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PubMed1996

Chronic suppurative parotitis: a proposed classification.

OBJECTIVE: To propose a practical and reasonable classification of chronic suppurative parotitis (CSP) on the basis of the various entities. MATERIAL AND METHODS: Clinical, laboratory, sialographic, scintigraphic, histopathologic (including ultrastructural) study of recurrent parotid swellings (RPS) was performed in 291 patients over a 10-year period. RESULTS: It is suggested that CSP should be classified into recurrent parotitis in childhood (RPC), recurrent parotitis in adults (RPA), chronic obstructive parotitis (COP) and should be differentiated from other subdivisions including subclinical Sjögren's syndrome (SCSS), chronic parotid swelling of Sjögren's syndrome and sialadenosis with retrograde infection. RPA is a continuation of recurrent parotid swelling from childhood (RPC) to adulthood. Remission can take place spontaneously in RPC and RPA so that self-conservative therapy is mainly used for reducing the parotid swellings. COP is recurrent parotid swellings and/or purulent discharge resulting from various obstructive factors. Mild COP can recover completely with the use of conservative methods, severe COP is often resistant to conservative treatment and should be treated with surgical modality or injection of methyl violet into the diseased gland. Treatment with methyl violet is considered as a convenient and practical method with a definite effect. SCSS is an autoimmune disease and should be treated as systemic disease. CONCLUSIONS: Because there exists confusion in the nomenclature of RPS this revised classification is based on the various entities and can be used as a guide in the diagnosis and treatment of RPS.

Adolescent↗
PubMed1978

Recurrent mumps parotitis following natural infection and immunization.

Mumps is presumed to confer permanent immunity. Three patients previously known to possess mumps serum antibodies subsequently developed clinical parotitis and showed a diagnostic fourfold rise in mumps V antibody. A review of the literature disclosed several cases of parotitis, either recurrent or postimmunization, but the preparotitis immune status of the patient was unknown or the cause of the mumps was not verified. Case reports of parotitis due to parainfluenza 3 and coxsackie viruses A and the heterotypic serological responses among the myxoviruses are reviewed. Parotitis, especially after prior immunization, requires definitive diagnosis by viral isolation and/or serology before it can be attributed to mumps virus.

Adolescent↗
PubMed1994

[Etiology of epidemic parotitis].

Blood samples of 204 acute parotitis patients in a fifteen month period (1991-1992) were systematically examined for IgM, IgA, IgG antibodies of mumps and parainfluenza-virus 1, 2, 3 (PIV) by immunofluorescent test (IFT) and, in special cases several other virological examinations have been done. The etiological role of mumps-virus, parainfluenza-virus 1, 2, 3, one of the other viruses was confirmed in 76.0%, 1.5%, 6.3%, 1.5%, 4.9% of the cases, respectively. The etiology remained unknown in 9.8%. There were clinical symptoms of meningitis or orchitis in some and lymphadenopathy in several of the parainfluenza-virus caused parotitis patients. The authors conclude, that the parainfluenza-viruses are the second most frequent etiological agents of parotitis next to mumps-virus. They found that the Respiratory Syncytial Virus (RSV) also play etiological role in parotitis. This observation should be confirmed in the future by some other kind of virological tool too. The authors call attention to the difficulties and pitfalls of the virological serology in the infections caused by paramyxoviruses (PMV).

Adolescent↗
PubMed1992

Diagnosis and management of parotitis.

Of all the salivary glands, the parotid gland is most commonly affected by an inflammatory process. Infections of the parotid gland range from acute to severe. Assessment of the disease process should differentiate local primary parotid infection from systemic infection when this gland is also involved as part of a generalized inflammatory condition. Viral parotitis can be caused by paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses. Acute suppurative parotitis is generally caused by Staphylococcus aureus, Streptococcus species, and rarely, gram-negative bacteria. Anaerobic bacteria, mostly Peptostreptococcus species and Bacteroides species, and pigmented Porphyromonas species and Prevotella species have been recently recognized as an important cause of this infection. beta-Lactamase-producing organisms can be isolated in almost three fourths of the patients. Predisposing factors to suppurative infections are dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation. Pus, aspirated from a suppurative parotic abscess, should be plated on media that are supportive for the growth of aerobic and anaerobic bacteria, mycobacteria, and fungi. Early and proper antimicrobial therapy may prevent suppuration. Initial empiric therapy that is directed against both aerobic and anaerobic bacteria may be required until a specific causal diagnosis is available. Surgical drainage may be indicated when pus has formed. This may prevent complications and facilitate recovery.

