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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Lactation mastitis usually affects only one breast and the symptoms can develop quickly. The signs and symptoms usually appear suddenly and they include:
- Breast tenderness or warmth to the touch
- General malaise or feeling ill
- Swelling of the breast
- Pain or a burning sensation continuously or while breast-feeding
- Skin redness, often in a wedge-shaped pattern
- Fever of 101 F (38.3 C) or greater
- The affected breast can then start to appear lumpy and red.
Some women may also experience flu-like symptoms such as:
- Aches
- Shivering and chills
- Feeling anxious or stressed
- Fatigue
Contact should be made with a health care provider with special breastfeeding competence as soon as the patient recognizes the combination of signs and symptoms. Most of the women first experience the flu-like symptoms and just after they may notice a sore red area on the breast. Also, women should seek medical care if they notice any abnormal discharge from the nipples, if breast pain is making it difficult to function each day, or they have prolonged, unexplained breast pain.
The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis are a separate entity.
Names for non-puerperal mastitis are not used very consistently and include mastitis, subareolar abscess, duct ectasia, periductal inflammation, Zuska's disease and others.
Postpartum metritis, also known as puerperal sepsis, occurs within 21 days and is most common within 10 days of delivery. Metritis is characterized by an enlarged uterus and a watery red-brown fluid to viscous off-white purulent uterine discharge, which often has a bad smell. The severity of disease is categorized by the signs of health:
- Grade 1 metritis: An abnormally enlarged uterus and a purulent uterine discharge without any systemic signs of ill health.
- Grade 2 metritis: Animals with additional signs of systemic illness such as decreased milk yield, dullness, and fever >39.5°C.
- Grade 3 metritis: Animals with signs of toxemia such as inappetence, cold extremities, depression, and/or collapse.
Clinical endometritis is defined in cattle as the presence of a purulent uterine discharge detectable in the vagina 21 days or more postpartum. Simple grading systems for clinical disease are based on the character of the vaginal mucus and typical Grading schemes for clinical endometritis are widely used by veterinarians.
Subclinical endometritis is characterized by inflammation of the endometrium and the presence of neutrophils in cytology or biopsy histology, in the absence of signs of clinical endometritis.
Mastitis in dairy cattle is the persistent, inflammatory reaction of the udder tissue. Mastitis, a potentially fatal mammary gland infection, is the most common disease in dairy cattle in the United States. It is also the most costly to the dairy industry. Milk from cows suffering from mastitis has an increased somatic cell count.
Metritis is inflammation of the wall of the uterus, whereas endometritis is inflammation of the functional lining of the uterus, called the endometrium The term pelvic inflammatory disease (PID) is often used for metritis.
Mastitis occurs when white blood cells (leukocytes) are released into the mammary gland, usually in response to bacteria invading the teat canal. Milk-secreting tissue and various ducts throughout the mammary gland are damaged due to toxins released by the bacteria. Mastitis can also occur as a result of chemical, mechanical, or thermal injury.
Signs and symptoms usually include a fever greater than , chills, low abdominal pain, and possibly bad smelling vaginal discharge.
The term nonpuerperal mastitis describes inflammatory lesions of the breast (mastitis) that occur unrelated to pregnancy and breastfeeding.
It is sometimes equated with duct ectasia, but other forms can be described.
Comedo mastitis is a very rare form similar to granulomatous mastitis but with tissue necrosis. Because it is so rare it may be sometimes confused with comedo carcinoma of the breast although the conditions appear to be completely unrelated.
After childbirth a woman's genital tract has a large bare surface, which is prone to infection. Infection may be limited to the cavity and wall of her uterus, or it may spread beyond to cause septicaemia (blood poisoning) or other illnesses, especially when her resistance has been lowered by a long labour or severe bleeding. Puerperal infection is most common on the raw surface of the interior of the uterus after separation of the placenta (afterbirth); but pathogenic organisms may also affect lacerations of any part of the genital tract. By whatever portal, they can invade the bloodstream and lymph system to cause septicemia, cellulitis (inflammation of connective tissue), and pelvic or generalized peritonitis (inflammation of the abdominal lining). The severity of the illness depends on the virulence of the infecting organism, the resistance of the invaded tissues, and the general health of the woman. Organisms commonly producing this infection are "Streptococcus pyogenes"; staphylococci (inhabitants of the skin and of pimples, carbuncles, and many other pustular eruptions); the anaerobic streptococci, which flourish in devitalized tissues such as may be present after long and injurious labour and unskilled instrumental delivery; "Escherichia coli" and "Clostridium perfringens" (inhabitants of the lower bowel); and "Clostridium tetani".
Also called Zuska's disease (only nonpuerperal case), subareolar abscess is a subcutaneous abscess of the breast tissue beneath the areola of the nipple. It is a frequently aseptic inflammation and has been associated with squamous metaplasia of lactiferous ducts.
