Non-lactic purulent mastitis: symptoms and treatment

Purulent mastitis is the most serious and unpleasant disease for women. The most serious of its forms is non-lactational purulent mastitis - we will pay special attention today, as the health of a woman is the main condition for the health and prosperity of the nation.

History of research

From a deep antiquity, a rare woman passed the knowledge of the essence of the disease, which from time immemorial was called a nursingress, and later became known as mastitis. Yes, and no wonder, since this pathology, which is a massive infectious and inflammatory process in the mammary gland, and even having a tendency to actively spread, often led to a purulent lesion of the actual glandular body of the breast and adjacent tissues, and then to sepsis from For the generalization of the infectious process.

Subtleties of statistics

In modern times, mastitis is divided into lactation, when milk products are produced in the mammary gland (most often purulent mastitis feeding), and non-lactation, which we would like to talk about today. According to the statistics of the last decades, in 90-95% of registered cases of mastitis it developed during the postpartum period, while non-lactating mastitis, which is not associated with pregnancy and childbirth, affects about 5% of women on average.

Age categories

Usually women from 15 to 60 years old are exposed to the development of non-lactational mastitis. Within this age range, this form of mastitis, unlike the lactation one, does not manifest itself violently, and septic complications are practically not met. In contrast to this, women who fell ill in the mentioned age period, have to learn to coexist with mastitis for many years, because it often turns into a chronically relapsing form. However, non-lactational mastitis can affect not only women, but also men, and infants of both sexes.

Etiology

Non-lactating purulent mastitis has no connection with lactation, occurs relatively rarely and is often due to a violation of the hormonal background and a decrease in the immune response to infectious agents. As a rule, it is expressed by progressive one- or two-sided inflammation of the mammary glands.

Detailing the reasons

It so happened that most often non-lactating purulent mastitis develops when a hormonal background is broken in the female body or the immune response to infectious agents decreases. Usually the following periods can be referred to these periods:

1. Massive decrease in the level of estrogens, and at the same time a significant suppression of immune defense, manifests itself during the period of post-menopause.

2. The period of puberty of a teenager with its unstable hormonal background also becomes a powerful stress for the forming organism, which creates fertile soil for the development of such an unwanted disease. In addition, it should be noted that non-lactational mastitis affects not only girls, but also boys in the period of puberty.

3. It is impossible not to mention the cases of infection of wounds after operations performed on the mammary gland, for example, after implant placement or removal of fibro-cystic growths, with traumas of the breast, which were accompanied by squeezing her tissues.

4. Even the most invisible eye trauma to the skin of the mammary glands or nipples can contribute to the penetration of the infection and the development of non-lactational mastitis.

Forms of the disease

The disease we are considering usually takes place in two forms - acute and chronic. Acute non-lactational mastitis without timely treatment in the hospital and adequate therapy from the catarrhal (infiltrative) form rather quickly and relatively unnoticeably for a woman can be transformed into purulent non-lactational mastitis with extremely severe course, when without hospitalization it is already impossible to manage, and even before the generalization of the process There are only days left, or even hours.

Pathogenesis

In the case of non-lactational mastitis, infectious agents usually penetrate the breast through the skin lesions that are caused either by accidental injury or by thermal damage, for example, when using a warmer or an accidental burn, and sometimes because of small pustules on the skin of the breast . Then the bacteria first damage the subcutaneous fat and fatty capsule of the breast, and then again attack the glandular tissue.

Less often, women have to deal with chronic non-lactational mastitis, which usually develops when acute mastitis is left untreated, finding the first signs of improvement in the argumentation for stopping medication prescribed by a doctor and procedures. In such cases, relapse of mastitis becomes a constant companion of a woman, showing itself at the slightest hormonal failure, after hypothermia, stress, or with a general weakening of the body's defenses.

Non-lactic purulent mastitis. Symptoms

At the very beginning of the development of acute non-lactational mastitis - in the serous stage, when the tissue of the affected thoracic gland is consistently saturated with serous fluid and leukocytes actively enter into it - the woman observes the occurrence of pain in the mammary gland in which the densified area can be palpated with clear boundaries in one Or several lobes. Body temperature is raised to 37-38 grams, and in some cases up to 39. In addition, during this period, a woman may be disturbed by a pronounced general weakness. In extremely rare cases, there is a reverse development of the serous stage and the onset of spontaneous recovery, but much more often after the serous stage of infiltration develops.

In the infiltrative stage in the affected mammary gland, a painful compaction is formed without clear boundaries called the infiltrate. Moreover, the skin above the infiltrated inflamed does not look at all, there is no edema in this area, and the local temperature remains within the norm. The body temperature remains high, which is due to the active entry of bacterial products into the blood from the foci of lactostasis through the damaged ducts of the mammary gland. It is extremely important for a woman to seek medical help from a mammalogist, gynecologist or surgeon when the first symptoms appear, without waiting for their progression and the transition into a purulent form. In the catarrhal stage, mastitis is treated extremely successfully and does not entail severe complications, as in the case of non-lactative purulent mastitis.

In the absence of adequate treatment, after 5 days, the infiltration stage passes to the stage of destruction, that is, destruction. The inflammatory process becomes purulent, and the mammary gland turns into a complete likeness of the sponge, thoroughly soaked with pus.

