Systemic Medicine-I
Lecture #01 CLMS-02606
Mastitis
Derived from Latin word Mastos (which means udder) and itis (means inflammation).
Anatomy of Teat
Streak Canal: Opening up to the opening of rosette.
Teat sphincter: Circular contractions for closure.
Gland Cistern: Milk is stored here.
Milk Alveolus: Basic unit and milk is produced here.
Annular Folds: these are present at the opening of gland cistern. When there is pressure on gland cistern they will open and milk let down.
Quarter: lobules and lobes collectively make it.
Teat: It starts from end of quarter and continue downward.
Theilitis
It is the inflammation of the teat.
Mastitis
It is the inflammation of quarter.
Mastitis is characterized by physical chemical and microbiological changes in milk and pathological changes in glandular tissue. Change in milk color, consistency lymphocytes and epithelial cells.
Mastitis causes
1. 21% decrease in milk production.
2. 25% decrease in butter fat.
3. Milk of inferior quality.
4. Huge economic losses to dairy industry.
5. 2 billion dollars incriminated for this disease in UAS. In world 35 billion dollars are economic loss.
6. 278 million economic loss in milk yield in clinical cases in Punjab province.
7. 53 crore losses in India annually, and 1607 crore are the overall losses in dairy industry of India.
8. Milk is to be discarded due to change in characteristics of milk and antibiotics.
9. Cost of veterinary services, drugs and labor are other aspects which cause economic losses.
Etiology
Leptospirosis, brucellosis, scarlet fever, staphylococcus toxemia gastroenteritis more than 200 bacteria, different viruses and traumatic injuries are responsible for causing mastitis.
Bacteria enter through teat opening and colonize internal lining of teat canal and can be palpated in the form of beats this is called teat stenosis.
Etiological agents go to teat canal after crossing fursenburg rosette. Then cross annular folds then go to gland cistern then to collecting ducts then milk alveoli and causes damage to milk producing cells. Also, causes collapsing of all the ducts and ultimately leads to different types of diseases.
Forms of Mastitis
• Sub-Acute
• Acute
• Per-Acute
• Chronic
• Sub-Clinical Mastitis:
Etiological agent passes from teat opening and goes to milk alveoli. At beginning low grade response. No change in color and taste of milk. Sub-acute mastitis is only characterized by tow changes
1. Slight and progressive reduction of milk quality.
2. Slight decrease in milk let down.
These changes can be felt by person that milks the animal. It is not visible by naked eye. Can be noticed only if one person milks daily. This is beginning of the disease. There is no inflammation in skin, muscle layers or sub cut tissues surrounding teat canal. At some stage sub clinical mastitis may become clinical mastitis.
• Clinical Mastitis:
All signs of cardinal inflammation are there. Loss of function, redness, hotness, tenderness etc. Any person may recognize the affected quarter. Change in color, consistency, flakes and clots in milk are there. Nature of milk is also changed. It is far better if the infection is traced in the beginning when it is in subclinical form. As in clinical form there is excessive damage to milk producing cells, infrastructure damages, certain pathological changes in quarters, collecting ducts, gland cistern, annular folds, internal lining of teat canal and teat cistern.
When chronic inflammation leads to thick architecture then it is called cord formation and can be felt by palpation. It is rope like structure.
Tests to detect Sub Clinical Mastitis
California Mastitis Test: It was discovered in California university. Its reagent is expensive, about 1 litter reagent costs for 2000 Rs. In an effort to find cheap alternative test several scientists worked to devise SFMT.
Surf Field Mastitis Test (SFMT): this test is commonly used. House hold detergents are used.
3% solution off detergent (prepared by liver brothers) is used. Solution is prepared and preserved in any plastic bottle or cups or special types of containers are used. Mastitis detection paddle is prepared. It is cube shaped and has four receptacles. It is blackish in color.
Procedure: it is performed when there is slight decrease in milk letdown or more time is required for milk to come in teat canal.
• First few streaks of milk are discarded.
• 1ml of directly poured milk is taken in mastitis pedal (wash the pedal toughly before use). From each teat 1ml milk is taken in four different receptacles of mastitis detection pedal.
• 1ml of 3% surf solution is added in all parts.
• Pedal is moved in circular fashion for 30 seconds for mixing of solution and milk.
• After 30 seconds, each receptacle is seen carefully.
Results
• If no change in texture is present result is -ve that means mastitis in not present.
• If slight small flakes are present result is Traces.
• If flakes can be seen easily result is one positive.
• If gel is formed result is two positive.
• If gel is moved in circular fashion and it is viscous result is three positive.
• If gel is more viscous result is four positive.
