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Abstract：
Breastfeeding mothers commonly experience nipple pain accompanied by radiating, stabbing or constant breast pain between feeds, sometimes associated with pink shiny nipple epithelium and white flakes of skin. Current guidelines diagnose these signs and symptoms as mammary candidiasis and stipulate antifungal medications.
This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome.
The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review.
There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes.
Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance.
Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
This study reviews existing research into the relationship between Candida albicans and nipple and breast pain in breastfeeding women who have been diagnosed with mammary candidiasis; whether fluconazole is an effective treatment; and the presence of C. albicans in the human milk microbiome.
The author conducted three searches to investigate (a) breastfeeding-related pain and C. albicans; (b) the efficacy of fluconazole in breastfeeding-related pain; and (c) composition of the human milk mycobiome. These findings are critiqued and integrated in a narrative review.
There is little evidence to support the hypothesis that Candida spp, including C. albicans, in maternal milk or on the nipple-areolar complex causes the signs and symptoms popularly diagnosed as mammary candidiasis. There is no evidence that antifungal treatments are any more effective than the passage of time in women with these symptoms. Candida spp including C. albicans are commonly identified in healthy human milk and nipple-areolar complex mycobiomes.
Clinical breastfeeding support remains a research frontier. The human milk microbiome, which includes a mycobiome, interacts with the microbiomes of the infant mouth and nipple-areolar complex, including their mycobiomes, to form protective ecosystems. Topical or oral antifungals may disrupt immunoprotective microbial homeostasis. Unnecessary use contributes to the serious global problem of antifungal resistance.
Antifungal treatment is rarely indicated and prolonged courses cannot be justified in breastfeeding women experiencing breast and nipple pain. Multiple strategies for stabilizing microbiome feedback loops when nipple and breast pain emerge are required, in order to avoid overtreatment of breastfeeding mothers and their infants with antifungal medications.
摘要：
母乳喂养的母亲通常会经历乳头疼痛并伴有放射，喂食之间的刺伤或持续的乳房疼痛，有时与粉红色有光泽的乳头上皮和白色的皮肤薄片有关。目前的指南将这些体征和症状诊断为乳腺念珠菌病，并规定了抗真菌药物。
这项研究回顾了现有的研究，这些研究涉及被诊断患有乳腺念珠菌病的哺乳期妇女的白色念珠菌与乳头和乳房疼痛之间的关系；氟康唑是否是有效的治疗方法；以及人乳微生物组中白色念珠菌的存在。
作者进行了三项搜索，以调查（a）母乳喂养相关的疼痛和白色念珠菌；（b）氟康唑在母乳喂养相关疼痛中的功效；和（c）人乳分枝杆菌的组成。对这些发现进行了批评，并将其整合到叙述性审查中。
几乎没有证据支持念珠菌，包括白色念珠菌,在母乳中或在乳头-乳晕复合体上引起一般诊断为乳腺念珠菌病的体征和症状。没有证据表明抗真菌治疗比具有这些症状的女性的时间流逝更有效。包括白色念珠菌在内的念珠菌通常在健康的人乳汁和乳头-乳晕复合体真菌中被鉴定。
临床母乳喂养支持仍然是一个研究前沿。人乳微生物组，其中包括一个分枝杆菌，与婴儿口腔和乳头-乳晕复合体的微生物群相互作用，包括他们的分枝杆菌，形成保护性生态系统。局部或口服抗真菌剂可破坏免疫保护性微生物体内平衡。不必要的使用导致了严重的全球抗真菌耐药性问题。
在经历乳房和乳头疼痛的哺乳期妇女中，很少需要抗真菌治疗，延长疗程是不合理的。当乳头和乳房疼痛出现时，需要多种策略来稳定微生物组反馈循环，为了避免用抗真菌药物过度治疗母乳喂养的母亲和婴儿。
这项研究回顾了现有的研究，这些研究涉及被诊断患有乳腺念珠菌病的哺乳期妇女的白色念珠菌与乳头和乳房疼痛之间的关系；氟康唑是否是有效的治疗方法；以及人乳微生物组中白色念珠菌的存在。
作者进行了三项搜索，以调查（a）母乳喂养相关的疼痛和白色念珠菌；（b）氟康唑在母乳喂养相关疼痛中的功效；和（c）人乳分枝杆菌的组成。对这些发现进行了批评，并将其整合到叙述性审查中。
几乎没有证据支持念珠菌，包括白色念珠菌,在母乳中或在乳头-乳晕复合体上引起一般诊断为乳腺念珠菌病的体征和症状。没有证据表明抗真菌治疗比具有这些症状的女性的时间流逝更有效。包括白色念珠菌在内的念珠菌通常在健康的人乳汁和乳头-乳晕复合体真菌中被鉴定。
临床母乳喂养支持仍然是一个研究前沿。人乳微生物组，其中包括一个分枝杆菌，与婴儿口腔和乳头-乳晕复合体的微生物群相互作用，包括他们的分枝杆菌，形成保护性生态系统。局部或口服抗真菌剂可破坏免疫保护性微生物体内平衡。不必要的使用导致了严重的全球抗真菌耐药性问题。
在经历乳房和乳头疼痛的哺乳期妇女中，很少需要抗真菌治疗，延长疗程是不合理的。当乳头和乳房疼痛出现时，需要多种策略来稳定微生物组反馈循环，为了避免用抗真菌药物过度治疗母乳喂养的母亲和婴儿。
