## Distinguishing Lactational Mastitis from Engorgement ### Clinical Presentation Comparison | Feature | Engorgement | Lactational Mastitis | |---------|-------------|---------------------| | **Onset** | 24–48 hours postpartum | 1–3 weeks postpartum (typically) | | **Fever** | Absent | Present (>38.5°C) | | **Systemic symptoms** | None | Chills, malaise, myalgia | | **Localization** | Bilateral, diffuse | Unilateral, localized | | **Erythema** | Absent or mild | Present, often wedge-shaped | | **Milk flow** | Impaired initially, improves | May be impaired | | **Response to emptying** | Rapid improvement | Slower; may require antibiotics | ### Key Point: **Fever and systemic symptoms (chills, malaise) are the hallmark discriminators of mastitis and indicate bacterial infection, whereas engorgement is a physiological phenomenon without constitutional signs.** ### High-Yield: Engorgement is self-limited and resolves with frequent feeding, cold compresses, and analgesia. Mastitis requires antibiotic therapy (typically flucloxacillin or amoxicillin-clavulanate) and continued breastfeeding to prevent abscess formation. ### Clinical Pearl: A lactating woman with unilateral breast pain, erythema, and fever should be treated as mastitis until proven otherwise. Delayed antibiotic initiation increases risk of breast abscess (10–11% of untreated mastitis cases).
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