Parotitis: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Changes made per Mahshid's request)
 
(33 intermediate revisions by 9 users not shown)
Line 1: Line 1:
{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = Mumps virus.jpg|
  Caption        = Mumps virus|
  DiseasesDB    = |
  ICD10          = |
  ICD9          = |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
}}
{{SI}}
{{CMG}}
__NOTOC__
__NOTOC__
{{Editor Help}}
{{Parotitis}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


== Overview ==
{{CMG}}; {{AE}} {{LRO}} {{KS}} {{Faizan}}


Parotitis is an inflammatory disorder of the salivary gland, or sialadenitis. It is most commonly infectious in etiology but can be autoimmune or neoplastic.
{{SK}} Parotiditis; Acute viral parotitis; Acute bacterial parotitis; Acute suppurative parotitis; Juvenile recurrent parotitis; Pneumoparotitis
==[[Parotitis overview|Overview]]==


== Epidemiology and Demographics ==
==[[Parotitis historical perspective|Historical Perspective]]==


The first report of acute bacterial sialadenitis dates back to 1828 described in a 71-year-old man whose infection progressed to gangrene. President Garfield died from acute parotitis complicating abdominal surgery. Parotitis carried an 80% mortality rate in the 1800s and remains a quite morbid infection with estimated mortality of 20-50% in the present day.
==[[Parotitis pathophysiology|Pathophysiology]]==


Acute infection can occur in any salivary gland but the most commonly affected one is the parotid. This is thought to be due to a combination of anatomic and physiologic factors. The saliva from the parotid is less mucoid than that from the other salivary glands.  IgA, lysozyme and sialic acid are all found in smaller amounts in the more viscous parotid secretions. These substances are thought to help fight off ascending bacterial infection. Bacterial parotitis is generally unilateral in adults (75-90%), while viral is generally bilateral. 
==[[Parotitis causes|Causes]]==


Though 80-90% of salivary calculi occur in the Wharton’s duct of the submandibular gland, the parotid remains the most common site of acute suppurative salivary infection. The secretions from the submandibular gland are more alkaline, thought to result in a higher concentration of insoluble calcium phosphate.
==[[Differentiating parotitis from other diseases|Differentiating Parotitis from other Diseases]]==


== Pathophysiology ==
==[[Parotitis epidemiology and demographics|Epidemiology and Demographics]]==


Parotitis is a disease that occurs in debilitated patients. Dehydration and decreased salivary flow/stasis are the main risk factors for ascending infection through Stenson’s duct to the gland. Postoperative patients who are dehydrated and NPO with little salivary stimulation are at particular risk with an incidence estimated at 1 in 1000. Debilitating medical conditions such as [[Diabetes mellitus]], renal failure, [[HIV]] and [[Sjögrens’s syndrome]] are risk factors.
==[[Parotitis risk factors|Risk Factors]]==


Patients with [[Anorexia]], [[Bulimia]], [[CF]] or those with salivary ductal dilation are also at risk.  Ductal dilation is found in those with high intraoral pressure such as trumpet players and glass blowers. Medications with anticholinergic properties or diuretic effects
==[[Parotitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


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.
==Diagnosis==
[[Parotitis history and symptoms|History and Symptoms]] | [[Parotitis physical examination|Physical Examination]] | [[Parotitis laboratory findings|Laboratory Findings]] | [[Parotitis CT or MRI|CT or MRI]]


Viral etiologies include paramyxovirus (particularly Mumps), influenza, parainfluenza, echovirus and coxsackie.  Cytomegalovirus (CMV) and adenovirus have been implicated in HIV patients.
==Treatment==
[[Parotitis medical therapy|Medical Therapy]] | [[Parotitis surgery|Surgery]] | [[Parotitis primary prevention|Primary Prevention]] | [[Parotitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Parotitis future or investigational therapies|Future or Investigational Therapies]]


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 predispose 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>
==Case Studies==
 
[[Parotitis_case_study one|Case study #1]]
== Diagnosis ==
 
The diagnosis is a clinical one. Imaging is usually reserved to assess for a complication such as abscess formation, invasion of the deep neck spaces, [[mediastinitis]], jugular vein thrombosis or [[osteomyelitis]] of the [[mandible]]. Local invasion of the [[temporomandibular joint]] (TMJ) and [[thrombophlebitis]] of the retromandibular and facial veins have also been noted. [[Facial nerve]] dysfunction is rare and usually transient if the infection is treated. More prolonged palsy suggests neoplasm. Because of the underlying debility, the most worrisome complications are systemic and [[sepsis]] can rapidly develop. Chronic recurrent parotitis can occur as a separate entity or secondary to ductal stenosis from initial infection.
 
== Treatment ==
 
The treatment of viral parotitis is largely supportive. Bacterial parotitis is targeted toward gram positive and anaerobic organisms.  70% of those cultured are beta-lactamase producers so Augmentin is recommended. Antistaphylococcal penicillins are also advocated.  Some suggest the addition of metronidazole or clindamycin. Systemic symptoms or failure to improve in 48 hrs warrants IV therapy and consideration of additional coverage for GNR. Adjunctive therapy with warm compresses, mouth irrigation, administration of sialagogues (lemon drops) and bimanual massage of the gland intraorrally and externally can be employed. 
 
Surgery is referred for recalcitrant infections, abscess drainage and to obtain tissue if a noninfectious cause is suspected.   
 
== References ==
{{Reflist}}
 
 
 
 
{{SIB}}


[[ro:Parotidita Acută]]
[[ro:Parotidita Acută]]
[[Category:DiseaseState]]
[[Category:Infectious disease]]
[[Category:Oncology]]
[[Category:Rheumatology]]
[[Category:Needs patient information]]
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Disease]]
[[Category:Glands]]
[[Category:Inflammations]]

Latest revision as of 18:38, 18 September 2017

Parotitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Parotitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT or MRI

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Parotitis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Parotitis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Parotitis

CDC on Parotitis

Parotitis in the news

Blogs on Parotitis

Directions to Hospitals Treating Parotitis

Risk calculators and risk factors for Parotitis

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S. Kiran Singh, M.D. [2] Faizan Sheraz, M.D. [3]

Synonyms and keywords: Parotiditis; Acute viral parotitis; Acute bacterial parotitis; Acute suppurative parotitis; Juvenile recurrent parotitis; Pneumoparotitis

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Parotitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | CT or MRI

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case study #1

Template:WikiDoc Sources