Parotitis overview: Difference between revisions
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==Causes== | ==Causes== | ||
The most common [[bacterial]] cause is S. aureus. S. pneumonia, S. pyogenes, and H. influenza are also common. Less commonly [[gram negative rod]]s (GNR) as well as [[anaerobe]]s are found. M. tuberculosis and T. pallidum have also been reported but are usually associated with chronic, painless infection. [[Viral]] etiologies include paramyxovirus (particularly Mumps), influenza, parainfluenza, echovirus, and coxsackie. [[Cytomegalovirus]] (CMV) and [[adenovirus]] have been implicated in [[HIV]]patients. Nonbacterial causes include [[Wegener’s granulomatosis]] and [[lymphoma]]. [[Cat-scratch]] and [[actinomycosis]] should be considered if the patient fails to respond to standard therapy. This predisposes to parotitis.<ref>McQuone SJ. Acute Viral and Bacterial Infections of the Salivary Glands. Otolaryngologic Clinics of North America. 1999, 32:793-811.PMID 10477787</ref> | The most common [[bacterial]] cause is S. aureus. S. pneumonia, S. pyogenes, and H. influenza are also common. Less commonly [[gram negative rod]]s (GNR) as well as [[anaerobe]]s are found. M. tuberculosis and T. pallidum have also been reported but are usually associated with chronic, painless infection. [[Viral]] etiologies include paramyxovirus (particularly Mumps), influenza, parainfluenza, echovirus, and coxsackie. [[Cytomegalovirus]] (CMV) and [[adenovirus]] have been implicated in [[HIV]]patients. Nonbacterial causes include [[Wegener’s granulomatosis]] and [[lymphoma]]. [[Cat-scratch]] and [[actinomycosis]] should be considered if the patient fails to respond to standard therapy. This predisposes to parotitis.<ref>McQuone SJ. Acute Viral and Bacterial Infections of the Salivary Glands. Otolaryngologic Clinics of North America. 1999, 32:793-811.PMID 10477787</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
Revision as of 16:35, 20 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation. It is most commonly infectious in etiology but can be autoimmune or neoplastic.
Historical Perspective
The first report of acute bacterial sialadenitis dates back to 1828 described in a 71-year-old man whose infection progressed to gangrene. President Garfield died from acute parotitis complicating abdominal surgery.
Pathophysiology
Acute infection can occur in any salivary gland but the most commonly affected one is the parotid. This is thought to be due to a combination of anatomic and physiologic factors. The saliva from the parotid is less mucoid than that from the other salivary glands. IgA, lysozyme and sialic acid are all found in smaller amounts in the more viscous parotid secretions. These substances are thought to help fight off ascending bacterial infection. Bacterial parotitis is generally unilateral in adults (75-90%), while viral is generally bilateral. Though 80-90% of salivary calculi occur in the Wharton’s duct of the submandibular gland, the parotid remains the most common site of acute suppurative salivary infection. The secretions from the submandibular gland are more alkaline, thought to result in a higher concentration of insoluble calcium phosphate.
Causes
The most common bacterial cause is S. aureus. S. pneumonia, S. pyogenes, and H. influenza are also common. Less commonly gram negative rods (GNR) as well as anaerobes are found. M. tuberculosis and T. pallidum have also been reported but are usually associated with chronic, painless infection. Viral etiologies include paramyxovirus (particularly Mumps), influenza, parainfluenza, echovirus, and coxsackie. Cytomegalovirus (CMV) and adenovirus have been implicated in HIVpatients. Nonbacterial causes include Wegener’s granulomatosis and lymphoma. Cat-scratch and actinomycosis should be considered if the patient fails to respond to standard therapy. This predisposes to parotitis.[1]
Risk Factors
Parotitis is a disease that occurs in debilitated patients. Dehydration and decreased salivary flow are the main risk factors for ascending infection through Stenson’s duct to the gland. Postoperative patients who are dehydrated and NPO with little salivary stimulation are at particular risk with an incidence estimated at 1 in 1000. Debilitating medical conditions such as Diabetes mellitus, renal failure, HIV, and Sjögrens’s syndrome are also risk factors. Patients with Anorexia, Bulimia, CF, or those with salivary ductal dilation are also at risk. Ductal dilation is found in those with high intraoral pressure such as trumpet players and glass blowers and medications with anticholinergic properties or diuretic effects.
Treatment
Medical Therapy
The treatment of viral parotitis is largely supportive. Bacterial parotitis is targeted toward gram positive and anaerobic organisms. 70% of those cultured arebeta-lactamase producers so augmentin is recommended. Antistaphylococcal penicillins are also advocated. Some suggest the addition of metronidazole or clindamycin. Systemic symptoms or failure to improve in 48 hrs warrants IV therapy and consideration of additional coverage for GNR. Adjunctive therapy with warm compresses, mouth irrigation, administration of sialagogues (lemon drops), and bimanual massage of the gland intraorrally and externally can be employed.
Surgery
Surgery is recommended for recalcitrant infections, abscess drainage, and to obtain tissue if a noninfectious cause is suspected.
References
- ↑ McQuone SJ. Acute Viral and Bacterial Infections of the Salivary Glands. Otolaryngologic Clinics of North America. 1999, 32:793-811.PMID 10477787