Breast abscesses in Nigeria: lactational versus non-lactational

Abstract

This review of 299 cases of breast abscesses seen over a 10-year period (1981-1990) at the University of Calabar Teaching Hospital in Nigeria seeks to establish the current status of breast abscesses in the tropics. Lactational breast abscess constitutes 95% of breast abscesses while non-lactational breast abscess constitutes only 5% in this review. The commonest pathogen cultured from lactational breast abscess is Staphylococcus aureus and the disease responds to incision and drainage and systemic antibiotics, while non-lactational breast abscess is caused mostly by anaerobic organisms, usually with underlying mammary duct ectasia. The low incidence of non-lactational breast abscess corresponds to the low incidence of cigarette smoking and mammary duct ectasia in Nigerian women. While the high incidence of lactational breast abscess corresponds to the high rate of breast feeding and low level of personal hygiene in the low income group Nigerian women in which the disease is commonest. Economic recession has also reduced patronage of artificial feeds thus intensifying breast feeding and consequent lactational breast abscess.

PIP: A consultant surgeon analyzed data on 299 women aged 18-56 treated for breast abscess during 1981-1990 at the University of Calabar Teaching Hospital in Nigeria to examine the differences and similarities in the etiology, presentation, management, and prognosis of lactational and nonlactational breast abscess. This hospital treats an average of 30 cases annually. Only 14 women (5%) were not lactating at the time of presentation. The lactating group comprised younger women than the nonlactating group (median age, 25 vs. 42). 85% of all lactational breast abscesses submitted for culture grew Staphylococcus aureus. 5% grew coliforms and 10% grew no organisms. 9 nonlactational breast abscesses were submitted for culture: 4 grew anaerobic organisms (3 Bacteroides sp. and 1 Streptococcus), 1 grew coliforms, and 2 grew nothing. All the women with lactational breast abscess improved with treatment: incision and drainage followed by daily packing with gauze soaked in magnesium sulfate solution (135 cases), Eusol (100 cases), and honey (50 cases) and systemic antibiotic with erythromycin, ampiclox, or amoxicillin/clavulanic acid. Only 4 of the women with nonlactational breast abscess improved with this treatment. The other 10 women experienced recurrence of breast abscess. Excision biopsy was required to treat them. They had acute or chronic inflammation with duct ectasia. All the women in the lactational breast abscess group were poor, while 6 of the 14 women with nonlactational breast abscess were from the high income group. No one from either group smoked cigarettes, probably explaining the low incidence of nonlactational breast abscess in Nigeria. The continual high incidence of lactational breast abscess coincides with the high incidence of breast feeding and with poor personal hygiene in the low income group in Nigeria.