Gangrenous Mastitis

An Overview of Gangrene Mastitis

For a brief overview of other types of mastitis, check out this blog post.

Risk Factors

Why does mastitis progress to gangrenous mastitis? Simple ol' rotten luck, by most accounts. But there are some suggested predisposing factors. It commonly affects young does not long after kidding, perhaps when their immune system is at its lowest. As with other forms of less serious mastitis, a wet, dirty environment or poor miking hygiene increase risk. Causes All sources agree that the most common cause of gangrene mastitis is the bacteria Staphylococcus aureus. Less commonly it is caused by coliforms like Escheria coli and co-infections with clostridiums. In this unfortunate case, one Boer doe was battling an infection with all three simultaneously.

In 2013, this study was published that discovered a half dozen cases of gangrenous mastitis were caused by Bacillus cereus - the same bacteria found in the environment that can lead to food poisoning in people - this is an interesting one to read as it provides a lot more detail than most, including production for years after the gangrenous ordeal.

Infections caused by strains of Mycoplasma are often associated with herd-wide mastitis outbreaks and high mortality, as evidenced by this study of a California dairy in the 1990's. While sources say it can cause gangrenous mastitis, I did not find a specific case study where that was confirmed.

Additionally, I could not find any cases where any sort of fungus caused gangrenous mastitis specifically.

Pseudomonas aeruginosa can cause mastitis in goats, as evidenced by this interesting case in which "The bacterium was isolated from the teat dip and the teat dip container. The teat dip consisted of water, liquid soap, and several drops of essential oils (including tea tree, lavender, and peppermint)" However, I only found evidence of it causing gangrenous mastitis in sheep in goats in Israel.

No matter which bacteria are responsible, gangrenous mastitis is a very serious and all too often fatal health issue. While it is possible for it to happen in pregnant does, it usually occurs in fresh does. In this study, you can see how quickly the goats reacted to being experimentally infected with S. aureus strains.

The entire process, from onset to losing necrotic tissue to healing, might last months or it might last a day, causing sudden death (Smith and Sherman 666) In many of the case studies I've found, the timeline was usually around a month. The longest case I've found was the young LaMancha doe whose ordeal lasted 18 months from start to finish, back up in the Bacillus case. In this unusual case, a senior doe that had not kidded recently (perhaps ever - the text was unclear) developed gangrenous mastitis and was successfully treated by a total mastectomy.

Symptoms Across the board, the most common first symptom gangrenous mastitis cases present are anorexia (off-feed) and depression. A fever may be present but it is often a transient fever, meaning the animal's temperature will spike then return to normal or even subnormal. In this case, the doe in question had a subnormal temperature just two days after clinical symptoms appeared - this study is well worth reading as it has a very clear and concise explanation on how S. aureus causes gangrenous mastitis. Sub-normal temps were recorded in a few other cases, as well.

The next stage, and sometimes the one that is noticed first, is udder inflammation, during which time the udder can still be warm to the touch. While it seems more common that the doe's udder is affected unilaterally, a bilateral infection is possible, too. The doe is often uncomfortable, sometimes showing lameness or a general reluctance to move or even stand because of the pain. As it progresses, the affected tissue turns cool or cold to the touch, showing the characteristic reddish or purplish blue discoloration. A line of demarcation will form, which is the boundary between necrotic tissue and healthy tissue. During all this, it is likely milk will go from normal to reddish or brown and watery and turn into a pus-like secretion. Goat Medicine by Smith and Sherman mentions "gas bubbles may be present" in the gangrenous udder but I did not find that particular symptom in any case study, so I am assuming it is uncommon. (I was disappointed in the small amount of information this textbook offered on this particular type of mastitis but many offered none at all. I am hopeful the new edition (my copy is the second edition published in 2009) will be more detailed.

In some cases, the affected area dies entirely, leaving a mass of completely dried up tissue, often the teat. In the case I describe below, most external tissue survived, the doe retaining most of her teat and general udder shape. This study shows a good example of a necrotized teat.

Treatment

I must reiterate this is for informational purposes only. After reading many case studies and talking with or reading about many cases, I think it is safe to say there is no singular best treatment for gangrenous mastitis. More often than not, the owner is trying to save the doe's life by preventing the the animal from going septic (bacteria entering the bloodstream) rather than save the infected udder.

