Pathogenesis (development of disease)
Mastitis puerperalis (puerperal mastitis) is caused by an intracanalicular ascending (ascending) infection, usually originating from nipple rhagades. Bacteriological infection of the mammary gland tissue occurs due to:
- Staphylococcus aureus (95%).
- Staphylococcus epidermidis (4%)
- Streptococcus (3%)
- Pseudomonas aeruginosa (< 1 %)
- Et al.
Mastitis non-puerperalis has a pathogenesis that is not yet clearly understood, although there is probably a connection with mastopathy or hormonal disorders (hyperprolactinemia; hyperthyroid metabolism). It may be an acute abacterial (= non-bacterial) or bacterial inflammation. In the case of bacterial inflammation, there is usually a mixed flora infection:
- Staphylococcus aureus (40%).
- Coagulase-negative staphylococci (40%)
- Anaerobes (10-20 %)
- Escherichia coli (< 5%)
- Proteus mirabilis (> 5 %)
- Enterococci and B streptococci, lactobacilli, fusobacteriaceae, mycoplasma, and others (< 5%).
Abacterial (non-bacterial) variants of non-puerperal mastitis are concomitant mastitis, granulomatous mastitis (GM), plasma cell mastitis or specific mastitis. For example, concomitant mastitis is mastitis associated with hormonally stimulated mammary (e.g., hyperprolactinemia (elevation of prolactin levels in the blood)). This leads to milk stasis, which in turn triggers the inflammation. The cause of granulomatous mastitis is usually retinal secretion, which has an inflammatory pattern dominated by plasma cells. The resulting granulation tissue is the result of microabscesses. Histopathologically, three different forms of GM are distinguished:
- Granulomatous, galactostatic, or destructive mastitis.
- Granulomatous lobular or idiopathic mastitis.
- Specific granulomatous form
Etiology (causes)
Biographical causes
- Macromastia (excessively large breasts) (mastitis non-puerperalis).
- Age/hormonal factors
- Sexual maturity
- The maximum incidence of mastitis puerperalis (postpartum mastitis) is 2-3 weeks after delivery. More often affected are first-time mothers and women who have previously had mastitis.
- The maximum incidence of mastitis non-puerperalis (mastitis outside pregnancy or the puerperium) is up to 40 years of age. Another peak in frequency is found in the pre-menopausal period.
Behavioral causes
- Consumption of stimulants
- Insufficient hygiene during breastfeeding (mastitis puerperalis).
- Overweight (BMI ≥ 25; obesity) (mastitis non-puerperalis).
Disease-related causes
- Actinomycosis – chronic fungal infection.
- Galactorrhea – abnormal breast milk discharge without pregnancy having occurred (mastitis non-puerperalis).
- Inverted nipples (mastitis puerperalis).
- Hyperprolactinemia – increased levels of prolactin in the blood (hormone that, among other things, promotes mammary gland growth and milk secretion) (mastitis non-puerperalis).
- Leprosy – chronic tropical infectious disease.
- Macromastia – excessive size of the breast.
- Mammary injuries – injuries to the breast
- Mastodynia – cycle-dependent tightness in the breasts or breast pain.
- Mastopathy – changes in the mammary gland.
- Lactic congestion (mastitis puerperalis)
- Sarcoidosis (synonyms: Boeck’s disease; Schaumann-Besnier’s disease) – systemic disease of connective tissue with granuloma formation (skin, lungs and lymph nodes).
- Secretion congestion (mastitis non-puerperalis).
- Syphilis – sexually transmitted infectious disease.
- Tuberculosis – consumption; bacterial infection that occurs mainly in the lungs.
- Typhoid fever – infectious disease with severe diarrhea.
Medication
- Estrogen-enhanced ovulation inhibitors (contraceptives).
- Sex steroid depot preparations – combination of female sex hormones used primarily for menopausal symptoms (menopause).
- Tranquilizers – sedatives such as diazepam.
Other causes
- Expired breastfeeding period
- Breastfeeding
