Mastitis Exams and Differential Diagnosis

Etiology of Disease

The disease is listed among the most common breast infections, and its causes remained unknown for many decades. In terms of classification, modern researchers single out two types of mastitis – lactational and non-lactational (Patel, Vaidya, Joshi, & Kunjadia, 2016). As is clear from the terms, the disease is not always related to lactation. As Patel et al. (2016) state, there are numerous research gaps when it comes to the etiology of human mastitis.

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Mastitis is regarded as a multi-etiological condition, and modern microbiologists prove that its development is related to the activity of “Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumonia” (Patel et al., 2016, p. 438). In terms of its physiological mechanism, mastitis in lactating women usually develops when the milk cannot be expressed properly (milk stasis) or is infected with bacteria (Angelopoulou et al., 2018). Various nipple traumas or cracks also play a pivotal role in its development.

Clinical Findings

Being an acute inflammation of mammary tissue, mastitis can be manifested in a variety of ways. Among its most common clinical manifestations are abnormal body temperature (it increases with the progression of inflammation), poor general health, redness of the skin, breast swelling, and acute pain (Angelopoulou et al., 2018). Also, as the disease progresses, the above-mentioned symptoms usually become worse, and it leads to the formation of pus in breast milk, which is not safe for children. The above symptoms tend to develop and worsen very quickly and are manifested in both forms of mastitis. Disregard their pregnancy status, adult women are recommended to pay increased attention to these symptoms because they are often mistaken for the symptoms of influenza (Cullinane et al., 2015).

Patient History Pertinent to the Problem

The patient medical history should be collected with special attention to well-known risk factors and symptoms. The presence of fever, redness, pain, abnormal nipple discharge and impaired milk ejection is to be paid focused attention to during medical data collection (Cullinane et al., 2015). Breastfeeding or pregnancy status of female patients should be taken into account. Apart from that, when taking a medical history, a healthcare specialist should ask specific questions to establish the presence of common risk factors.

According to the research by Cullinane et al. (2015), the development of mastitis is associated with the following risk factors: the regular use of nipple shields for breastfeeding, producing too much maternal milk, nipple traumas or piercing, and wearing too tight bras. Essential questions should also refer to the history of mastitis with previous children, the use of topical medications (creams or gels), and current breastfeeding habits (Angelopoulou et al., 2018).

Necessary Exams

The exams to be conducted at suspicion on mastitis are directly related to its key symptoms. Thus, the essential components of a physical examination should include measuring the temperature of the body, testing for the symptoms of systemic diseases, and excluding breast tuberculosis. In addition to that, the breasts and the lymph glands of the armpit should be examined manually and visually to establish the presence of abnormal firmness, swelling, erubescence, and nipple abnormalities such as inversion (Angelopoulou et al., 2018).

Necessary Lab Tests and Studies

Having conducted physical examinations, it can be necessary to order and review certain lab tests to understand patient cases better. Both mastitis and breast cancer, the conditions with intersectional symptoms, are successfully detected with the help of breast US or mammography (Ezeonu et al., 2015). Other tests that can be used in cases of suspected mastitis include sonoelastography and the biopsy of mammary tissue to conduct a histopathologic examination (Sousaris & Barr, 2016). It is important to order various culture tests of patients’ breast milk to identify the best pharmaceutical treatment options based on the key causal agents. Also, maternal milk can be studied with the help of WBC counts. If any nipple discharge is present, it should also be tested for culture to confirm the diagnosis and establish its form (infectious or non-infectious) (Patel at al., 2016).

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Differential Diagnosis

The most dangerous disease with symptoms that partially coincide with those of mastitis is breast cancer (non-inflammatory) and one of its most aggressive forms, breast cancer carcinoma (Sripathi, Ayachit, Bala, Kadavigere, & Kumar, 2016). Nowadays, it is possible to differentiate between the above conditions using such tests as breast MRI and mammography (Sripathi et al., 2016). Healthcare specialists should also distinguish between the signs of mastitis and other conditions such as mastodynia, breast traumas, and fibrocystic breast changes. To do that, it is pivotal to focus on the signs of inflammation, steatonecrosis, the degree to which breast pain depends on menstrual cycles, and the presence/localization of lumps (Patel et al., 2016).

The Plan of Care

Patients with mastitis should be provided with recommendations concerning pharmaceutical treatment depending on the subtype of the disease. If patients are diagnosed with Staphylococcal or recurrent mastitis, they are usually recommended to take Flucloxacillin, Dicloxacillin, or probiotics; Clindamycin and Cephalexin can be taken in case of penicillin allergy, whereas breast abscesses are usually treated surgically with the use of antibiotics (Angelopoulou et al., 2018).

Patient education should also be regarded as an essential part of comprehensive treatment plans. To decrease the risks of disease recurrence, lactating patients are to develop proper breastfeeding habits (feeding children frequently and gradual weaning). Apart from that, the recommendations on the choice of lactation support products, medications for cracked nipples, and bras should be given. Also, in non-lactational mastitis, recommendations may refer to sexual activity because certain practices lead to nipple traumas and, therefore, increase the risks of recurrence.

References

Angelopoulou, A., Field, D., Ryan, C. A., Stanton, C., Hill, C., & Ross, R. P. (2018). The microbiology and treatment of human mastitis. Medical Microbiology and Immunology, 207(2), 83-94.

Cullinane, M., Amir, L. H., Donath, S. M., Garland, S. M., Tabrizi, S. N., Payne, M. S., & Bennett, C. M. (2015). Determinants of mastitis in women in the CASTLE study: A cohort study. BMC Family Practice, 16(1), 181. Web.

Ezeonu, P. O., Ajah, L. O., Onoh, R. C., Lawani, L. O., Enemuo, V. C., & Agwu, U. M. (2015). Evaluation of clinical breast examination and breast ultrasonography among pregnant women in Abakaliki, Nigeria. OncoTargets and Therapy, 8, 1025-1029.

Patel, S. H., Vaidya, Y. H., Joshi, C. G., & Kunjadia, A. P. (2016). Culture-dependent assessment of bacterial diversity from human milk with lactational mastitis. Comparative Clinical Pathology, 25(2), 437-443.

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Sousaris, N., & Barr, R. G. (2016). Sonographic elastography of mastitis. Journal of Ultrasound in Medicine, 35(8), 1791-1797.

Sripathi, S., Ayachit, A., Bala, A., Kadavigere, R., & Kumar, S. (2016). Idiopathic granulomatous mastitis: A diagnostic dilemma for the breast radiologist. Insights into Imaging, 7(4), 523-529.

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