At this time, there's no antibiotic labeled for mastitis treatment in goats specifically, so any drug is considered off-label.

Most, but not all, of the bacteria causing gangrenous mastitis will be gram positive and there is varying degrees of antibiotic resistance among those bacteria. Since gangrenous mastitis can progress so quickly and because it usually takes at least 24 hours for a culture (never mind if you have to ship a sample etc.), a broad spectrum antibiotic is usually the first choice until the milk is cultured and the culprit(s) identified.

To further complicate things, it is difficult for intramuscular antibiotics to penetrate the blood milk barrier in the udder and different bacteria accumulate in different areas. In this article, "Treatment of Mastitis During Lactation," the author says "An important question regarding the treatment of mastitis is whether the antimicrobial should accumulate in the milk or in the udder tissue [9]. The target site may depend on the causative agent: streptococci are known to remain in the milk compartment, but S. aureus penetrates udder tissue and causes deep infection (Table 1)"

Among the studies conducted in the United States and when consulting vet books and university websites, the most used or suggested systemic antibiotics include oxytetracycline, penicillin, ampicillin, florfenicol, and cetiofur.

Intramammary treatments need to be for lactating animals, not dry, and common ones include cetiofur, cephaperin sodium, penicillin g procaine, sodium cloxacillin, and pirlimycin. Note that intramammary treatments are not without the risk of damaging the teat canal and even causing more bacteria to enter the udder - great care must be taken to be very clean (washing the udder, wearing gloves, sanitizing hands etc,) and to insert the tip of the applicator into the teat orifice as little as possible.

When possible, treatment also included frequent "stripping" of the affected teat. Compresses, especially alternating hot and cold, can help relieve the inflammation (in addition to drugs, not in place of!) and possibly help express more fluid. Supportive care is critical. In nearly every case study, non-steriodal anti-inflammatories were utilized. Flunixin-meglumine not only helps manage pain but this review in the Journal of Dairy Science shows that it helps the blood-milk barrier recover faster during mastitis. Meloxicam is also helpful: "Meloxicam is a COX-2–selective NSAID that is used in dairy cow mastitis treatment because it can lower the SCC, increase the probability of bacteriological cure, and reduce of the likelihood of culling compared with cows treated only with antibiotics (McDougall et al., 2009, 2016)."

Additional supportive care can include maintaining hydration and making sure metabolic issues don't arise from the animal being off-feed. In many instances, lactated ringers or intravenous fluid therapy were utilized, as were various electrolyte supplements. Vitamin B is helpful to encourage appetite. In one study, Vitamin C was also given, presumably to boost the immune system. Keeping the area clean is essential. Care should be taken to keep it dry and to ward off flies, as well. Betadine or iodine spray is helpful once the tissue has sloughed, especially. Flushing with water for long several minutes not only keeps the area clean, but promotes healing.

Mastectomy

A unilateral (one side) mastectomy or bilateral mastectomy (both sides of the udder) is the most aggressive treatment option. It is likely that the procedure cannot be done by a local vet but at a university. There are various methods and possible complications but it is safe to say the procedure is more common now than it was ten years ago and seemingly more successful. The owner will likely be dealing with the following during aftercare: keeping the doe from chewing or itching at sutures, keeping the area clean, and administering antibiotics. It usually requires a few days stay and some follow-up visits.

A Case of Gangrene Mastitis at Hefty Goat Holler Farm GRAPHIC PHOTOS BELOW - I DO NOT RECOMMEND THIS POST IF YOU DON'T WANT TO SEE BLOOD AND SLOUGHING/DECAYING TISSUE

I talked to many folks, read my vet text books, and searched for similar cases. Protocol is quite variable. Most people opt for strong antibiotics. Some for emergency mastectomies.

You will notice the only antibiotics I used were Penicillin (injection) and ToDay (intramammary). I gave the ToDay at 12 hour intervals until I could not longer express milk/fluid. Penicillin I gave I think a total of 4 or 5 days. Essentially just a day or so longer than her possible neurological symptoms stopped.

