Staph/bacterial infection mistaken for thrush?

[luckiest]

My thrush saga continues...

After months of home treatment, including 2 rounds of gentian violet and nystatin (for me and baby), I'm still having problems.  I finally called a midwife (the midwives who attended my birth are out of state) and over the phone she told me she doesn't think it's thrush and wants to see me.

In the meantime I've been trying to figure out what it could be, if not thrush.  It all started after a bleb/clogged duct, serving as the entry point for infection.  At first it looked like typical thrush - shiny, red, flaky, burning.  Now the shine and flakiness is gone, but my nipple (just one side) is still VERY red, moderately painful (though not burning, necessarily, just painful).  No cracks, just redness and if you look closely it's like there are a bunch of broken capillaries under the skin.  

My guess is that I had both thrush and some kind of bacterial infection, possibly staph, and I've gotten rid of the thrush with my home treatment but not the bacteria.  

Has anyone else had a bacterial infection in their nipples?  How did you treat it?  This has been going on for so long that it's really starting to affect my mental state.  I'm incredibly discouraged and have panicky moments where I think it's just never going to go away.  

[wehrli]

subbing.

i'm having the very same issues... I didn't even entertain that it could be anything more/other than thrush...

[luckiest]

Ok, I found a couple of things...this article mentions very briefly that staph can feel like thrush.

http://www.pregnancy-info.net/when-breastfeeding-hurts-part-one-sore-nipples.html

"Similar nipple pain may also be caused by a staph infection of the nipples."

And an old thread about this exact same thing...

http://www.mothering.com/community/t/871617/staph-infection-mistaken-for-yeast

All day I haven't been using any thrush treatments, just a mixture of 1% cortisone and polysporin.  It looks the same...if it were yeast I would've expected it to flare up by now with no treatment.  Even though I've read that gentian violet can be effective against some bacteria, I think in my case it may have been so irritating that it actually exacerbated the problem.  Not sure.

[gemasita]

I had a staph infection in my nipples.  They treated me for thrush and none of the treatments helped at all so I went to a dermatologist.  I also had nerve pain in my nipples and I think that was caused by so much pumping.  Are you pumping?

[luckiest]

I'm not pumping.  I hand express occasionally because I nurse more on the unaffected side.  

Right now I'm on a hunt for a dermatologist who doesn't have a 3 month waiting list :^/  How did the dermatologist treat the staph?  I'm hoping that a topical antibiotic would be enough, my digestive system is a wreck when I'm on oral antibiotics.  

[HappyHappyMommy]

Hi Mamas,

I had a yeast infection and a bacterial infection and eczema on my nipples all at the same time (yuck!), so it's definitely possible and figuring out what all I was dealing with was important to getting better. I then had an allergic reaction to the compound-ed topical medication prescribed to address the infections. (Apparently, that's not very common, but I wanted to mention it because it's possible that you could also be reacting the treatments.) It took a bit of time and close work with my doctor, but ultimately the bacterial infection and the eczema were fairly easy to clear up and I was able to do so without an oral antibiotic. For me, the yeast infection was much, much harder to clear up. I tried all sorts of things (including gentian violet, which I know works for a lot of people, but didn't work for me and irritated my skin and grapefruit seed oil, which did nothing positive or negative for me). Ultimately, I needed an oral anti-yeast medicine, a topical ointment (which had only one medicine in it that we determined I wasn't allergic too, instead of the ointments that contain multiple medicines in them), and--most of all--VINEGAR! We discovered that I was reinfecting my breasts with yeast through my clothes (bras and cloth pads). I had thought  that washing in hot water would be sufficient to kill the yeast, but it actually wasn't. Once I washed everything (bras, cloth pads, towels, etc.) with white vingear--while treating the current infection with the oral and topical meds--I did not get reinfected. You can google wash with vinegar to get the amounts of vinegar to use.

Best of luck to you Mama! I'm sending hugs and good thoughts your way. :-)

PS I was able to be treated for all of this by my OB, who was great. If you have trouble getting into a dermatologist, a midwife or OB or your child's ped might be able to call and explain the urgency and get you moved up on the dermatologist's calendar.

[katelove]

Dr Jack's all purpose nipple cream has a component which will treat bacterial infections. I believe in Canada you don't need a prescription to get it made up. Not sure about the US. In Australia you need a 'script but I took the recipe to my GP and he was happy to write it for me.

The other possibility is dermatitis which is treated by a short course (usually a week) of topical steroids.

Hope you're feeling better soon.

[gemasita]

Originally Posted by luckiest 

I'm not pumping.  I hand express occasionally because I nurse more on the unaffected side.  

Right now I'm on a hunt for a dermatologist who doesn't have a 3 month waiting list :^/  How did the dermatologist treat the staph?  I'm hoping that a topical antibiotic would be enough, my digestive system is a wreck when I'm on oral antibiotics.  

My LC got me in to a breastfeeding-friendly derm.  Otherwise, it would have been weeks before I could get in.

They actually treated it with Hibiclens.  Hope that's the same for you.  It was easy.

