Which clinical feature best distinguishes lactational mastitis from breast engorgement in a postpartum woman?

Explanation

## Distinguishing Lactational Mastitis from Breast Engorgement ### Key Clinical Discriminator **Key Point:** Fever and systemic symptoms (malaise, myalgia, headache) are the hallmark features that distinguish mastitis from physiological engorgement. ### Comparative Features | Feature | Breast Engorgement | Lactational Mastitis | |---------|-------------------|----------------------| | **Fever** | Absent | Present (>38.5°C) | | **Systemic symptoms** | None | Present (malaise, myalgia) | | **Onset** | 2–5 days postpartum | 1–4 weeks postpartum | | **Localization** | Bilateral, diffuse | Unilateral, localized | | **Skin erythema** | Absent or minimal | Present over affected area | | **Milk flow** | Impaired initially | Impaired due to pain/swelling | | **Response to emptying** | Resolves with frequent feeds | Persists; requires antibiotics | ### Clinical Pearl **Clinical Pearl:** Engorgement is a physiological phenomenon caused by increased blood flow and interstitial edema; mastitis is an infection (usually *Staphylococcus aureus* or *Streptococcus agalactiae*) and requires antibiotic therapy. The presence of fever and constitutional symptoms mandates bacterial infection workup and antibiotic initiation. ### High-Yield Mnemonic **Mnemonic:** **FEVER distinguishes Mastitis** — Fever, Erythema, Vasculitis (localized inflammation), Exudate (purulent if abscess), Rigors. ### Management Implications - **Engorgement:** Frequent breastfeeding, warm compresses, analgesics, supportive care. - **Mastitis:** Continue breastfeeding (safe for infant), antibiotics (flucloxacillin or cephalexin), NSAIDs, and urgent review if no improvement in 48 hours (risk of abscess formation). [cite:Williams Obstetrics 26e Ch 37]