The term is usually understood to include breast abscesses located in the retroareolar region or the periareolar region, but not those located in the periphery of the breast.
Subareolar abscess can develop both during lactation or extrapuerperal, the abscess is often flaring up and down with repeated fistulation.
90% of cases are smokers, however only a very small fraction of smokers appear to develop this lesion. It has been speculated that either the direct toxic effect or hormonal changes related to smoking could cause squamous metaplasia of lactiferous ducts. It is not well established whether the lesion regresses after smoking cessation.
Extrapuerperal cases are often associated with hyperprolactinemia or with thyroid problems. Also diabetes mellitus may be a contributing factor in nonpuerperal breast abscess.
Patients mostly present with a hard lump in one breast without any sign of a systemic disease. Other possible symptoms include nipple retraction, pain, inflammation of the overlying skin, nipple discharge, fistula, enlarged lymph nodes, in rare case peau d'orange-like changes.
Presentation is mostly unilateral although a significant share of cases is bilateral, also in many cases contralateral or bilateral recurrences were documented.
Several cases occurring together with fever, polyarthralgia and erythema nodosum were documented.
Characteristic for idiopathic granulomatous mastitis are multinucleated giant cells and epithelioid histiocytes forming non-caseating granulomas around lobules. Often minor ductal and periductal inflammation is present. The lesion is in some cases very difficult to distinguish from breast cancer and other causes such as infections (tuberculosis, syphilis, corynebacterial infection, mycotic infection), autoimmune diseases (sarcoidosis, granulomatosis with polyangiitis), foreign body reaction and granulomatous reaction in a carcinoma must be excluded.
The condition is diagnosed very rarely. As the diagnosis is a lengthy differential diagnosis of exclusion there is considerable uncertainty about incidence. It has been suspected that some cases diagnosed as IGM in developing countries may have other explanations. On the other hand, IGM is usually diagnosed only after complications and referral to a secondary breast care center so light cases may resolve spontaneously or after symptomatic treatment and thus never be diagnosed as IGM. As a completely pathogen free breast will be exceedingly rare even in completely healthy population there is also uncertainty when to consider pathogens as causative or as mere coincidental finding.
Symptoms: The breasts are swollen and oedematous, and the skin looks shiny and diffusely red. Usually the whole of both breasts are affected, and they are painful. The woman may have a fever that usually subsides in 24 hours. The nipples may become stretched tight and flat which makes it difficult for the baby to attach and remove the milk. The milk does not flow well.
A fever may occur in 15 percent, but is typically less than 39 degrees C and lasts for less than one day.
Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat.
Engorgement usually happens when the breasts switch from colostrum to mature milk (often referred to as when the milk "comes in"). However, engorgement can also happen later if lactating women miss several nursings and not enough milk is expressed from the breasts. It can be exacerbated by insufficient breastfeeding and/or blocked milk ducts. When engorged the breasts may swell, throb, and cause mild to extreme pain.
Engorgement may lead to mastitis (inflammation of the breast) and untreated engorgement puts pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in one part of the breast, and the skin in that area may be red and/or warm. If it continues unchecked, the plugged duct can become a breast infection, at which point she may have a fever or flu-like symptoms.
Idiopathic granulomatous mastitis is defined as granulomatous mastits without any other attributable cause such as those above mentioned. It occurs on average two years and almost exclusively up to six years after pregnancy, usual age range is 17 to 42 years. Some cases have been reported that were related to drug induced hyperprolactinemia.
Exceptionally rarely it has been diagnosed during pregnancy and in men.
A puerperal disorder is a disorder which presents primarily during the puerperium.
An example is postpartum thyroiditis.
Puerperal disorders may be associated with psychiatric illness in offspring.
Cracked nipples are classified as a breast disorder. The nipple is not only the structure to delivery milk to the infant, it also contains small, sebaceous glands or Montgomery glands to lubricate the skin of the areola. Cracked nipples are most often associated with breastfeeding and appear as cracks or small lacerations or breaks in the skin of the nipple. In some instances an ulcer will form. The nipple in a nursing mother is in regular contact with a nursing infant. Cracked nipples are trauma to the nipple and can be quite painful. Cracked nipples typically appear three to seven days after the birth.
If the nipples appears to be wedge-shaped, white and flattened, this may indicate that the latch is not good and there is a potential of developing cracked nipples.
Cracked nipple (or "nipple trauma") is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its the base. Cracked nipples develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.
Breast diseases can be classified either with disorders of the integument, or disorders of the reproductive system. A majority of breast diseases are noncancerous.
Acute rheumatic fever (ARF) is a complication of respiratory infections caused by GAS. The M-protein generates antibodies that cross-react with autoantigens on interstitial connective tissue, in particular of the endocardium and synovium, that can lead to significant clinical illness.
Although common in developing countries, ARF is rare in the United States, possibly secondary to improved antibiotic treatment, with small isolated outbreaks reported only occasionally. It is most common among children between 5 and 15 years old and occurs 1–3 weeks after an untreated GAS pharyngitis.
