Salmonella Breast Abscess and Salmonella Mastitis: A Review and Update of the Literature

Abstract

Salmonella breast abscess / mastitis is a rare infection which can affect children and adults. It can affect females more commonly who are non-lactating and it does affect males as well as individuals who have predisposed conditions including: the immunocompromised, diabetics, rheumatoid arthritis, malignancies and other diseases. It may be acute, chronic, unilateral, or bi-lateral, as well as it may be recurrent if it is not appropriately treated. There tends to be a history of previous enteric fever (abdominal pain, vomiting, diarrhoea) which may not have been treated or adequately treated but this history has tended not to be apparent at the time of presentation. Manifestations of the disease tend to include a short- or long-history of: lump/mass in the breast which may or may not be painful, a history of previous diarrhoea, weight. The breast examination findings tend to be non-specific with some the findings including tenderness or no tenderness, a mass that may or may not be tender, a fluctuant lump that may feel like containing fluid, a firm or hard feeling lump that may mimic carcinoma of the breast. Confirmation of the diagnosis tends to be via obtaining culture and sensitivity results of a Salmonella organism and its sensitivity pattern. Treatments that have been given include: Utilization of correct antibiotics based upon the sensitivity pattern of the cultured organism, plus surgical treatment which could be complete aspiration of the pus, incision and drainage of the abscess or in cases where carcinoma of the breast was the provisional diagnosis or the diagnosis is unknown subcutaneous mastectomy and this can be avoided by biopsy of a lesion that mimics a malignant lesion. Follow up of patients is required to ensure the breast lesion has fully resolved. Adoption of the World Health organization guidelines for the prevention of Salmonella infection would help avoid the development of the infection. Urine culture, routine haematology and biochemistry blood tests as well as serology WIDAL tests and stool culture are some of the tests that tend to be undertaken in the investigation of the disease and in order to diagnose the disease a good history would be required including a history of travel from a non-typhoid endemic area to an endemic area. Conclusions: Salmonella breast abscess / mastitis is an uncommon disease which clinicians should have a high index of suspicion for. A history of previous enteric fever does help in suspecting the disease which at times does need to be distinguished from carcinoma of the breast. The diagnosis is confirmed by obtaining the culture results of the pus from the breast abscess / breast tissue. If all breast lesions are biopsied especially in cases of suspicion of a breast cancer and a past history of abdominal pain, diarrhoea and vomiting the results of the pathology examination of the specimen would negate malignancy and confirm an infection which would help in avoiding mastectomy procedures and enable utilization of antibiotics and drainage/aspiration of abscess to provide adequate treatment.