I opted for staying home and using as few antibiotics as I could. Mostly, this is because I didn't think Beryl was going to live. I was going to try to help her but I sincerely believe a trip to the vet, much less a vet stay or mastectomy, would have killed her from stress alone. The way she stopped eating, I think stronger antibiotics would have only made more rumen issues. I did it basically just when she had a fever and before it apparently walled itself off. After talking with a great goat mentor, in the future, I will utilize lactated ringers in cases like this (which I hope I never have again!) to at least keep them hydrated much easier than with drenching when they won't drink.

I also don't think this STARTED as mastitis, looking at her initial symptoms. I cannot find any reference to neurological type symptoms associated with gangrene mastitis but her SCC obviously did spike that same day. Did it spike because mastitis was setting in or because she was otherwise ill? I don't know, but her initial total lack of any udder-related symptoms for three days from onset, makes me inclined to believe the mastitis piggy-backed off of a different issue. Perhaps a neurological one that was kicked with the thiamine. Perhaps something else entirely. But I have no way of knowing that for sure, unfortunately.

I learned the hard way you have to have STERILE containers to get milk for accurate culturing. My vet gave me a sterile red top blood tube. Then I found out the hard way that most labs (at least the ones I looked at) will not take milk samples in these. I had also ordered some Accumast culture plates to do it myself. They arrived broken. Just as well, because I remembered I had sold my incubator (which is necessary to grow the bacteria on the plates). By that time, I could no longer express milk or fluid, anyway. So. Even though all the symptoms match gangrenous mastitis, I don't know which bacteria it was, which I am bummed about.

Long story short, she eventually, she lost the milk gland inside her udder. It essentially disconnected from the top of her udder, moved to the bottom, and burst through, as seen below. So she lost some external tissue, too, but not much. I did top this healing, oozing spot with pen g one particularly nasty looking day. Otherwise, it got hosed off with cold water during this final stage. To keep it clean and encourage new tissue growth. Talking with other folks that have experience with it, sometimes the whole process can happen in a few days. Weeks, months, it can vary widely. A friend had a case that went on for months longer than Beryl's; from onset to losing the udder, it was nearly a year. Just a note, I've had one mastitis case before, ever, and it was a simple, mild case corrected by a couple doses of ToDay.

February 7, 2023 Beryl kidded for the first time, on her birthday, funnily enough. She had zero issue and shelled out two pretty large bucklings at the edge of the woods in between feeding cattle that morning. It had started to rain lightly after they were born and she stood over them as they tried to get their legs under them, sheltering them from the precipitation. I moved the new family into a nice dry shed - the newborns weren't chilled a bit! Beryl was a very attentive, sensible dam.

February 21

First milk test! Beryl is only two weeks fresh, so she doesn't milk down entirely but her orifice and teat size are wonderful and she stands like an absolute champ - best of the whole bunch!

Sunday, March 26th Milk Test Number 2.

Beryl acted completely normal, ate with her normal gusto on the stand. She gave 2.5lb, a significant increase from her first milk test and an overall impressive amount for one milking! But immediately after being milked, she stood like she was uncomfortable, humped up a bit. It was cold that morning so I figured it could be that or maybe needing some calcium. All test does were left in the yard area (away from kids since I dam raise) with grass hay, alfalfa, and whatever grass was growing. Beryl did eat but she also laid around more than normal. Her milk was normal at both milkings but her production had dropped sharply by the PM test – down to .9lb. No other symptoms.

The udder photos are from the AM milking - wow! The nicest I've raised, I think and a definite increase in production from the first test even though she didn't milk down quite as well as some of the others. It just so happened that my husband got a photo of her laying down that afternoon, you can tell she is a "off."

March 27th

Beryl ate but still felt off. She’d developed a fever – 105.4 (in the sun). I gave her banamine. Kids were still nursing. I checked her milk in case it was mastitis and it still looked normal. Her udder looked and felt normal and she showed no discomfort when milked. Her FAMACHA score was good. I evaluated whatever I could think of, as per usual when a goat is ill - No change in diet. No toxic plants. No bad hay etc.

March 28th

Beryl seemed to feel better and ate more enthusiastically at her AM breakfast (grain) with the other does. Immediately afterward, she felt poorly again. At this time, I considered ruminal acidosis. She received banamine, probiotics, Vitamin B, and later, a baking soda slurry. I consulted Goat Medicine for the dosage on the slurry. Since I still wasn’t sure what I was dealing with, I gave her only about half the recommended dosage. She ate only a few bites of hay and things I was tempting her with for the rest of the day – I offered grass, honeysuckle, pine etc. I ran a fecal – only a couple eggs on the whole slide.

