HWN Suggests

Fever and neck swelling in a teenaged girl

(Parotitisnitially managed conservatively with broad spectrum antibiotics, analgesics, hydration, warm massage, and sialagogues. Most common bacterial etiologies include gram-positive organisms whereas gram-negatives are less frequently seen. Therefore, penicillin derivatives and cephalosporins will provide appropriate coverage as first-line antibiotics...

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  Things That Go ‘Mump’ in the Night: What to do with Parotid Swelling

THE DIFFERENTIAL Many other viral infections can cause parotid swelling (EBV, HSV, HIV, CMV, coxsackie, etc.). Bacterial parotitis presents as typically firm, tender swelling associated with high fevers and toxic appearance. S.aureus is most often implicated. Salivary gland stone, salivary tumor, sarcoidosis, Sjögren's syndrome.

 A Bump in Mumps: Is Your MMR Knowledge Updated?

Mumps, a vaccine-preventable illness, is a self-limited paramyxovirus, diagnosed by viral PCR swab, whose treatment is entirely supportive care. Parotitis is unilateral in up to 25% of cases, but typical presentations are bilateral.

 Parotitis and Sialadenitis

Don’t dismiss sialadenitis as a simple infection and throw antibiotics at it. It is multifactorial and may not merely be an antibiotic deficiency. Keep other etiologies in mind, especially when educating families about it.

Articles of Interest

Daunting Diagnosis

The patient presents with right facial swelling and erythema. Labs and a facial CT are obtained. What is the patient’s diagnosis?

Elderly Male With Cheek Swelling

Acute suppurative parotitis. Acute suppurative parotitis affects primarily the elderly and immunocompromised. Predisposing factors include poor oral hygiene, dehydration, malnutrition, alcoholism, diabetes, autoimmune disease, use of oral secretion-reducing medications, and ductal obstruction by sialolithiasis, tumor, or foreign body. The differential diagnosis includes viral infection (mumps), sarcoidosis, sialolithiasis, chronic recurrent parotitis, and neoplasm. The most commonly cultured microorganisms are Staphylococcus aureus (including MRSA3), α-hemolytic streptococci, enteric gram-negative rods, and anaerobic bacteria.

For parotitis in children, should antibiotic therapy be considered, and if so, what bacterial coverage should be provided?

Although the majority of parotitis cases are viral, suspected bacterial causes (ie, S. aureus, Strep species, H. influenzae, and anaerobes) warrant antibiotic coverage.

Left Acute Viral Parotitis

The diagnosis of parotitis is primarily clinical. Sonography of the gland may help confirm the diagnosis and rule out abscess formation. Elevations of white blood count, erythrocyte sedimentation rate, C-reactive protein level and serum amylase level are observed in patients with suppurative parotitis. Serum amylase is elevated in 90% of patients, differentiates parotitis from adenitis, and is not a specific indicator of viral parotitis.

Lightning Learning: Mumps

Parotitis (occurs in 95% of symptomatic cases). Peak size of parotid glands occurs at 2-3 days. A quarter of cases can have unilateral parotitis. Non-specific symptoms include: fever, headache, earache and general malaise.

Mumps

Obviously, other conditions can cause parotid swelling… and are likely more common! When there is no Outbreak, consider these entities as being more probable.

Parotitis on Ultrasound The Pomegranate Sign

The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.

Pediatric Facial Swelling

Juvenile recurrent parotitis (JRP) is the second most common cause of inflammatory salivary gland disease in childhood, with viral parotitis being the most common.

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Radiopaedia

Computed tomography shows enlargement of the right parotid gland, associated with edema of the adjacent subcutaneous soft tissue determined by clinical history of acute parotitis. No collections or abscesses in the parotid space and no obvious stones or ductal dilatation. Right level II lymphadenopathy, likely reactive.

StatPearls

Of the many viral infections resulting in parotitis, mumps (a paramyxovirus) is the classic cause of epidemic parotitis. Other viral causes include coxsackie A virus, cytomegalovirus, echovirus, enterovirus, influenza, and parainfluenza viruses. The treatment of parotitis is primarily symptomatic control with a focus on local application of heat, gentle glandular massage from posterior to anterior, sialagogues, and adequate hydration.