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==Overview== | ==Overview== | ||
The cause of parotitis can be due to infection, autoimmune origin, | The cause of parotitis can be due to infection, autoimmune origin, blockage of the parotid duct or some diseases of uncertain etiology. | ||
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> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
The cause of parotitis can be due to infection, autoimmune origin, blockage of the parotid duct or some diseases of uncertain etiology.
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 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.[1]
Causes
Infectious parotitis
Acute bacterial parotitis: is most often caused by a bacterial infection of Staphylococcus aureus but may be caused by any commensal bacteria.[2]
Parotitis as Extrapulmonary Tuberculosis: 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[2].
Acute viral parotitis (mumps): The most common viral cause of parotitis is mumps. Routine 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].
Autoimmune causes
These are also collectively known as chronic punctate parotitis or chronic autoimmune parotitis.
Sjögren's syndrome: 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.[2]
Mikulicz disease: Antiquated name for any enlargement of the parotid gland that was not tuberculosis, leukemia, or some other identifiable disease.
Lymphoepithelial lesion of Godwin: Most frequently associated with a circumscribed tumor with the histologic features of Sjögren syndrome. This designation has also fallen out of favour.
Blockage
Blockage of the main parotid duct, or one of its branches, is often a primary cause of acute parotitis, with further inflammation secondary to bacterial superinfection. The blockage may be from a salivary stone, a 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.[3] Stones may be diagnosed via X-ray (with a success rate of about 80%[3]), 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 stones. 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.[3]
Diseases of uncertain etiology
Chronic nonspecific parotitis: 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.[2]
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.[2]
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.[2]
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.[2]
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
- ↑ McQuone SJ. Acute Viral and Bacterial Infections of the Salivary Glands. Otolaryngologic Clinics of North America. 1999, 32:793-811.PMID 10477787
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 [1] Templer JW , MD, Professor of Otolaryngology, University of Missouri Medical Center at Columbia. Parotitis: Overview, Accessed 03/04/2009
- ↑ 3.0 3.1 3.2 Salivary Gland Stones (Salivary Calculi) Accessed March 20, 2008.