Purulent mastitis is the most serious and unpleasant disease for women. The most difficult of its forms - non-lactating purulent mastitis - we will pay special attention today, since the health of a woman is the main condition for the health and prosperity of the nation.
Research history
Since ancient times, a rare woman has passed the knowledge of the essence of the disease, which from ancient times was called the baby, and later became known as mastitis. And no wonder, since the indicated pathology, which is a massive
infectious and inflammatory process in the mammary gland, and which also has a tendency to actively spread, often led to purulent damage to the mammary gland itself and adjacent tissues, and then to sepsis from -for the generalization of the infectious process.
Subtleties of statistics
In modern times, mastitis is usually divided into lactational, when milk is produced in the mammary gland (most often purulent mastitis is nursing), and non-lactational, which we would like to talk about today. According to statistics from recent decades, in 90-95% of registered cases of mastitis, it developed in the period after childbirth, while non-lactational mastitis, which is not associated with pregnancy and childbirth, affects an average of about 5% of women.
Age categories
Usually women from 15 to 60 years old are subject to the development of non-lactational mastitis. In the specified age framework, this form of mastitis, in contrast to lactational, does not manifest itself vigorously, and septic complications practically do not occur. In contrast, women who have become ill during the mentioned age period have to learn to coexist with mastitis for many years, because it often goes into a chronically relapsing form. However, non-lactational mastitis can affect not only women, but also men and infants of both sexes.
Etiology
Non-lactic purulent mastitis is not associated with lactation, occurs relatively rarely and is often caused by a hormonal imbalance 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.
Detail reasons
It just so happened that most often non-lactating purulent mastitis develops when the hormonal background is disturbed in the female body or the immune response to infectious agents decreases. Typically, these periods include the following:
1. A massive decrease in estrogen levels, and at the same time a significant suppression of the immune defense, manifests itself in the postmenopausal period.
2. The puberty of a teenager with his unstable hormonal background also becomes a powerful stress for the emerging organism, which creates fertile ground for the development of such an undesirable disease. In addition, it is worth noting that non-lactational mastitis affects not only girls, but also boys during puberty.
3. It should be noted cases of wound infection after operations performed on the mammary gland, for example, after implant placement or removal of fibrocystic growths, with injuries of the mammary gland, which were accompanied by compression of its tissues.
4. Even the most invisible eye injuries to the skin of the mammary glands or nipples can contribute to the penetration of infection and the development of non-lactational mastitis.
Forms of the disease
The disease under consideration usually proceeds in two forms - acute and chronic. Acute non-lactation mastitis without timely admission to the hospital and adequate therapy from the catarrhal (infiltrative) form can quickly and relatively imperceptibly transform into a purulent non-lactational mastitis with an extremely severe course, when it is already impossible to do without hospitalization in a hospital, and even before the generalization of the process there are only a few days, or even hours.
Pathogenesis
In the case of non-lactating mastitis, infectious agents usually penetrate into the breast through skin lesions that are caused either by accidental injury or thermal damage, for example, when using a heating pad or an accidental burn, and sometimes due to small abscesses on the skin of the mammary gland . Then the bacteria first damage the subcutaneous fat layer and the fat capsule of the mammary gland, and then attack the
glandular tissue again
.Far less often, women have to deal with chronic non-lactating mastitis, which usually develops when acute mastitis is left untreated, considering the first signs of improvement with argumentation to stop taking medications and procedures prescribed by a doctor. In such cases, the recurrence of mastitis becomes a constant companion of a woman, manifesting itself at the slightest hormonal disruption, after hypothermia, stress, or with a general weakening of the body's defenses.
Non-lactic suppurative mastitis. Symptoms
At the very beginning of the development of acute non-lactational mastitis - in the serous stage, when the tissue of the affected part of the breast is sequentially saturated with serous fluid and leukocytes are actively entering it - the woman notes the occurrence of pain in her mammary gland, in which it is possible to palpate the compacted area with clear boundaries in one or several shares. Body temperature is increased to 37-38 gr., And in some cases to 39. In addition, during this period, a woman may be disturbed by severe general weakness. In extremely rare cases, there is a reverse development of the serous stage and the onset of spontaneous recovery, however, the infiltration stage develops much more often after the serous.
In the infiltrative stage in the affected mammary gland, a painful compaction without clear boundaries is called an infiltrate. At the same time, the skin above the infiltrate does not look inflamed at all, there is no swelling in the indicated area, and the local temperature remains within the normal range. Body temperature remains elevated, due to the active entry of bacterial products into the bloodstream from foci of lactostasis through damaged ducts of the mammary gland. It is imperative that a woman seek medical attention from a mammologist, gynecologist or surgeon when the first symptoms appear, without waiting for their progression and transition to a purulent form. In the catarrhal stage, mastitis is treated extremely successfully and does not entail serious complications, as in the case of non-lactating purulent mastitis.