[luckiest]

An update - 

Got a script for triple nipple cream, and after using it for a few days it seems worse...!  I suppose I could be allergic to something in the compound, like you were happymommy?  Very frustrating.  My left nipple, which has not been very affected, is red now as well.  

I'm feeling very worn down by all of this.  It doesn't help that DS nurses all day and night, and is very active about it (lap gymnast).

My current plan is to get in with a GP I've heard good things about next week.  There is a dermatologist in the same office, so if I need to see her hopefully the GP can get me in or just consult.  I'm going to ask for a culture of both my nipples (and maybe DS's saliva?).  At this point I'm thinking a good bit of the problem is just irritation/dermatitis from all of the treatments, and now the reaction to the compound.  Until I get in, I'm just not going to mess with it.  Heavy sigh.  

Your post was really helpful, happymommy, thank you!

[BodesMama]

Luckiest, any updates? Your story sounds familiar to me and I'm just not sure where to go from here. I'm not sure whether this is thrush or bacterial, and whether I should go for an oral antibiotic or oral antifungal at this point.  I used the APNO (triple ointment) cream and then just a topical antifungal, with no improvement.

I'd love to hear the latest for you!

[luckiest]

Well, the good thing is that now there is no pain at all.  I don't have any discomfort on the affected side whatsoever.

Bad news is it's still there, whatever it is.  I visited a GP and requested a culture - which was worthless.  She cultured my milk, but not my skin (?), and the results were positive for staph and strep bacteria, but that it could have been just a normal amount and they couldn't say definitively that they were causing the infection.  Arg.  Doc prescribed augmentin, even though she told me that it may not take care of the staph.  Why would I take ten days of antibiotics that probably won't take care of the problem you're not even sure I have?  

I'm using the triple nipple cream twice a day (which seems to be the most often I can use it without having additional redness from it).  I'm scared to see what would happen if I just stop using it.  It is for sure better than  it was two months ago, but it may just be a result of the steroid in the cream making the skin less red, while the root cause remains.  

It's been on my list for two weeks to call the GP and request that she get me in with the derm in her office.  Of course, with no more pain to serve as motivation, it keeps getting bumped down...plus with Thanksgiving and DS's birthday and Christmas...ah!

I think I need a *real* culture of my actual skin.  There's on patch that seems more affected.  Now it looks generally reddish, and if you look closely there's a network of broken capillaries (they are the redness, if that makes sense).  It must be some kind of infection, right?  I mean...if it were latch, or vasospasm, or teeth, I don't think it would've come on suddenly and only affect one side. I don't think DS is harboring whatever it is in his mouth, because it's just the one side.  

I'll update when I see a derm.

[luckiest]

Update - 

I still haven't seen a derm yet, but today my mom (who is a nurse/breastfeeding consultant) noticed that when DS sticks out his tongue it always points off to one side.  Good thing he's really into mimicking right now - we were both sticking our tongues out at him trying to see if it was always like that.  Sure enough - it almost looks like one side of his tongue is shorter (although I'd imagine it's just weaker for some reason).  Even when he isn't poking it out, you can peek in and see that one side looks a little thicker.

So now we're wonder if this whole thing IS physical/latch related rather than an infection after all.  If his tongue is weak on one side and kind of torques my nipple, wouldn't that cause irritation and the little broken capillaries I'm seeing?  And it could be on one side because my nipples are actually shaped very differently and his latch could be different.  And maybe it started when he was around six months because he started solids and his tongue got more developed or something?  Ok, maybe I'm grasping at straws with that last one...

My SIL is a speech pathologist (and my other SIL is an occupational therapist) so I'm going to have her poke around on Thanksgiving.  Fingers crossed that that's the root issue and we can fix it with some exercises.  

[luckiest]

Final update!  (hopefully)

I saw a dermatologist, and she was the first truly helpful professional I've seen in this process.  She diagnosed nipple eczema, probably brought on by the harsh thrush treatments (GSE, two rounds of gentian violet, vinegar, etc), and perpetuated by the constant wet/dry/wet/dry that goes along with nursing.  My triple nipple cream was helping somewhat with the steroid, but the antibiotic was causing its own irritation, and thus further perpetuating the eczema.  Also, I didn't know that prolonged topical steroid use can thin your skin, and my nipple was showing signs of that.  Eek!

So she prescribed a "non-steroid steroid" called pro topic ointment, along with lanolin as a barrier and making sure I dry my nipple after each feed.  It's been a week and I'm seeing major, major improvement.  This is the best my nipple has looked and felt in 6 months.  Hurray!

[BodesMama]

Great news, Luckiest!  I'm finally comfortable now, too! I think I had a contact dermatitis reaction to the antifungal ointment in the APNO cream and the antifungal cream my doc prescribed, so my nipples and areolas were in ROUGH shape. Ugh. I ended up doing a vinegar rinse after every feeding and using lanolin on the especially sore nipple. I also did 3+ weeks of Diflucan. I stopped taking it two days ago and I am SO happy to report that I'm feeling great! Well, despite my cold and my 2 month old's virus and rash. Boo. But at least we're through the rough breastfeeding stuff!