Candida and breastfeeding
Candida albicans is the most common occurring of the candida species found as a commensal on mucosal tissue of mother and child. As a pathogen it can cause a distressing fungal infection for both mother and baby resulting in nipple and breast pain for the women and feeding difficulties for the infant. Clinicians can often presume that these symptoms are due to C. albicans, which has resulted in an overuse of systemic antifungal therapy in many of these patients. It is therefore important to ensure that there is a clear diagnosis and that the problem can be treated appropriately.
Candida albicans is the most common naturally occurring candida species found as a commensal on the mucosal tissue of mother and child. It is also a pathogen that can cause fungal infections in both mother and baby. These infections may result in nipple and breast pain for the women and feeding difficulties for the infant. It is found less frequently in bottle-fed babies but can still cause concern for mother and child (Zöllner and Jorge, 2003).
Up to 96% of women who breastfeed experience nipple pain in the first 6 weeks of feeding (Tait, 2000; Amir et al, 2007). One of main reasons women stop breastfeeding early is due to breast or nipple pain (Mass, 2004). Although most cases of persistent nipple pain can be resolved by revisiting the positioning and attachment of the infant to the breast, some nipple pain may be caused by bacterial or candida infections (McClellan et al, 2012). In the past, nipple pain was often attributed to C. albicans (MacDonald, 1995) and Andrews et al (2007) found C. albicans to be the main cause of pain in mothers who reported having pain while breastfeeding. However, bacteria is often considered as the cause of breast pain (Mass, 2004). Staphylococcus aureus has commonly been found in samples of breast milk and oral swabs of babies (Amir et al, 2013) and other common organisms, such as strains of methicillin-resistant S. aureus and anaerobic Streptococci have been identified in breast milk although these generally cause mastitis (Dixon and Khan, 2011). S. aureus is also associated with nipple fissures (Weiner, 2006). There is some doubt as to whether there is a relationship with fungal organisms and the deep breast pain associated with breastfeeding (Dixon and Khan, 2011). Carmichael and Dixon (2002) suggest that there is little direct evidence to support the aetiological role of C. albicans in this condition and that further research needs to be done.
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