Parotiditis: Definition, Description, Causes and Risk Factors:
Parotiditis is inflammation of the parotid salivary gland: it can be acute, chronic, or chronic with acute exacerbations. Acute suppurative parotiditis was a well-recognized complication of abdominal surgeries prior to routine administration of perioperative antibiotics. The incidence of parotiditis has been reported to be 0.01%-0.02 % of all hospital admissions and 0.002%-0.04% of postoperative patients. The etiology of parotiditis is assumed to be ascending infection from the oral cavity. Many risk factors are associated with acute parotiditis based on patient population with dehydration being the most significant. Staphylococcus aureus is the most common bacterial pathogen; however, anaerobes and mixed infections are increasingly being identified.
A variety of factors can lead to an inflamed parotid gland. They include:
- Mumps is the main virus causing parotiditis, but this virus is rare today because of vaccines.
- AIDS can cause swelling and enlarged parotid glands.
A blockage may block saliva flow and lead to a bacterial infection; causes include:
- Salivary stone in the parotid gland.
- Mucus plug in a salivary duct.
- Tumor (usually benign).
- Sjögren syndrome — an autoimmune disease.
- Radiation treatment of head and neck cancer can lead to parotid gland inflammation.
Other conditions can cause the parotid glands to become enlarged, but not infected, including:
- Swelling in front of your ears, below your jaw, or on the floor of your mouth.
- Dry mouth.
- Strange or foul taste in your mouth.
- Pus draining into the mouth.
- Mouth or facial pain, especially when you are eating or opening your mouth.
- Fever, chills, and other signs of infection.
The diagnosis is clinical. Acute parotiditis presents with sudden onset of indurated, warm, erythematous swelling (a) of the pre- and post-auricular areas, with intense local pain and tenderness. Symptoms are often associated with high fevers, chills, and marked systemic toxicity. The infection is usually unilateral; bilateral infections are more associated with neonatal cases. Purulence from the gland (b) and Gram stain may support the diagnosis of acute suppurative parotiditis. Cultures may be obtained from parotid needle aspiration.
Late in the course of the infection, massive swelling of the neck and respiratory obstruction may occur. Other late manifestations include septicemia, osteomyelitis of adjacent bones, and organ failure.
Sialography is contraindicated in the acute stage of infection due to the risk of rupture of an ectatic duct from the pressure of injected dye and usually incites intense pain. Ultrasound is replacing sialography in the evaluation as it is easier to perform, demonstrates solid masses or fluid collections within the gland, and detects hypoechoic areas that correspond to punctate sialectasis by sialography. CT scanning and MRI with gadolinium (Gd) enhancement may be used to determine the size, shape, and presence of a neoplasm or abscess within the gland.
Adequate hydration and antimicrobial therapy are the main stays of treatment. Antibiotics should be administered intravenously in acute bacterial parotiditis after obtaining blood cultures. Staphylococcus aureus is the most common organism in community-acquired parotiditis and first-line antibiotic therapy should include the anti-staphylococcal antibiotic (Unipen®, oxacillin, AncefTM, etc). MRSA coverage should be considered if the patient has a history of recurrent cutaneous MRSA abscesses, residence in a Nursing home with endemic MRSA, or other predisposing condition. For healthcare-associated parotiditis, broad spectrum antibiotics are recommended. Cefoxitin, imipenem, InvanzTM, the combination of a penicillin plus beta-lactamase (amoxicillin/clavulanate, ampicillin/sulbactam) will provide adequate coverage. However, the presence of MRSA may mandate the use of vancomycin, Zyvox™, or Cubicin™. The presence of associated dental infection warrants anaerobic coverage. In penicillin allergic patients, clindamycin is an alternative option.
Treatment should be adjusted based on culture results and presence or absence of bacteremia. Standard therapy is 10 to 14 days, likely longer in the presence of bacteremia. Surgical drainage and decompression of the gland are occasionally required if spontaneous drainage does not occur. Therapy for chronic parotiditis should initially be conservative. Parotidectomy may eventually be required for people with long-standing infection. Good oral hygiene, adequate hydration, and early therapy for bacterial infections of the oropharynx are helpful measures for preventing acute bacterial parotiditis.
NOTE: The above information is for educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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