In the destructive stage, which is also known as acute purulent mastitis, the general condition of a woman deteriorates sharply, as toxins from the focus of purulent inflammation continuously enter the blood. The body temperature continues to increase and usually in this period is 38-40 grams, and together with it the general symptoms of intoxication are also increasing. The affected mammary gland grows in size, becomes tense. The skin above the zone of destruction becomes red, the subcutaneous veins widen. As the pain increases, it spreads to the area of the armpit, as regional lymph nodes also get involved rather quickly in the infectious process. The patient does not get to sleep and food.

Kinds

Non-lactic purulent mastitis, a photo of which can be seen in medical reference books, requires a competent approach when making a diagnosis.

There are following its varieties:

1. Mastitis abscessing, which is characterized by the fact that a large number of abscesses are formed in the affected mammary gland - cavities that are filled with pus. Usually, at the same time, softening can be palpated in the infiltration area or it can feel under the fingers a fluid that is poured during the palpation - a positive symptom of fluctuations (in 99% of cases).

2. Mastitis is infiltrative-abscessing. He is characterized by a heavier current than the previous one. A dense infiltrate consists of many small abscesses of very different size and shape, so the symptom of fluctuations is positive only in 5% of patients. Occupies such an infiltrate usually no more than two quadrants of the breast.

3. Mastitis phlegmonous. In this case, the mammary gland is totally enlarged and pronounced edematous. The skin of the affected breast is distinctly red (and sometimes bluish-red), tense, with a retracted nipple. The palpation of the gland is extremely painful, the symptom of the fluctuation is positive. In more than half the patients, a purulent lesion spreads over a minimum of three quadrants.

4. Mastitis gangrenous, as a rule, is accompanied by the defeat of blood vessels and active thrombus formation. As the normal blood supply of the breast becomes impossible, its necrosis develops. At the same time, the gland is significantly enlarged, there are areas of tissue necrosis on its surface, blisters that are filled with a syphilis, the skin becomes bluish-purplish. Inflammation covers the entire mammary gland. During this period, the condition of the patients is extremely difficult, the mind becomes confused, tachycardia increases against a background of lowering blood pressure. A distinct pattern of sepsis is formed in the blood. Of course, at this stage, the risk to the patient's life becomes extremely high.

Operative treatment

If "non-lactic purulent mastitis" is diagnosed, its treatment can be either operational or conservative.

A direct indication for surgical intervention are all destructive forms of the infectious-inflammatory process, purulent-catarrhal mastitis, the signs of which were described above.

In the case when the drug therapy does not significantly improve for two days, usually there is a purulent process in the mammary gland, which is the most direct indication for an operative intervention that is performed exclusively in a hospital setting, usually under general intravenous anesthesia.

Subtlety of operation

During the operation, the abscess is carefully opened, cleaned, all non-viable tissues excised and removed. Thus purulent mastitis is completely eliminated. The operation, as a rule, is easily tolerated by women. After intervening in the mammary gland, drainages must be installed to drip the wound and not give the bacteria even a tiny chance of activation. The drip irrigation of the wound is carried out from 5 to 12 days, which corresponds to the patient achieving a good overall condition and disappearing of fibrin, pus and necrosis from the wash water.

Postoperative therapy

Also after the operation, drug therapy is conducted, which is aimed at removing as soon as possible and more thoroughly toxins from the body and correcting those disorders that have developed against the background of purulent process. Antibiotics must be prescribed (intramuscularly or intravenously). Usually, these are preparations of the cephalosporin series I, II or, in case of secondary infection - III-IV generation.

Non-lactic purulent mastitis: treatment without surgery.

Treatment conservative is possible only when the general condition of the patient remains relatively satisfactory, the disease lasts no more than three days, the body temperature does not exceed 37.5 gr., The local symptoms of purulent inflammation are not present, the pain in the projection of the infiltrate is moderate, the infiltration is probed in not more than one Quadrant of the breast, and in the general analysis of blood the picture of progressive inflammation does not grow.

Most often, women seek medical help at the initial stages of mastitis - serous or infiltrative, on which conservative treatment is possible and quite effective. First and foremost, it implies providing rest for the affected breast, for which it is recommended that women move less actively, wear a loose fabric bra or bandage, with which it is possible to support the patient's chest, but not to squeeze it, so as not to provoke the progression of the process. In order to influence the infectious agents, antibiotics ("Cephalexin", "Cefixim", "Levofloxacin") are prescribed, they are usually administered intramuscularly, at doses not exceeding the mediotherapy dose. In addition to antibiotics, in order to reduce inflammation and swelling, desensitisation of the body with antihistamines of the last generations is conducted to avoid causing drowsiness in the patient and to minimize side effects.

In addition to "heavy artillery," vitamins B and vitamin C are prescribed to stimulate the defenses of the body. In the event that the reverse development of the inflammatory process does not make you wait, after a day ultrasound and UHF therapy is added, which also stimulates the rapid resolution of the infiltrate and the restoration of natural Processes in the mammary gland.

Take care of yourself, remember this insidious disease, like non-lactating purulent mastitis. Treatment can be by no means difficult, if you start it at the earliest stages. Health to you!