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==Overview==
==Overview==
The cause of parotitis can be due to infection, autoimmune origin, blockage of the parotid duct or some diseases of uncertain etiology.
Parotitis is most commonly caused by [[viral]] or [[bacterial]] infections, but can also result from autoimmune syndromes, [[parotid gland]] blockages, and from diseases with uncertain etiologies.
 
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>


==Causes==
==Causes==
===Infectious parotitis===
===Infection===
 
*'''Acute viral parotitis'''
''Acute bacterial parotitis:''  
**[[Mumps]] [[virus]] is the most common cause of [[viral]] parotitis.<ref name="urlSalivary gland infections: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001041.htm |title=Salivary gland infections: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
is most often caused by a bacterial infection of [[Staphylococcus aureus]] but may be caused by any [[commensal]] bacteria.<REF NAME="Templer">[http://emedicine.medscape.com/article/882461-overview] Templer JW , MD, Professor of Otolaryngology, University of Missouri Medical Center at Columbia. Parotitis: Overview, Accessed 03/04/2009</ref>  
**Other [[viruses]] that can cause parotitis are below:<ref name="pmid1571113">{{cite journal |vauthors=Brook I |title=Diagnosis and management of parotitis |journal=Arch. Otolaryngol. Head Neck Surg. |volume=118 |issue=5 |pages=469–71 |year=1992 |pmid=1571113 |doi= |url=}}</ref>
 
***[[Epstein-Barr]]
''Parotitis as Extrapulmonary Tuberculosis:''
***[[coxsackievirus]]
The mycobacterium that cause [[tuberculosis]] can also cause parotid infection. Those infected tend to have enlarged, nontender, but moderately painful glands. The diagnosis is made by typical chest radiograph findings, cultures, or histologic diagnosis after the gland has been removed. When diagnosed and treated with antitubercular medications, the gland may return to normal in 1–3 months<REF NAME="Templer"/>.
***[[Influenza]]
 
***[[Human parainfluenza virus]]
''Acute viral parotitis (mumps):''
The most common viral cause of parotitis is [[mumps]]. Routine [[vaccine|vaccinations]] have dropped the incidence of mumps to a very low level.  Mumps resolves on its own in about ten days.
 
''HIV parotitis:'' Generalized [[lymphadenopathy]] has long been associated with [[HIV]], but the localized enlargement of the parotid gland is less well known{{Citation needed|date=January 2011}}.
 
===Autoimmune causes===
 
These are also collectively known as chronic punctate parotitis or chronic autoimmune parotitis.


''Sjögren's syndrome:''  
*'''Acute bacterial parotitis:'''
Chronic inflammation of the salivary glands may also be an autoimmune disease known as [[Sjögren's syndrome]].  The disease most commonly appears in people aged 40–60 years, but it may affect small children.  In Sjögren syndrome, the prevalence of parotitis in women versus men is approximately 9:1. The involved parotid gland is enlarged and tender at times. The cause is unknown. The syndrome is often characterized by excessive dryness in the eyes, mouth, nose, vagina, and skin.<REF NAME="Templer"/>
**The most common cause of [[bacterial]] parotitis is ''[[Staphylococcus aureus]]''<ref name="urlSalivary gland infections: MedlinePlus Medical Encyclopedia">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001041.htm |title=Salivary gland infections: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref>
**Other [[bacterial]] causes of parotitis include the following:
***''[[streptococcus]]''
***[[Gram-negative]] [[bacteria]]
***''[[Peptostreptococcus]]''
***''[[Bacteroides]]''
***[[Porphyromonas]]
***''[[Prevotella]]''


''Mikulicz disease:''
*'''[[Extrapulmonary tuberculosis]]
Antiquated name for any enlargement of the parotid gland that was not tuberculosis, leukemia, or some other identifiable disease.
**Parotitis can result as a symptom of acute [[tuberculosis]]<ref name="pmid7661432">{{cite journal |vauthors=Henderson SO, Mallon WK |title=Tuberculosis as the cause of diffuse parotitis |journal=Ann Emerg Med |volume=26 |issue=3 |pages=376–9 |year=1995 |pmid=7661432 |doi= |url=}}</ref>