March 29th

Beryl was still in the yard while the other does had been put back in with their kids. She would not eat more than a nibble nor drink much at all. She was drooling and frothing excessively by morning. It was such a long time after such a small baking soda slurry and it was too much like Rosemary and Aubrey (goats I'd lost to listeriosis years prior) to ignore the possibility of something neurological. She received her third (and final) dose of banamine, thiamine, and pen G at the listeriosis dosage. I drenched her with electrolytes several times. I got her hauled up to the barn and put in a stall. I went and dug a grave.

By that evening, the symptoms hadn’t improved but hadn’t gotten worse. I dewormed her at this time; my reasoning being might as well try it in case it was something (or at least something that could be piggy-backing off other issues) that just wasn’t shedding many eggs, as a last-ditch effort. (Remember that there is a stage where Barber Pole females are sucking blood but are not mature enough to lay eggs.)

I checked milk again. It was the odd-colored fluid from the right side. I could not get much to express. I started a Today mastitis treatment that afternoon. I did warm compresses and massage.

March 30th

Still administering thiamine in an effort to stave off anything neurological and hopefully boost her still-poor appetite and also giving pen G at the listeriosis dosage. Beryl was still drooling but had stopped frothing. Still needing to drench her with electrolytes and was still giving probiotics in between pen g dosages.

By afternoon, her right teat had turned cool to the touch. It also looked discolored. This happened very quickly. Since the mastitis was noticeable, I had been milking as much as I could as often as every couple hours, trying to get it flushed out of her body. At 2:00 PM milking, it was still the clearish, yellow tinted liquid. By 4:00 PM it had turned into a reddish tint. Since I could not give her another dose of banamine, I gave her one dose of livestock aspirin that day. I decided, if she was still alive the next day, I would get meloxicam, which has far fewer potential side effects and is much easier to administer and can be given long term (side note – I will ALWAYS have this on hand, now). I was massaging and doing warm compresses, still. Alternated with cold after talking to someone that said that can help the fluid express.

March 31st

Beryl turned a corner. She was eating and drinking much better. It was a very warm day and the flies were out. I doubled the amount of strips in the barn and Beryl got to wear Toot’s fly mask. Pine became her favorite thing! Still a bit of excess drool but not bad. But by PM milking and treatment, her milk was essentially blood. The rest of her right side was so hot and she was so hot that I soaked a rag in nearly frozen water and tucked it between her udder and her leg - not on the teat, though I figured it was a lost cause. She loved it - made her so much more comfortable. Did that throughout the day.

April 1st

Much the same as the previous day except I could no longer get anything to express from her right teat. She was getting her appetite back. I started reintroducing grain, VERY slowly.

April 2nd

Appetite and overall alertness was leaps and bounds better! Her right teat started weeping. It looked similar to a burn blister. I tried to keep her as clean as possible but it was quite sticky.

April 4th Beryl’s left side had essentially dried up when she was at her worst. As she started eating again, her left side was starting to produce again. Not just a little – she was uncomfortable. I milked the left side, taking care to be as sterile as I possibly could! That side was completely unaffected.

April 5th

Teat still weeping but scab forming. I thought that was a clear line of demarcation forming.

April 9th

By Easter, her right teat had stopped weeping and a scab had formed. The teat above the scab was warm to the touch. Her left side was still milking normally.

April 14th

Beryl acts completely normal. Wants to go with other goats, but is also happy getting spoiled in the yard. Tries to pick fights through the fence. Her left side is milking around 2lb a day. The scab around the right teat is almost off. The teat and udder are normal-warm to the touch. April 19th

The last of the scab fell off.

April 22nd - May 11 Was able to express a small amount of fluid from her right teat off and on. Note the bit of tissue on the April 22nd sample. But she's feeling good and slowly gaining back the condition she's lost.

May 30

From my Facebook post: "The right side of her udder has gone through several stages. Looking bad. Looking nearly normal. Now looking like this; it appears that all the dying tissue has migrated downward.

I have gotten "stuff" out of it off and on. It is interesting how that color and consistency has changed. Since it started migrating downward, it has bothered her to try to express anything so I generally haven't been.

