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PubMed1998

[Histopathogenesis of chronic sialectatic parotitis as precursor of myoepithelial sialadenitis lesion (Sjögren syndrome)].

BACKGROUND: Chronic sialectatic parotitis (CSP) is classified as a characteristic form of chronic recurrent parotitis the etiology and pathogenesis of which still remains unclear. The multiplicity of different therapeutic advices, especially the permanent failure of antibiotic treatment, underlines the lack of an appropriate causal therapy. CASE REPORT: Detailed histopathological investigations of an 41-year old woman were possible over a seven-year period. These follow-up observations enabled clarification of the histopathogenesis of CSP by means of immunohistochemistry. RESULTS: During the course and development of CSP different stages can be observed: The initial phase is characterised by mild infiltration of B-lymphocytes (CD20, CD45 R) and plasma cells in the environment of ectatic ducts. Progredient stages show neogenetic lymph follicles periductular as well as metaplasia of the ductal epithelium. Terminal phases of CSP are characterised by near-total lymphatic transformation of parenchyma, follicular lymphatic hyperplasia (KiM4) and myoepithelial proliferation. In this phase myoepithelial sialadenitis (MESA, i.e. benign lymphoepithelial lesion, possibly part of Sjögren's syndrome) develops. Beyond it low grade non-Hodgkin's lymphoma of the MALT-Type of the submandibular gland occurred finally. CONCLUSIONS: CSP presents as a precursor of MESA. Immunohistological detection of follicular dentritic network (KiM4) within extensive lymphatic hyperplasia periductular demonstrates overshooting humoral immune reaction of B-lymphocytes. Hence, CSP should be classified with regard to pathogenesis as an immunopathological disorder of the MALT system.

Adult↗

PubMed2006

Candida parotitis with abscess formation.

This report describes the case of an elderly, diabetic man who developed acute suppurative parotitis with abscess formation. The causative agent of parotid abscess was Candida albicans, which is an unusual cause of salivary gland pathology. The parotid gland is the salivary gland most commonly affected by inflammation. Acute parotitis occurs most often in elderly patients who are debilitated by systemic disease or are in a state of dehydration following major surgical procedures. Despite the high prevalence of oral candida carriage, there have been few previous reports of candida sialoadenitis in the literature. This is due to the toxicity of saliva to fungi under normal conditions. The diagnosis of candidiasis in our patient was made by culturing the purulent discharge from Stensen's duct and by culture of the pus obtained at surgical drainage of the abscess. After incision and drainage, the patient was treated with intravenous and then oral fluconazole for a total of 4 weeks with complete resolution of his condition. This case is interesting in light of recent and ongoing investigations of salivary proteins as potential new antifungal agents.

Abscess↗

PubMed1982

Parotitis: clinical presentations and management.

Although mumps virus is the most common and, therefore, best known cause of parotitis, other causes are not infrequent and need to be distinguished from mumps. Knowledge of the various clinical presentations of parotitis and judicious use of a few ancillary tests will facilitate differential diagnosis.

Acute Disease↗

PubMed1988

Acute suppurative parotitis in a patient on total parenteral nutrition.

A report of a patient who developed acute suppurative parotitis while on total parenteral nutrition for small bowel fistula is presented. The importance of early detection of parotitis as a cause of fever is emphasized. Attention to oral hygiene and early resumption of oral intake, whenever possible, are to be encouraged.

Acute Disease↗

PubMed2002

Parotitis due to organophosphate intoxication.

Acute pancreatitis due to pancreatic exocrine over-secretion induced by organophosphate poisoning has been previously reported but parotid gland involvement has not. This paper describes a case of acute organophosphate-induced parotitis in a patient with pre-existing sialolithiasis. The patient developed bilateral facial swelling in the pre-auricular area extending to the angle of the jaw and also developed elevated serum amylase on the second day of the poisoning. Serum lipase remained normal. Autopsy confirmed parotid gland inflammation and pre-existing ductal lithiasis. This case illustrates that organophosphate-induced parotitis can occur and should be considered in patients with organophosphate poisoning who have hyperamylasemia without elevation in serum lipase.

Aged↗

PubMed1997

Microbiology of recurrent parotitis.

