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A young woman experienced pain and swelling in a non-lactating breast. The culture test result showed an unusual microbe, which is increasingly prevalent in Norway and internationally.

Background: This article presents an update on causes and management of mastitis in general practice., Material and Methods: Published articles on the causes and management of mastitis were identified by Medline and Embase searches, and reviewed. In addition, clinical experience from The National Breast-Feeding Centre in Norway is included., Results and Interpretation: Most studies report an incidence of mastitis of less than 20% though major methodological limitations make estimates difficult. Common symptoms of mastitis is a swollen, red, hot and painful breast, and systemic symptoms as fever occur frequently. Mastitis may be inflammatory or caused by microorganisms, and often secondary to milk stasis. Effective milk removal is a most essential part of the treatment and may make antibiotics superfluous. In most cases bacterial mastitis is caused by Staphylococcus aureus resistant to beta-lactamase sensitive antibiotics. Culture of the milk is necessary to determine the infecting organism and its antibiotic sensitivity. When antibiotics are warranted, dicloxacillin or cloxacillin are suggested as first-line drugs. The transfer of dicloxacillin/cloxacillin to breast milk is minimal. In most cases women with mastitis can continue to breast-feed also from the affected breast during treatment.

For a period of 22 months, postpartial women in Oslo were asked to consult one of several specific general practitioners in the event of mastitis. Clinical symptoms, bacteriological findings in breast milk and treatment were recorded in 43 patients. Patients with a favourable (n = 35) and with an unfavourable outcome (n = 8) defined as abscess, relapse and/or relief of symptoms after more than seven days, were compared. Unfavourable outcome was characterized by higher score of clinical symptoms and a higher isolation frequency of Staphylococcus aureus. The occurrence of fever did not differ between the groups. Bacteriological findings in milk from both breasts were compared with the findings from 100 milk donors. Staphylococcus aureus was more frequently isolated in milk from affected breasts than from unaffected and control breasts (17/40 versus 4/40 versus 4/100). Most of the Staphylococcus aureus strains (70%) were betalactamase producers. Coagulase negative staphylococci were a frequent finding in all milk samples, whereas Gram-negative bacteria were frequent only in the controls. The presence of pathogenic bacteria, as well as high bacterial counts, were associated with a higher number of symptoms. However, the predictive value of the bacteriological examination was low. Our study indicates that bacteriological examination of breast milk is justified only in patients with severe, acute symptoms and recurrences when betalactamase producing Staphylococcus aureus are suspected.

The cell counts in milk of goats seem to vary quite a lot. It is difficult to diagnose mastitis in goats using only cell counts as a criterion. Clinical symptoms correlated with bacteriology and differences in the cell counts of milk samples from the two halves are probably the criteria of choice in the laboratory mastitis diagnosis in goats.

A case of mastitis in a goat caused by S. aureus is described. Cytological and bacteriological examinations of milk samples throughout the entire lactation period were made. The average cell counts/ml in millions in milk samples were 6,12 (right half with mastitis) and 0,51 (left half which was normal) throughout the entire lactation period.