Diagnosis, Differential↗
PubMed1993

Autoimmune exocrinopathy presenting as recurrent parotitis of childhood.

OBJECTIVE: To describe a case of autoimmune exocrinopathy in a child at the age of 3 months who presented with the original diagnosis of recurrent parotitis. DESIGN: This a case report of a 9-year-old girl with recurrent parotitis who was later found to have Sjögren's syndrome. The literature relating to primary Sjögren's syndrome in the pediatric population is reviewed. SETTING: The patient was seen in the rheumatology and otolaryngology clinics at a university medical center. INTERVENTIONS: This study did not address therapy. MAIN OUTCOME MEASURE: Diagnosis of Sjögren's syndrome. RESULTS: The patient had xerostomia, an abnormal result of a salivary gland biopsy, SSA and SSB antibodies, and the histocompatibility antigens HLA-B8 and HLA-DR3 that are associated with Sjögren's syndrome. CONCLUSION: Primary Sjögren's syndrome should be considered in cases of recurrent parotitis of childhood. More studies are needed to assess the natural history of autoimmune exocrinopathy in children.

Autoimmune Diseases↗
PubMed1982

[Surgical treatment of chronic parotitis (author's transl)].

Of 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70-80% if its is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis. The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth. In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.

Chronic Disease↗
PubMed1994

Acute parotitis during induction therapy including L-asparaginase in acute lymphoblastic leukemia.

In a patient affected by acute lymphoblastic leukemia (ALL) and subjected to therapy with Erwinia L-asparaginase, acute parotitis was observed. Microbiological studies excluded any infectious etiology. Regression of parotitis was spontaneous. This complication has not been previously reported and could be due to the same mechanism of pancreatic injury. The occurrence of acute parotitis needs to be promptly recognized in order to avoid the continuation of L-asparaginase.

Acute Disease↗
PubMed2006

Infantile recurrent parotitis: follow up study of five cases and literature review.

UNLABELLED: Recurrent parotitis (RP) is defined as recurrent parotid inflammation, generally associated with non-obstructive sialectasis of the parotid gland. It is a rare condition, and its etiology remains an enigma. AIM: The purposes of the present study were (1) to relate the follow up of five RP cases; (2) to examine the role of sialography and ultrasound in diagnosis and follow up; and (3) to make a literature review. STUDY DESIGN: Series review. MATERIAL AND METHOD: We reviewed all recurrent parotitis cases from the files of the Otolaryngology Division at University of Sao Paulo, Brazil. The criteria for inclusion were at least two years of evolution and more than one year and a half follow-up in our service. We included five children in the study. Sialography was performed in the first evaluation and sonography was executed annually. Recurrent parotitis showed male predominance, and affected mainly children between the ages of 3 and 6. Frequency of crisis improved with time in all cases. Sialography showed sialectasis aspect in the affected glands and sonographic exams demonstrated hypoechoic and heterogeneous internal echoes. One case showed regression of ultrasound changes after clinical improvement.

Adolescent↗
PubMedDate not supplied

[Clinical, histopathologic and immunohistochemical studies of chronic sialectatic parotitis in childhood and adolescence].

