| Fungal infection of the breast (mammary candidosis) is largely unstudied, but its symptoms often prompt mothers to consult lactation professionals.; Procedures for diagnosis of mammary candidosis, including laboratory confirmation, are not well defined. Lactoferrin present in human milk can inhibit growth of Candida albicans, limiting the ability to detect yeast infections. Effects of various lactoferrin concentrations, with or without added iron, on the growth of C. albicans in whole human milk were studied. Addition of iron led to a significant increase in cell counts and reduced the likelihood of false negative culture results.; A prospective cohort study of 100 lactating women was conducted to document the occurrence of, and risk factors for, Candida colonization and mammary candidosis. Skin and milk samples were collected from the participants and tested for Candida species at 2 wk postpartum. Skin samples were also collected from 40 non-pregnant, non-lactating women, and none tested positive for Candida. Of the lactating women, 23% tested positive for Candida and 20% had mammary candidosis. Bottle use (first 2 wk postpartum) and gestation >40 wk were associated with increased risk of colonization. Of the 100 infants, 20% tested positive for Candida. Bottle use (first 2 wk postpartum) and the presence of siblings were associated with increased risk of colonization. Of women who tested positive at 2 wk, 43% were still breastfeeding at 9 wk postpartum compared to 69% of the women who did not test positive (p < 0.05).; Using data from the same cohort, the sensitivity, specificity, and positive predictive value of signs and symptoms for predicting Candida colonization were evaluated. Positive predictive value was highest when there were 3 or more signs or symptoms simultaneously, or when flaky or shiny skin of the nipple/areola were reported together or in combination with breast pain.; These results illustrate that mammary candidosis can be common and is strongly linked to bottle use early postpartum. Addition of iron to milk prior to culture for Candida is recommended to improve the detection rate, but certain combinations of signs and symptoms are highly indicative of infection. |
