Mumps

Disease Description (Causes and Symptoms)

• Definition: Mastitis is a bacterial infection that develops in breast tissue. It is classified into acute suppurative mastitis, chronic non-lactational mastitis, chronic lactational mastitis, and other types.
• Causes/Pathophysiology: Bacteria (mainly Staphylococcus aureus, streptococci, etc.) enter the milk ducts through small cracks or wounds in the nipple. When milk accumulates and becomes stagnant in the milk ducts, bacteria multiply there and cause inflammation. Risk factors include milk duct obstruction (nipple cracks, tight bras, infrequent breastfeeding, etc.) and reduced maternal immunity (anemia, stress, fatigue).
• Main symptoms: Localized redness of one breast (wedge-shaped), warmth, swelling, localized pain (stabbing or throbbing), high fever (often 38.5°C or higher), chills, and general malaise. Swollen lymph nodes in the armpit may occur, and if untreated, the condition may progress to a breast abscess (collection of pus).
• Prevalence/Timing: Experienced by approximately 20–30% of breastfeeding women, and common within the first 3 months after childbirth.

Treatment Methods and Precautions

• Initial basic treatment
  • Continue breastfeeding (or express milk): Continue breastfeeding from the affected breast whenever possible or express milk regularly to prevent milk from stagnating in the milk ducts. Stopping breastfeeding delays healing and increases the risk of an abscess.
  • Conservative treatment: Get sufficient rest, drink fluids, control pain (nonsteroidal anti-inflammatory drugs, such as ibuprofen), and use warm compresses (15–20 minutes before breastfeeding to relieve pain and promote milk flow) or cold compresses (use whichever method is more comfortable for the patient).
• Antibiotics
  • Common recommendations: For Staphylococcus aureus infections without consideration of beta-lactamase resistance, dicloxacillin or flucloxacillin (e.g., dicloxacillin 250–500 mg 4 times a day) or first-generation cephalosporins (e.g., cephalexin) are commonly used.
  • If streptococcal infection is suspected: Penicillin-class antibiotics may be used (at the physician’s discretion).
  • Antibiotic selection may vary depending on the infant’s age and the prevalence of resistance (MRSA) in the region. In recurrent, severe, or non-improving cases, treatment may be changed based on culture results or a specialist’s decision. Example according to RAG information: dicloxacillin for Staphylococcus aureus, penicillin for streptococci, and ampicillin or erythromycin may be considered if the baby is at least 1 month old (regional guidelines and pediatric safety must be considered).
  • Treatment duration: Generally 10–14 days. Even if symptoms improve, complete the prescribed course to reduce the risk of recurrence.
• In case of an abscess (breast abscess)
  • After confirmation by ultrasound, repeated ultrasound-guided needle aspiration or incision and drainage is performed depending on the progress. Continuing breastfeeding after drainage is often recommended (follow the physician’s instructions).
• Additional measures
  • Severe systemic symptoms, bilateral symptoms, or infection associated with a newborn (e.g., suspected β-hemolytic streptococcal infection) require testing and treatment in coordination with obstetrics and gynecology/pediatrics.
• Precautions regarding complications
  • Delayed treatment may lead to a breast abscess, chronic mastitis, nipple retraction or changes in breast shape, and, rarely, sepsis. In cases of repeated recurrence, ductal dilation or atypical causes (e.g., differential diagnosis of inflammatory breast cancer) should be considered, and a biopsy may be considered.

Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)

• Items to bring
  • List of medications currently being taken (including prescription drugs, OTC drugs, and supplements)
  • Record of fever (body temperature) and when symptoms began (how many days ago)
  • Breastfeeding frequency and pattern (recent changes in breastfeeding patterns), and photos of the breast (if redness or swelling is severe)
  • History of previous breast conditions (previous mastitis/abscess, surgery, and breast examination results)
  • Allergies (medications and foods) and underlying conditions (such as diabetes)
• Key information to tell the physician during the outpatient visit
  • Date symptoms began and their progression (whether they are improving or worsening)
  • Whether breastfeeding has been stopped and the reason
  • Whether antibiotics have previously been used (which medication and since when)
  • The baby’s condition (fever, symptoms of infection, etc.)
• Possible tests
  • Breast ultrasound (to check for an abscess), mammography (if necessary), milk culture (in cases of recurrence or treatment failure), and blood tests (in cases of severe systemic symptoms).

Examples of General Questions to Ask the Physician

• “Is this antibiotic safe to take while breastfeeding? What effects could it have on the baby?”
• “How long can I continue breastfeeding? Is it safe to continue breastfeeding from the affected breast?”
• “If my symptoms do not improve within a few days, what additional tests will I need?”
• “What lifestyle habits should I change to prevent recurrence?”

Examples of Condition-Specific Questions

• “If my symptoms do not improve now, do I need an ultrasound to check whether I have a breast abscess?”

• “Is the rate of MRSA (methicillin-resistant Staphylococcus aureus) high in this region? Should I have a culture test?”

• Emergency Contact/Return Visit Guidelines (Warning Signs)

  • Immediate emergency medical care is needed if a high fever (38.5°C or higher) persists or worsens, redness continues to spread, there is pulsating or rapidly worsening localized pain or a fluctuant sensation (suggesting an abscess), or systemic toxicity symptoms such as generalized weakness, difficulty breathing, or low blood pressure occur.