''Lymphoepithelial lesion of Godwin:''
===Autoimmune Causes===
Most frequently associated with a circumscribed tumor with the histologic features of Sjögren syndrome. This designation has also fallen out of favour.
*'''[[Sjögren's Syndrome]]'''
**Parotitis can result from [[Sjögren's syndrome]] due to chronic [[inflammation]] of the [[parotid gland]].<ref name="urlFast Facts About Sjogrens Syndrome">{{cite web |url=http://www.niams.nih.gov/Health_Info/Sjogrens_Syndrome/sjogrens_syndrome_ff.asp |title=Fast Facts About Sjogren's Syndrome |format= |work= |accessdate=}}</ref>


===Blockage===
===Blockage===
*Parotitis can result from the following forms of blockages:
**'''[[Sialolithiasis]]''': [[salivary gland]] calcified stones, causing [[parotid gland]] [[inflammation]].<ref name="pmid26912292">{{cite journal |vauthors=Hernandez S, Busso C, Walvekar RR |title=Parotitis and Sialendoscopy of the Parotid Gland |journal=Otolaryngol. Clin. North Am. |volume= |issue= |pages= |year=2016 |pmid=26912292 |doi=10.1016/j.otc.2015.12.003 |url=}}</ref>
**[[Mucous]] plugs<ref name="pmid17957846">{{cite journal |vauthors=Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L |title=Modern management of obstructive salivary diseases |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=4 |pages=161–72 |year=2007 |pmid=17957846 |pmc=2640028 |doi= |url=}}</ref>
**Benign or malignant [[neoplasia]].<ref name="pmid22058591">{{cite journal |vauthors=Bussu F, Parrilla C, Rizzo D, Almadori G, Paludetti G, Galli J |title=Clinical approach and treatment of benign and malignant parotid masses, personal experience |journal=Acta Otorhinolaryngol Ital |volume=31 |issue=3 |pages=135–43 |year=2011 |pmid=22058591 |pmc=3185824 |doi= |url=}}</ref>


Blockage of the main parotid duct, or one of its branches, is often a primary cause of acute parotitis, with further inflammation secondary to [[bacteria]]l [[superinfection]].  The blockage may be from a salivary stone, a [[mucus|mucous]] plug, or, more rarely, by a tumor, usually benign.  Salivary stones, also called [[salivary duct calculus]], are mainly made of [[calcium]], but do not indicate any kind of calcium disorder.<REF NAME="STONE">[http://www.patient.co.uk/showdoc/23069166/ Salivary Gland Stones (Salivary Calculi)] Accessed March 20, 2008.</ref> Stones may be diagnosed via [[X-ray]] (with a success rate of about 80%<REF NAME="STONE"/>), a [[computed tomography]] (CT) scan or [[Medical ultrasonography]].  Stones may be removed by manipulation in the doctor's office, or, in the worst cases, by surgery.  [[Lithotripsy]], also known as "shock wave"  treatment, is best known for its use breaking up [[kidney stone]]s.  Lithotripsy can now be used on salivary stones as well.  Ultrasound waves break up the stones, and the fragments flush out of the salivary duct.<REF NAME="STONE"/>
===Diseases of Uncertain Etiology===
 
*The following diseases are of uncertain etiology that can cause parotitis:
===Diseases of uncertain etiology===
**Chronic nonspecific parotitis
 
**Recurrent childhood parotitis
''Chronic nonspecific parotitis:''
**[[Sialadenosis]]
This term is generally used for patients in whom no definite etiology is found.  Episodes may last for several days, paralleling the time course of a bacterial or viral illness. Others may experience episodes that last only a few hours from onset to resolution. Some episodes may last for several weeks. Quiescent periods between episodes last for hours, days, or even years.<REF NAME="Templer"/>
**[[Sarcoidosis]]
 