UNLABELLED: Chronic sialectatic parotitis (CSP) causes problems in differential diagnosis and therapy. CSP shows the typical clinical features of chronic recurrent parotitis and will be investigated histopathologically only after ultimative parotidectomy. The etiology and pathogenesis of these unspecific inflammations is still unknown. Therefore no causal therapy is available and a lot of different trials (sialogoga, gland massage, infrared light, antibiotics, antiphlogistics, Trasylol, duct occlusion, duct ligation, gland denervation, radiotherapy) are not successful in the long run. MATERIAL AND METHOD: The salivary gland registry of the University of Hamburg (1965-1996) contains 22 infants and juvenile patients showing very severe courses of CSP. These cases have been investigated clinical (ultrasound, sialography), histopathological (paraffin embedded sections, histomorphometry of the ectatic duct lumina) and immunohistochemical (CK-MNF, AKTIN, KiM4) in a retrospective study to research the pathogenesis of CSP. RESULTS: Recurrent and always very dolent parotid swelling occurs between the age of 3 and 14 years for the first time. The courses vary from 3 months until 25 years. Local findings as well as ultrasound and sialographic features allow no certain differentiation of chronic recurrent parotitis. Conservative therapy fails in each case and leads to the necessity of surgical treatment. Histopathological three different stages of development can be observed: Initial stages show regular lobular architectonic structure of the parotid gland parenchyme with duct ectasies surrounded by slight inflammation of lymphocytes and plasmacells. Advanced stages are characterized by an increase of periductal inflammation and the appearance of lymphfollicels. Nearly complete lymphatic transformation of the parenchyme with destruction of the lobular formation dominates the terminal "immunologic" stage. Some cases show multiple myoepithelial islands within this lymphatic stroma typically observed in benign lymphoepithelial lesions. Whether bacteria nor primary obstructive changes can be observed. The histomorphometric analyses of the average and maximal luminal duct diameters show marked increase of 39% respectively 46% from and- vanced to terminal stages of CSP. Therefore the pathognomonic duct ectasies seem to depend on the progredient inflammation and are not due to a hereditary malformation of the duct system. Immunohistochemical terminal stages show follicular lymphatic hyperplasia (KiM4) expressing overshooting humoral immune reaction of MALT. CONCLUSION: Concerning the pathogenesis CSP corresponds to a immunopathological disorder of MALT and seems to be a prestage of benign lymphoepithelial lesion. Consequently important changes in the diagnosis and therapy of CSP lead to early histopathological investigation to differentiate the stage of inflammation. In stage III conservative parotidectomy should be carried out because spontaneous healing can not be expected. In contrast initial cases should be treated at first by glucocorticoids and immunosuppressives.

Adolescent↗
PubMed2000

Tympanic neurectomy and chronic parotitis.

The preoperative findings and operative outcome were evaluated in 49 patients who underwent tympanic neurectomy to treat chronic parotitis. Forty-two patients had chronic non-suppurative parotitis and 7 patients had chronic suppurative parotitis. The main symptoms prior to operation were recurrent swelling and pain of the parotid gland. After operation, 40 patients (82%) had relief of their symptoms (28 patients were totally free of symptoms and 12 patients were markedly improved). In 9 patients (18%) the symptoms remained the same. Three patients (6%) had a tympanic membrane perforation due to the operation.

Adolescent↗
PubMed1981

Acute suppurative parotitis associated with anaerobic bacteremia.

Most episodes of acute suppurative parotitis are caused by Staphylococcus aureus. Reported here is a patient who had acute parotitis associated with anaerobic sepsis caused by Bacteroides melaninogenicus and Peptostreptococcus micros. Acute parotitis should be included in the ever-widening spectrum of clinical infections caused by anaerobic bacteria.

Acute Disease↗
PubMed1989

Acute suppurative parotitis caused by Pseudomonas pseudomallei in children.

During a prospective clinical study of melioidosis in northeast Thailand, suppurative parotitis was observed as a characteristic presentation in children. Parotitis constituted 6.3% of all culture-positive melioidosis and 38% of melioidosis in children. Nine cases are described. None had apparent predisposition to infection, although two patients developed rising mumps virus antibody titers, suggesting a possible relation between these conditions. Complications included abscess formation (nine), spontaneous rupture into the auditory canal (five), facial nerve palsy (two), and septicemia and osteomyelitis with septic arthritis (one each). All children initially responded to surgical drainage and appropriate antibiotic therapy. Pseudomonas pseudomallei parotitis should be considered in children from endemic areas with fever and facial swelling. It has a good prognosis with appropriate treatment. It may also prove to be a sensitive clinical indicator of the presence of melioidosis within a particular geographic area.

Abscess↗
PubMed2003

Acute bacterial suppurative parotitis: microbiology and management.

The parotid gland is the salivary gland most commonly affected by inflammation. The most common pathogens associated with acute bacterial parotitis are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp.), Fusobacterium spp., and Peptostreptococcus spp. Streptococcus spp. (including S. pneumoniae) and gram-negative bacilli (including Escherichia coli) have also been reported. Gram-negative organisms are often seen in hospitalized patients. Organisms less frequently found are Arachnia, Haemophilus influenzae, Klebsiella pneumoniae, Salmonella spp., Pseudomonas aeruginosa, Treponema pallidum, cat-scratch bacillus, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of parotitis. Therapy includes maintenance of hydration and administration of parenteral antimicrobial therapy. Once an abscess has formed surgical drainage is required. The choice of antimicrobial depends on the etiologic agent. Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis.

