Ductal breast infection

An ongoing deep, burning, throbbing or shooting breast is an indication of an infection of the mammary ducts

• pain occurs during and/or after feedings
• clinical signs are variable
  • erythema, induration or tenderness is not present
  • nipple and areolar complex may appear normal or may reveal redness, flakes, shininess, fissures, crusts or scabs
  • in some there can be whitish, creamy caseous exudates (usually associated with yeast) or yellow, honey-colored exudates (usually associated with bacterial infection)
  • patients generally do not have fever and feels well (1)

The infectious agents responsible for ductal infection are Candida albicans, Staph aureus, or a combination of these organisms

• burning breast pain or nipple soreness after antibiotic treatment for mastitis is usually caused by a candida infection (1)
• bacterial infections may be present independently of mastitis or may develop subsequent to mastitis (2)

Any cause which disrupts skin integrity such as nipple trauma and eczema of the nipples may lead to duct infections (1) Before treatment, rule out other causes of breast and nipple pain e.g. - check whether the positioning and attachment are optimal (1).

In mothers with suspected yeast infection

• look for signs of yeast infection in the infant e.g. - white patches or clumps on the tongue, cheeks or inner lip; diaper or other rashes
• most often patients are treated with fluconazole (3)
• treat both the mother and the infant if yeast is found in either individual.

If bacterial infection is suspected (honey-colored exudates) treat with antibiotics

In some women a combination of bacterial and candidal infection may be present and may require treatment with both antibiotic and anti-fungal therapy (2)

Reference:

• 1. Betzold C.M. Infections of the Mammary Ducts in the Breastfeeding Mother. J Nurse Pract. 2005;1(1):15-21
• 2. Guidelines and Audit Implementation Network (GAIN) 2009. Guidelines on the treatment, management & prevention of mastitis.
• 3. The Breastfeeding Network (BFN) 2009. Thrush and breastfeeding