`Periductal -nipple discharge, (SAME AS 1. Admitted to wardmastitis/ subareolar mass/ LACTATINGsubareolar abscess, mammary ) 2. Supportive measures:abscess duct fistula, nipple +: •Fluid retraction, repeated •analgesia : diclofenac 50 mg tdsass. with incidence •RBS •antipyretic : paracetamol 1g bdduct ectasia •AFB 3. Antibiotics -metronidazole 400mg tds 5. Surgery •repeated aspirations under AB +/- US guidandance •I & D + biopsy of abscess wallHPE once acute phase resolves: Hadfields operation 6. oral AB continued for 10 days post-op 7. TCA 1/52,once infection resolves MMG/ USS
MAMMARY DUCT FISTULA RETROAREOLA ABSCESS: ILL-DEFINED, NONCALCIFIED MASSES HIGH-DENSITY, ILL-DEFINED HETEROGENEOUS MASS WITH AN IRREGULAR MARGIN.
CRITERIA PRESENTATION INV. MANAGEMENTBREASTINFECTION`TB of breasts -slow growing •FBC 1. Admitted to ward-nodular, -painless mass •MANTOUXdiffuse, -tubucle ulcer TEST 2. Supportive measures:sclerosing -multiple sinuses •CRP Fluidtypes -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 therapydefined margins or •FNAC •2 months with a 4-drug combinationcomplex cystic masses (ethambutol, rifampin, isoniazid, and •Culture pyrazinamide)• diffuse: • 4 months with a 2-drug combinationill-defined hypoechoic masses (isoniazid and rifampin) -low response,draining fistula: surgical• sclerosing breast tb: interventiondraining cold abscess orincreased echogenecity of the mastectomy with/without axillarybreast parenchyma often with clearanceno definite mass is seen