Abscess↗
PubMed2001

Facial palsy associated with mumps parotitis.

Peripheral facial nerve paralysis is relatively common in the pediatric age group. However, facial palsy rarely has been documented in patients with mumps parotitis. This case report describes the findings of a 3-year-old Japanese boy who developed facial palsy immediately after mumps parotitis. This work calls attention to a possible association between mumps parotitis and facial palsy.

Child, Preschool↗
PubMed2005

Recurrent parotitis of childhood.

BACKGROUND: Recurrent parotitis (RP) of childhood is a rare condition of unknown aetiology, probably immunologically mediated. OBJECTIVE: To review the clinical presentation, diagnosis and management of RP of childhood. METHODS: Retrospective study from 1983 to 2004 of children diagnosed with RP of childhood at a tertiary children's hospital. RESULTS: We identified 53 children, 37 (70%) male and 16 (30%) female. The age of onset was biphasic, with peaks at 2-5 years of age and at 10 years. The commonest symptoms were swelling (100%), pain (92.5%) and fever (41.5%). Symptoms usually lasted 2-7 days with a median of 3 days. The mean frequency was 8 episodes per year. The diagnosis was often delayed, >1 year in 70% of patients, maximum 8 years. The most common diagnoses, before the definitive diagnosis of RP, were mumps (21%), 'infection' (15%) and stones (11%). Sialogram (57%) and/or ultrasound (41%) showed sialectasis in 81% of patients. Over half the patients (54%) were given antibiotics at least once to treat the parotitis. Two children had hypogammablobulinaemia, one child had human immunodeficiency virus infection, and one child had Sjogren's syndrome. Two children had high titre antinuclear antibodies. CONCLUSIONS: Recurrent parotitis had a biphasic age distribution. The major clinical features that distinguish it from other causes of parotid swelling are the lack of pus and recurrent episodes. A clinical diagnosis can often be confirmed by ultrasound. Antibiotics do not have a role in treatment. Affected children should be screened for Sjogren's syndrome and immune deficiency.

Adolescent↗
PubMed1980

Sialochemistry in chronic recurrent parotitis: electrolytes and glucose.

The concentration of parotid fluid electrolytes and glucose was measured in: (a) a subject during an acute exacerbation of chronic recurrent parotitis and then at various stages of recovery following treatment with corticosteroids; (b) a group of seven patients seen during an acute exacertation and then when clinical symptoms had subsided; and (c) a group of 22 patients studied at various stages of parotitis. During acute exacerbations sodium and chloride concentrations were markedly elevated despite the very low flow rate and potassium was only half the normal salivary level. Phosphate concentration was also extremely low; glucose was very high. During recovery flow rate gradually increased while sodium, chloride and glucose levels fell. Potassium returned quickly to normal while the phosphate level rose very gruadually. The pattern of flow rate and sialochemistry during recovery was essentially the same for all patients. The pattern of flow rate and sialochemistry during recovery was essentially the same for all patients. In most subjects there was a residual effect, and elevated sodium and chloride and a decreased phosphate relative to flow rate. The degree of change from normal appeared to be a good indication of residual pathology within the gland. Sialochemistry should be useful to the clinician in the diagnosis and treatment of chronic recurrent parotitis.

Adult↗
PubMed1998

Autosomal dominant juvenile recurrent parotitis.

Juvenile recurrent parotitis is a common cause of inflammatory salivary gland swelling in children. A variety of aetiological factors has been proposed for the condition. Here we present a family where four members had juvenile recurrent parotitis and where two other family members may have had an atypical form of the condition. The segregation pattern in the family is consistent with autosomal dominant inheritance with incomplete penetrance and this suggests that, at least in some cases, genetic factors may be implicated in juvenile recurrent parotitis.

Child↗
PubMed2005

A downward spread in acute parotitis.

Acute parotitis occasionally spreads rapidly down the neck with severe symptoms of swelling and pain. However, the inflammatory course of parotitis with extraglandular spread has seldom been described. On CT images, we have noticed a unique area just below the parotid gland that is surrounded by the platysma muscle and the superficial layer of the deep cervical fascia (DCF). In this case report, we describe the CT imaging features of acute parotitis, focusing on this area.

Adult↗