Defense system of body rushes to site of infection (Leukocytes). The nature of detergent is basic and leukocytes have DNA which is acidic. So, reaction between acidic leukocytes and basic detergent damage cells and gel is formed. If there are more leukocytes, then more gel is formed. So, in this way SFMT is helpful in detection of sub clinical disease.
Diagnosis
Firstly diagnosis is done by clinical signs and testing the aseptic sample of milk so that basic etiological agent may be identified and antibody sensitivity is performed to know which Ab is to be used. If aseptic sample not taken, many other bacteria will lead to mistakes in that result as we want find single etiological agent responsible for that condition.
As at the site of teat sphincter skin comes out and makes ridges over there at the circumference of opening of teat. Naturally these wrinkles have lot of bacteria. Treat this portion with antiseptic and apply bandage after cutting bandages in various pieces (cube shaped pieces). Then pile these cubes and dip them in 70% alcohol in receptacles.
Put pressure with one hand to expose those wrinkles, protrude the wrinkles, remove the lid of that receptacles having cube shaped swabs, take piece of band one by one and scrub the part only once and then discard it. Take another piece and repeat the procedure for 7 times at least. After that a single piece of bandage with tincture iodine is scrubbed and after completion of this water is sterilized pressure is exerted to exclude the milk to make its sterilized or take a simple syringe and pull its plunger and sterilized sample is taken. Similar procedure is adopted before insertion of intra mammary tube. If this care is not taken bacteria present on the wrinkles will also be included in the sample and if mammary tube is pushed they will get into the teat. Milk is good medium for bacterial growth, so we are letting bacteria to chance of having multiplication. So, wrinkles on teat should be disinfected In a nice way.
Differential Diagnosis
This condition may be confused with several other conditions, any contusion when udder is enlarged.
1. Rupture of pre-pubic tendon so internal structures may come into udder.
2. Udder abscess
3. Post parturient udder edema
Review:
This disease comprises subclinical and clinical mastitis. Subclinical only detected by tests. In clinical all symptoms are clear and can be seen from distance. It causes putrefaction and that part becomes tender. If infection continues, may lead to chronicity and cord formation.
Another condition that may emerge is streak canal. It emerges when an animal is kept on hard floor, cemented surface and rubbing leads to irritation and it leads to condition called teat stenosis (as fibrous tissue is formed).
When teat canal is affected and fibrous tissue is formed a bead is formed and it causes narrowing of streak canal and milking becomes very difficult. And excessive pressure is required by man who milks the animal.
Treatment
• There are various instruments that may be used when in teat canal there is bead like structure.
Stricture Remover: Teat sphincter muscle, medial aspect of that tissue and this way this mass may temper the normal flowing of milk through teat.
1- Instrument must be sterilized (in boiling water)
2- Take some bowl and place water in it then keep boiling
3- Then effected teat is treated with antiseptic KMnO4 with hand
4- Instrument should be inserted into opening of teat
After insertion portion of crown cuts down the portion of streak canal because it has damaged the internal part so inflammation and fibrous tissue will be formed.
Teat dilator: Another instrument is doctor nayler's teat dilator is used to keep teat patent. This instrument comprises of wire and circular ring just and these are impregnated with piece of velvet that is soft and impregnated with antiseptic cream. Use it twice a day for a few days. Inflammatory process will cause fibrous tissue to pick up there and this instrument will keep the opening potent. Its presence will put pressure on formed fibrous tissue. Characteristics of fibrous tissue is that it keeps the teat contracted so this instrument is set to keep lumen of teat open.
• Another method for removing this cord like structure or bead like structure is to give an incision with sharp knife and whole portion including that mass is excised. bleeding will occur so bring both portion closer and stitches are place over there so it will lead to stoppage of bleeding and let it to lie for 12- 24 hours until when the animal is to be milked. At the time of milking the stitches are opened and milk the animal after it apply tincture iodine on the teat surface. After few days healing takes place. Note that the muscle is cut in this process so it is damaged and therefore there is continuous drippling of milk and there are increased chances of microbial contamination.
• As it occurs in animal lying on cemented floor and animals of urban area are mostly affected so this source is removed and let the animal lie over soft bedding like natural ground surface. Such type of animal will not be affected by this condition.
• Another method is homeopathic to dissolve this mass naturally and that is known as Inj. stenox 5ml and is repeated 3-5 injections per day to cure problem.
• Broad spectrum antibiotics is used when the case is presented but before use of antibiotics and take aseptic sample first and refer it to well-equipped lab. We should wait for result if the previously antibiotics is same as recommended by then keep it otherwise replace it.
• Use intra mammary tube after proper disinfection of teat.
• NSAIDS to reduce inflammation.
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