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

4. 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 )

5. 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

7. 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 4-6
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.

8. 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 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