Besides this right side, she's been completely normal and healthy. The left side has milked anywhere from 2 pounds to 2.7lb a day up to this point.

I don't know whether this right side will finally have a hole develop or what. If I trusted the local vets more, I'd maybe have it drained or something. But then I think, right now, with all the dang flies and dirt, maybe it is better not to have an open wound...never mind the trip, sedation, and stress. So with all that in mind, I'm just monitoring. She feels good and sassy and I don't want to mess with that."

May 30 - June 1 At the end of May, her udder started developing soft spots in the tissue. Then those spots started oozing. This happened VERY quickly.

June 4th

The soft spots continued to enlarge. They did weep, some. The tissue would move around these spots, especially that largest one in the front. I just tried to keep everything as clean as I could. She was still doing well but you could tell it bothered her to bump this. I gave meloxicam for pain management. I don't know how effective it was when so much of the tissue was dead but it certainly seemed to help.

June 5th 8AM

At this point, it barely resembled an udder. This was at the morning milking - yes, her other side is still totally unaffected. Her appetite is still great. She's slick and shiny and sassy!

June 5th 9AM

The milk gland detaches and falls out. As far as I can figure, it gradually detached from the top of her udder and essentially fell while still inside the skin. The little holes of dead tissue formed and one kept getting larger. This just fell through that largest soft/dead spot in the tissue.

She actually didn't act like it was painful during this for the most part. Every once in a while, she would bump it hard with her leg and didn't like that. This was obviously dead so I wonder if it was more the weight of it pulling on the live skin. She was definitely more comfortable when it fell out. I did give her a few days of meloxicam during the worst of it. Glad this part didn't last long!

I had just finished watering and saw her licking (ACK!) something on the ground. It was this. What looks to be the entire milk gland. It wasn't liquid at all - I rinsed the dirt off of it so there's water in the photo. It was solid. No odor. Surprisingly large and heavy. Incredibly fascinating and strange.

June 9th

I thought I had gotten a photo of the massive gaping hole left but apparently I did not, and I am super-disappointed about that. It was huge with just flesh dangling. It healed so quickly. I ran cold water over it many days, since it was weeping. I alternated between iodine and chlorhexidine when not rinsing or after cold water rinsing. My main issue was trying to keep flies away but we did! I did do a topical of penicillin once or twice.

June 14th

Almost healed up here, still some slight drainage. I think it is interesting it retained its teat shape, after all. There's still live tissue, as well. It just healed up so quickly!

July 31st

She lost the very last scab there at that little pink spot on the front of her teat a week or so ago. It may look funny, but she's alive and well! Her good side was mostly milked out in these.

August 2nd

Beryl is officially all healed up! These were taken a few days ago - more captions on the photos. Her good side is still milking away, too. She gave 2.1lb on the last test - milking very steadily despite the heat. I think it is funny that you can't tell she has a wonky udder if you see her from the left side.

August 19th

Go, Beryl, go!

Little one-teat wonder milked exactly 3lb this week for the August test

Beryl would have easily been right up there at 1000lb+ with the other three but I'm still just so thankful she lived through gangrene mastitis.

It ended up she milked almost 800lb in her 305 with only two tests on a fully functioning udder and that last evening test she was already sick and milked half of what she had in the AM.

Throughout the year milking on her one side, she was still sloughing then recovering for several months of it. She was six months fresh here. One tough cookie!

I reviewed the data I received from the milk tests and made a graph of somatic cell counts and then also milk production because I think it is an interesting visual. Note that of course there was no sample from her right side after the second test. So when the right side was having issues like sloughing, the left side did have a correlating increase in SCC but it never showed any clinical signs of mastitis. Not sure what the August increase was about exactly but we had had a crap-ton of rain just before this test then a very sharp drop in temperature the morning before. Just a couple days before the November test, she'd also be in heat, too, which might account for the decrease in pounds and slight increase in SCC.

Her official record is as follows:

Milk Test 2023 Results: 10 tests. 318 DIM. 820 pounds milk.

305 Day pounds 793.

31# butterfat; Highest BF: 5.5% Avg BF: 3.8%

26# protein: Highest Pro: 4.2%; Avg Pro: 3.3%