In the absence of adequate treatment, after 5 days, the stage of infiltration passes into the stage of destruction, that is, destruction. The inflammatory process becomes purulent, and the mammary gland turns into a complete likeness of a sponge soaked through 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 bloodstream. The body temperature continues to increase and usually during this period is 38-40 g., And with it the general symptoms of intoxication also increase. The affected mammary gland increases in size, becomes tense. The skin above the destruction zone turns red, the saphenous veins expand. As pain increases, it spreads to the armpit, as regional lymph nodes are also quite quickly involved in the infectious process. The patient is not up to sleep and food.
Kinds
Non-lactic suppurative mastitis, a photo of which can be seen in medical guides, requires a competent approach when making a diagnosis.
The following varieties exist:
1. Abscessing mastitis, 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, in this case, softening can be palpated in the infiltrate area or you can feel a liquid shimmering under your fingers when probing - a positive symptom of fluctuation (in 99% of cases).
2. Mastitis is infiltrative-abscessed. He is characterized by a more severe course than the previous one. Dense infiltration consists of many small abscesses of very different sizes and shapes, so the symptom of fluctuations is positive in only 5% of patients. Such an infiltrate usually occupies no more than two quadrants of the mammary gland.
3. Phlegmonous mastitis. In this case, the mammary gland is totally enlarged and pronounced swollen. The skin of the affected chest is markedly red (and in places bluish-red), tense, with the nipple retracted. Feeling the gland is extremely painful, the symptom of fluctuations is positive. In more than half of patients, a purulent lesion extends to at least three quadrants.
4. Gangrenous mastitis, as a rule, is accompanied by damage to blood vessels and active thrombosis. Since normal blood supply to the mammary gland becomes impossible, its necrosis develops. At the same time, the gland is significantly enlarged, on its surface there are areas of tissue necrosis, blisters that are filled with a sacrum, the skin becomes cyanotic-crimson. Inflammation covers the entire mammary gland. During this period, the condition of patients is extremely difficult, consciousness becomes confused, tachycardia increases against a background of lowering blood pressure. A distinct picture of sepsis forms in the blood. Of course, at this stage, the risk to the patient's life becomes extremely high.
Surgical treatment
If the diagnosis is "non-lactating purulent mastitis", its treatment can be both operative and conservative.
A direct indication for surgical intervention are all destructive forms of the infectious and inflammatory process, purulent-catarrhal mastitis, the signs of which were described by us above.
In the case when the drug therapy for two days does not give a significant improvement, they usually judge the presence of a purulent process in the mammary gland, which is the most direct indication for surgical intervention, which is performed exclusively in a hospital, usually under general intravenous anesthesia.
The subtleties of the operation
During the operation, the abscess is carefully opened, cleaned, all non-viable tissues are excised and removed. Thus purulent mastitis is completely eliminated. The operation, as a rule, is easily tolerated by women. After the intervention in the mammary gland, drains must be installed to rinse the wound and not give the bacteria even a tiny chance of activation. Drip washing of the wound is carried out from 5 to 12 days, which corresponds to the patient achieving a good general condition and the disappearance of fibrin, pus and particles of necrosis from the washings.
Therapy after surgery
Also, after the operation, drug therapy is carried out, which is aimed at eliminating toxins from the body as soon as possible and thoroughly and correcting those disorders that developed against the background of a purulent process. Be sure to prescribe antibiotics (intramuscularly or intravenously). Usually these are cephalosporin series I, II preparations, or, in the case of a secondary infection, III-IV generation.
Non-lactic suppurative mastitis: treatment without surgery.
Conservative treatment is possible only when the patient’s general condition is relatively satisfactory, the disease lasts no more than three days, the body temperature does not exceed 37.5 g., There are no local symptoms of purulent inflammation, the pain in the projection of the infiltrate is moderate, the infiltrate is felt in no more than one a quadrant of the mammary gland, and in the general analysis of blood, the picture of progressive inflammation does not increase.
Most often, women seek medical help in the initial stages of mastitis - serous or infiltrative, in which conservative treatment is possible and quite effective. First of all, it implies providing rest to the affected mammary gland, for which it is recommended that women move less actively, wear a loose fabric bra or bandage, with which you can support a sick breast, but not squeeze it so as not to provoke the progression of the process. For the purpose of influencing infectious agents, antibiotics ("Cephalexin", "Cefixime", "Levofloxacin") are necessarily prescribed, usually they are administered intramuscularly, in doses not exceeding the average therapeutic. In addition to antibiotics, in order to reduce inflammation and swelling, the body is desensitized with antihistamines of the latest generations, so as not to cause drowsiness in the patient and minimize side effects.
In addition to “heavy artillery”, vitamins of group B and vitamin C are prescribed to stimulate the body’s defenses. If the reverse development of the inflammatory process is not long in coming, ultrasound and UHF are added in a day, which also stimulates the speedy resorption of the infiltrate and the restoration of natural processes in the mammary gland.
Take care of yourself, remember about such an insidious disease as non-lactating suppurative mastitis. Treatment may not be difficult if you start it at the earliest stages. Health to you!