**Pneumoparotitis
''Recurrent parotitis of childhood:''
An uncommon syndrome in which recurring episodes clinically resembling mumps. Generally, episodes begin by age 5 years, and virtually all patients become asymptomatic by age 10–15 years. The duration of attacks averages 3–7 days but may last 2–3 weeks in some individuals. The spectrum varies from mild and infrequent attacks to episodes so frequent that they prevent regular school attendance.
Local heat applied to the gland, massaging the gland from back to front, and taking [[penicillin]] usually cure individual episodes. Treatment of individual infections may prevent injury to the gland parenchyma. Severe disease may be treated by [[parotidectomy]].<REF NAME="Templer"/>
 
''Sialadenosis (sialosis):''
In this disorder, both parotid glands may be diffusely enlarged with only modest symptoms. Patients are aged 20–60 years at onset, and the sexes are equally involved. The glands are soft and non-tender. Approximately half of the patients have endocrine disorders such as diabetes, nutritional disorders such as pellagra or kwashiorkor, or have taken drugs such as guanethidine, thioridazine, or isoprenaline.
 
''[[Sarcoidosis]]:''
The lungs, skin, and lymph nodes are most often affected, but the salivary glands are involved in approximately 10% of cases. Bilateral firm, smooth, and non-tender parotid enlargement is classic. [[Xerostomia]] occasionally occurs. The [[Heerfordt-Waldenstrom]] syndrome consists of [[sarcoidosis]] with parotid enlargement, fever, anterior uveitis, and facial nerve palsy.<REF NAME="Templer"/>
 
''Pneumoparotitis:''
Air within the ducts of the parotid gland with or without inflammation. The duct orifice normally functions as a valve to prevent air from entering the gland from a pressurized oral cavity. Rarely, an incompetent valve allows insufflation of air into the duct system. Pneumoparotitis most commonly occurs in wind instrument players, glass blowers, and scuba divers.<REF NAME="Templer"/>
 
Several lymph nodes reside within the parotid gland as a superficial and deep group of nodes. These nodes may be involved with any process that affects lymph nodes, including bacterial, fungal, viral, and neoplastic processes. Rarely, drugs such as iodides, phenylbutazone, thiouracil, isoproterenol, heavy metals, sulfisoxazole, and phenothiazines cause parotid swelling.
 


==References==
==References==
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[[Category:Grammar]]
[[Category:Disease]]
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[[Category:Glands]]
[[Category:Glands]]
[[Category:Inflammations]]
[[Category:Inflammations]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Parotitis is most commonly caused by viral or bacterial infections, but can also result from autoimmune syndromes, parotid gland blockages, and from diseases with uncertain etiologies.

Causes

Infection

Autoimmune Causes

Blockage

Diseases of Uncertain Etiology

  • The following diseases are of uncertain etiology that can cause parotitis:

References

  1. ↑ 1.0 1.1 "Salivary gland infections: MedlinePlus Medical Encyclopedia".
  2. ↑ Brook I (1992). "Diagnosis and management of parotitis". Arch. Otolaryngol. Head Neck Surg. 118 (5): 469–71. PMID 1571113.
  3. ↑ Henderson SO, Mallon WK (1995). "Tuberculosis as the cause of diffuse parotitis". Ann Emerg Med. 26 (3): 376–9. PMID 7661432.
  4. ↑ "Fast Facts About Sjogren's Syndrome".
  5. ↑ Hernandez S, Busso C, Walvekar RR (2016). "Parotitis and Sialendoscopy of the Parotid Gland". Otolaryngol. Clin. North Am. doi:10.1016/j.otc.2015.12.003. PMID 26912292.
  6. ↑ Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L (2007). "Modern management of obstructive salivary diseases". Acta Otorhinolaryngol Ital. 27 (4): 161–72. PMC 2640028. PMID 17957846.
  7. ↑ Bussu F, Parrilla C, Rizzo D, Almadori G, Paludetti G, Galli J (2011). "Clinical approach and treatment of benign and malignant parotid masses, personal experience". Acta Otorhinolaryngol Ital. 31 (3): 135–43. PMC 3185824. PMID 22058591.

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