BACKGROUND: Infantile chronic recurrent parotitis (ICRP) is characterized by episodes of recurrent swelling of the parotid gland with decreased salivary flow and purulent secretion. The etiology of this little unknown clinical condition has been attributed to multiple causes such as canalicular system malformations, ascending bacterial infection, hyposialia, parotitis sequelae, viral infections and immunologic disorders, among others. METHODS: We studied the types (with counts) of microorganisms involved in ICRP. Saliva samples were obtained from 56 patients and 20 controls, inoculated onto enriched media and incubated under aerobic and anaerobic conditions. Antimicrobial susceptibility and serotyping of the isolated organisms isolated were performed. RESULTS: Of 57 saliva samples from ICRP patients, 52 (91%) were culture-positive. The most frequently isolated microorganisms were Streptococcus pneumoniae and Haemophilus influenzae. Thirteen of twenty (65%) samples were also culture-positive, mostly for viridans streptococci. However, colony counts were lower than in clinical samples (P < 0.004). Approximately one-third of S. pneumoniae strains resistant or moderately resistant to penicillin, and all H. influenzae strains were susceptible to all of the antimicrobials tested. CONCLUSIONS: S. pneumoniae or H. influenzae were isolated in high concentrations in IRCP cases but not in controls, suggesting that these microorganisms may have a role in the development of this clinical entity. Quantitative cultures are very important in assessment of the pathogenic role of these microorganisms in patients but not in controls.

Adolescent↗

PubMed2002

Suppurative parotitis caused by anaerobic bacteria in newborns.

Staphylococci are the usual bacterial etiology of suppurative parotitis in newborns. This report describes for the first time recovery of anaerobic bacteria from aspirates of the infected gland in two infants with suppurative parotitis. Peptostreptococcus intermedius and Prevotella melaninogenica were isolated from one child and Prevotella intermedia from the other patient. Complete recovery occurred after 4 weeks of antimicrobial therapy.

Anti-Bacterial Agents↗

PubMed1995

Parainfluenza virus type 2 meningitis and parotitis in an 11-year-old child.

We describe the case of an 11-year-old Bolivian boy with parotitis and aseptic meningitis to demonstrate that parainfluenza virus type 2 can cause disseminated infection in a normal child. Parainfluenza virus type 2 was isolated from nasopharyngeal and CSF specimens from the patient and was confirmed to be parainfluenza virus type 2 by hemadsorption inhibition and by complement fixation. Parainfluenza virus type 2 may cause aseptic meningitis and parotitis.

Child↗

PubMed2004

Acute neonatal suppurative parotitis: case reports and review.

We describe two cases of neonatal suppurative parotitis caused by Staphylococcus aureus. Only 32 cases of neonatal suppurative parotitis (72% male) have been described in the English literature in the last 35 years. Thirty-eight percent were premature babies, only 41% were febrile and the causative agent in most cases was S. aureus. Recovery was achieved in 78% of the patients with antibiotic therapy without drainage.

Acute Disease↗

PubMed1985

A 16-month-old boy with infectious mononucleosis, parotitis and Bell's palsy.

The case of a 16-month-old boy with infectious mononucleosis who developed bilateral parotitis and unilateral Bell's palsy is presented. The diagnosis was confirmed by the development of specific antibodies for various Epstein-Barr virus antigens typical of primary Epstein-Barr virus infection. Serological tests for other viruses were negative. The Bell's palsy subsided within three months, while the clinical signs of infectious mononucleosis and parotitis persisted for three weeks.

Antibodies, Viral↗

PubMed1996

Clinical and microbiological analysis of six children with acute suppurative parotitis.

Six children including two neonates with acute suppurative parotitis are described. They presented typical symptoms and signs of fever (4/6) and swelling (6/6), tenderness (6/6), erythema (4/6) and local warmness (4/6) of the parotid gland affected. Leucocytosis and an elevated erythrocyte sedimentation rate and serum amylase level may be seen. The presence of purulent discharge from the Stensen duct when the parotid gland is externally compressed is pathognomonic of the disease, and the microbiological diagnosis can be made by culture of the pus. Microbiologically, this series highlights the polymicrobic nature and importance of Streptococcus viridans in paediatric suppurative parotitis, indicating, therefore, that the causative bacteria entered the gland from the oral cavity. Our data also suggest that initial antibiotic therapy for such patients should provide adequate coverage for streptococci and staphylococci as well as for anaerobic bacteria.

Acute Disease↗

PubMed1992

Recurrent parotitis.

Recurrent parotitis in children is a well described but rare condition of unknown cause. The clinical features of 11 children with recurrent parotitis are described.

Anti-Bacterial Agents↗

PubMed1984

Parotitis with secondary syphilis: a case report.