ARF is often clinically diagnosed based on Jones Criteria, which include: pancarditis, migratory polyarthritis of large joints, subcutaneous nodules, erythema marginatum, and sydenham chorea (involuntary, purposeless movement). The most common clinical finding is a migratory arthritis involving multiple joints.
Other indicators of GAS infection such as a DNAase or ASO serology test must confirm the GAS infection. Other minor Jones Criteria are fever, elevated ESR and arthralgia. One of the most serious complications is pancarditis, or inflammation of all three heart tissues. A fibrinous pericarditis can develop with a classic friction rub that can be auscultated. This will give increasing pain upon reclining.
Further endocarditis can develop with aseptic vegetations along the valve closure lines, in particular the mitral valve. Chronic rheumatic heart disease mostly affects the mitral valve, which can become thickened with calcification of the leaflets, often causing fusion of the commissures and chordae tendineae.
Other findings of ARF include erythema marginatum (usually over the spine or other bony areas) and a red expanding rash on the trunk and extremities that recurs over weeks to months. Because of the different ways ARF presents itself, the disease may be difficult to diagnose.
A neurological disorder, Sydenham chorea, can occur months after an initial attack, causing jerky involuntary movements, muscle weakness, slurred speech, and personality changes. Initial episodes of ARF as well as recurrences can be prevented by treatment with appropriate antibiotics.
It is important to distinguish ARF from rheumatic heart disease. ARF is an acute inflammatory reaction with pathognomonic Aschoff bodies histologically and RHD is a non-inflammatory sequela of ARF.
Signs of duct ectasia can include nipple retraction, inversion, pain, and sometimes bloody discharge.
A group A streptococcal infection is an infection with group A streptococcus (GAS). "Streptococcus pyogenes" comprises the vast majority of the Lancefield group A streptococci, and is often used as a synonym for GAS. However, "S. dysgalactiae" can also be group A. "S. pyogenes" is a beta-hemolytic species of Gram positive bacteria that is responsible for a wide range of both invasive and noninvasive infections.
Infection of GAS may spread through direct contact with mucus or sores on the skin. GAS infections can cause >500,000 deaths per year. Despite the emergence of antibiotics as a treatment for group A β-hemolytic streptococcus, infection of GAS is an increasing problem, particularly on the continent of Africa.
There are many other types of streptococci (species of "Streptococcus"), including group B streptococcus ("Streptococcus agalactiae") and "Streptococcus pneumoniae", which cause other types of infections and should not be confused with group A strep. Several virulence factors contribute to the pathogenesis of GAS, such as M protein, hemolysins, and extracellular enzymes.
Witch's milk or neonatal milk is milk secreted from the breasts of some newborn human infants of either sex. Neonatal milk secretion is considered a normal physiological occurrence and no treatment or testing is necessary. It is thought to be caused by a combination of the effects of maternal hormones before birth, prolactin, and growth hormone passed through breastfeeding and the postnatal pituitary and thyroid hormone surge in the infant.
Breast milk production occurs in about 5% of newborns and can persist for two months though breast buds can persist into childhood. Witch's milk is more likely to be secreted by infants born at full term, and not by prematurely-born infants. The consistency of neonatal milk is estimated to be quite similar to maternal milk. Its production may be also be caused by certain medications. In extremely rare cases neonatal mastitis may develop but it is unclear if it is related to neonatal milk secretion.
In some cultures the tradition of removing the milk ("milking") has been reported. This practice can prolong milk production and other problems can not be excluded. While breastfeeding may also contribute to prolonged milk production and breast enlargement, temporary, or permanent weaning is not recommended.
In folklore, witch's milk was believed to be a source of nourishment for witches' familiar spirits. It was thought to be stolen from unwatched, sleeping infants. In other cultures expressing milk from the infant's breasts is supposed to contribute to a good breast shape in adulthood.
Blood from the nipples is nearly always benign and frequently associated with duct ectasia; it should only be investigated when it is unilateral.
The changes in fibrocystic breast disease are characterised by the appearance of fibrous tissue and a lumpy, cobblestone texture in the breasts. These lumps are smooth with defined edges, and are usually free-moving in regard to adjacent structures. The bumps can sometimes be obscured by irregularities in the breast that are associated with the condition. The lumps are most often found in the upper, outer sections of the breast (nearest to the armpit), but can be found throughout the breast. Women with fibrocystic changes may experience a persistent or intermittent breast aching or breast tenderness related to periodic swelling. Breasts and nipples may be tender or itchy.
Symptoms follow a periodic trend tied closely to the menstrual cycle. Symptoms tend to peak in the days and, in severe cases, weeks before each period and decrease afterwards. At peak, breasts may feel full, heavy, swollen, and tender to the touch. No complications related to breastfeeding have been found.