The initial presentation is that of a diffuse cellulitis which localises into an abscess after several days.
The patient may be generally unwell with flu like symptoms (chills, headaches, muscle aches) and a spiking fever. The affected area of the breast is painful and tender, red and warm (1). There may be a purulent discharge if the lesion is extensive.
It is difficult to clinically differentiate between non infectious mastitis and infectious mastitis (1).
- infectious mastitis
- usually a part of a breast becomes red, painful, swollen and hard
- there may be general symptoms like fever and malaise
- a nipple fissure is present
- improvement of symptoms do not occur (after 12-24 hours) even after effective milk removal
- full breast
- seen between the 3rd and 6th day after delivery
- the breast feels hot, heavy and hard, seen in both breasts
- the breast is not shiny, oedematous or red
- the milk may sometimes drips out spontaneously
- resolves once the infant removes the milk by effective suckling
- engorged breast
- the breast is enlarged, swollen and painful
- may present as oedematous, shiny with diffuse red areas
- the nipple might appear flat due to stretching
- milk does not flow out easily and the infant may find it difficult to attach and suckle due to the swelling
- the women usually presents with fever which subsides within 24 hours
- blocked duct
- presents with a painful lump in the breast with an overlying patch of redness on the skin
- the patient usually feels well and does not have a fever
- expressed breast milk may contain white particulate matter
- there may be associated “white spot” at the end of the nipple (around 1mm in diameter) which is extremely painful during feeding
- breast abscess
- presents with severe pain and a swollen lump in the breast, the overlying skin may be red, hot and swollen
- the lump may be fluctuant and there might be skin discolouration and necrosis
- the patient may or may not have fever
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