Painless swelling of the parotid salivary gland was observed in a patient presenting with secondary syphilis. This case is of special interest to venereologists and surgeons as parotitis associated with syphilis may be mistaken for common tumours of the parotid glands. A diagnosis of syphilitic parotitis should be considered in patients presenting with swollen parotid salivary glands in countries where syphilis is prevalent.

Adult↗

PubMed1991

Recurrent parotitis and sialectasis in childhood. Clinical, radiologic, immunologic, bacteriologic, and histologic study.

Twenty children with juvenile recurrent parotitis, between 3 months and 16 years of age at onset, were followed up over a period of 7 to 22 years. Radiologic, histopathologic, cytologic, immunologic, and bacteriologic studies were performed to investigate the cause of sialectasis, commonly found in juvenile recurrent parotitis, and the pathogenesis of the disease. It was considered that a combination of a congenital malformation of portions of the salivary ducts and infections ascending from the mouth following dehydration of the children are contributory to the pathogenesis of the disease. The results of the investigations into the cause of the disease appear to exclude an auto-immunologic response or an allergic condition, an immature immune response, mumps, a sensitivity to upper respiratory tract infection, and familial factors.

Adolescent↗

PubMed1992

Recurrent parotitis in childhood.

Recurrent parotitis is characterized by a cyclic swelling of the parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppuration. Recurrent parotitis is hardly a common problem, but when it does present itself, it is most perplexing. Its etiology and the pathogenesis remain an enigma and, as a consequence, consensus on proper management is still lacking.

Child↗

PubMed1984

Computed tomography and sialography of chronic pyogenic parotitis.

We performed Computed Tomography (CT) immediately following, or simultaneous with, conventional sialography on a group of 45 patients with parotid gland swellings over a two-year period. Tumours occurred in eight, sarcoidosis in 22, actinomycosis in two and chronic pyogenic parotitis in 13 patients. In the latter group, there were two cases of bilateral disease, for a total of 15 glands. The sialographic and the combined CT-sialographic features were retrospectively analysed. In all cases, ductal pathology was more severe in the main and proximal branches, was better demonstrated on conventional sialography and was diagnostic in 10/14 glands (71%). CT-sialography was the superior modality in the evaluation of the gland parenchyma and the adjacent structures, demonstrating diagnostic features of infection in 8/14 glands (57%). However, a combination of both modalities presented a consistent pattern of infection in all cases, distinctive from tumours and sarcoidosis. CT-directed aspiration was performed on the four glands which were equivocal on conventional sialography, and two of these underwent a simultaneous aspiration-irrigation with antibiotics. Although this report is based on a limited experience, CT-sialography with aspiration appears to be an interventional radiological alternative to the traditional diagnostic superficial parotidectomy. Ultrasonography (two cases) and nuclear scintigraphy (one case) added little useful information in chronic pyogenic parotitis.

Adult↗

PubMed1990

The surgical management of chronic parotitis.

Chronic parotitis is a disorder characterized by recurrent painful swelling of the gland with purulent sialorrhea. Occasionally, the condition fails to respond to medical management and definitive surgical therapy is necessary. Sialolithiasis is the usual etiology in cases of parotitis, although occasionally severe recurrent parotid infections are superimposed on underlying Sjögren's disease. Total parotidectomy with facial nerve dissection has been used in such cases in our department and has proved to be an excellent way to manage this disease. A summary of our results indicate that the recurring infections were eradicated and that the complication rate is tolerable, considering the magnitude of the problem. We feel that it is better to use surgical management early rather than wait for the formation of fistulae or abscesses.

Adult↗

PubMed1991

Aerobic and anaerobic microbiology of acute suppurative parotitis.

Aspirates of pus from acute suppurative parotitis were studied for aerobic and anaerobic bacteria. Bacterial growth was present in 23 specimens. A total of 36 bacterial isolates (20 anaerobic and 16 aerobic and facultative) were recovered, accounting for 1.6 isolates per specimen (0.9 anaerobic and 0.7 aerobic and facultative). Anaerobic bacteria only were present in 10 (43%) patients, aerobic and facultatives in 10 (43%), and mixed aerobic and anaerobic flora in 3 (13%). Single bacterial isolates were recovered in 9 infections, 6 of which were Staphylococcus aureus and 3 were anaerobic bacteria. The predominant bacterial isolates were S. aureus (8 isolates), Bacteroides sp. (6 isolates, including 4 Bacteroides melaninogenicus group), and Peptostreptococcus sp. (5). beta-Lactamase-producing organisms were recovered from 11 (73%) of the 15 specimens tested. This study highlights the polymicrobial nature and importance of anaerobic bacteria in acute suppurative parotitis.

Acute Disease↗