Suppurative parotitis

Background

• Serious bacterial infection of parotid gland that occurs in patients with decreased salivary flow
  • Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
  • Usually caused by staph, strep, anaerobes

Risk factors

• Dehydration
• Prematurity or advanced age
• Sialolithiasis
• Oral neoplasms
• Salivary duct strictures
• Meds (cause systemic dehydration or decrease salivary flow)
  • Diuretics
  • Antihistamines
  • TCAs
  • beta-blockers
• Chronic illnesses
  • HIV
  • Sjögren Syndrome
  • Anorexia nervosa/bulimia nervosa
  • Cystic fibrosis

Clinical Features

• Rapid onset
• Skin over parotid gland is red and tender
• Purulent drainage from Stensen's duct
• Fever
• Trismus

Differential Diagnosis

Facial Swelling

• Buccal space infections
• Dental problems
• Canine space infection
• Facial cellulitis
• Herpes zoster
• Masticator space infections
• Maxillofacial trauma
• Neoplasm
• Parapharyngeal space infection
• Salivary gland diagnoses
  • Parotitis
    • Bilateral parotitis
    • Suppurative parotitis
    • Viral parotitis (Mumps)
  • Ranula
  • Sialoadenitis
  • Sialolithiasis
• Superior vena cava syndrome

Lymphadenitis

Infectious

• Reactive adenitis
• Bacterial lymphadenitis
• Tuberculous lymphadenitis
• Cellulitis
• Cat-scratch disease
• Parotitis
  • Suppurative parotitis
  • Viral parotitis
• Lymphangitis
• Toxoplasmosis
• Tularemia
• Viral disease
  • HIV-AIDS
  • Cytomegalovirus
  • Epstein-Barr Virus
• Fungal disease
• Reactive adenitis

Non-Infectious

• Malignancy
  • Lymphoma
  • Metastatic cancer
• Rheumatologic Disease
  • Kawasaki Disease
  • Systemic lupus erythematosus
  • Sarcoidosis
  • Juvenile Idiopathic Arthritis
  • Langerhans Cell Histiocytosis
• Cutaneous Lesions:
  • Bacillary angiomatosis
  • Purpura
  • Hematomas
  • Angiomas
  • Dermatofibromas
  • Nevi
• Drug reaction
  • Phenytoin or Carbamazepine
• Postvaccination
• Sarcoidosis
• Salivary gland diagnoses

Evaluation

• Usually clinical

Management

Supportive Care

1. Hydrate the volume-depleted patient
2. Massage and apply heat to the affected gland
3. Stimulate salivation using sialogogues such as lemon drops

Antibiotic Options

Treatment targeted at S. aureus, gram negative bacilli, mumps, enteroviruses, and influenza virus

• Amoxicillin/Clavulanate 875mg (45mg/kg) PO BID OR
• Clindamycin 450mg PO three times daily or 10mg/kg PO four times daily
• Dicloxacillin 500mg (7.5mg/kg) PO four times daily
• Cephalexin 500mg (12.5mg/kg) PO four times daily
• Nafcillin 2g IV six times daily or 50mg/kg IV four times daily
• Vancomycin 15-20mg/kg IV BID daily

See Also

• Salivary gland diagnoses