© Borgis - New Medicine 4/2007, s. 102-103
*Małgorzata Dębska
Parotitis acute in infancy
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Summary
Summary
Parotitis in infants is a rare illness. The most characteristic symptoms include swelling of he parotid glands, erythema, pain, fever and poor suckling. The differential diagnosis has to rule out such diseases as inflammation of the cervical lymph nodes, erysipelas, inflammatory angioma and others. The observation was carried out on four children aged 2 weeks to 10 months. In each case the symptoms were similar, general symptoms include: fever, loss of appetite and topical: swelling of the parotid gland, hyperaemia and skin redness. In the bacteriological examination of purulent secretion from the parotid gland Staphylococcus aureus, Escherichia coli and Streptococcus pneumoniae in two cases were found. In one case of Streptococcus pneumoniae aetiology a sepsis was stated. The diagnosis was easy to make and was based on clinical symptoms and ultrasound image. Intravenous antibiotics treatment due to bacteriological culture was used and continued for ten to fourteen days with good effect. In no case the abcess of the parotid gland was observed. There are no indications for sialography in acute parotitis and also it is difficult to perform this kind of examination in infants.
Parotitis in infants is a rare illness characterized by inflammatory swelling of the parotid glands, erythema, pain and general signs and symptoms like fever, fussiness, poor suckling and poor general condition. It is usually described as a secondary infection, affecting infants with lowered immunity (after infectious diseases or surgeries) or with chronic diseases like renal failure, diabetes and other metabolic disorders.
A differential diagnosis has to rule out inflammation of the cervical lymph nodes, Caffey Silverman Disease, inflammation of soft tissues due to erysipelas or infection due to H. Influenzae, swelling of odontogenic origin, infection of the parotid gland due to CMV, HBV, HCV, echovirus, Coxsackie A virus, flue, mumps and tumours of the parotid gland, e.g. inflammatory angioma.
The aim of the present paper is to analyse the causes, the course of disease and the treatment of parotitis in infants in the Warsaw Children´s Hospital in Litewska Street.
THE OBJECT AND THE METHODS
The observation was carried out on four infants aged 2 weeks to 10 months, hospitalized in the Warsaw Children´s Hospital and its branch in 2006 and 2007. The research is based on the analysis of medical history, physical examinations results as well as additional tests and outcome of the infants´ treatment.
RESULTS
The observation was carried out on 4 infants, two male and two female, aged 2 weeks to 10 months (mean 5 months). Two of them were premature infants with birth weight of 1500 g and 1800 g, 2 were born after an uncomplicated pregnancy. Before the symptoms of parotitis occurred in two of the infants, an infection of the upper respiratory tract was diagnosed in their families.
All the infants were admitted due to fever. The parents of two patients observed a painful swelling in the submandibular area. In the other two cases, it was a doctor who recognised the swelling of the parotid gland. During a laryngologic examination, apart form the painful swelling of the parotid gland (left in two cases and right in two), were also observed: hyperaemia and skin redness. All the infants had an inflammatory swelling of the ducts of the parotid glands and the pus expressed from the duct underwent a bacteriologic examination. In each case blood tests were performed on admission.
The children had slightly elevated inflammation parameters:
Blood leukocyte levels ranged from 12300 to 16900 (mean 15100), blood smears showing granulocytic cells
ESR value ranged from 5 to 35mm, mean 21
CRP levels ranged from 3,3 to 10 mg/dl, mean 6,2
All the patients were CMV IgM negative and their level of amylase was in the normal range.
The bacteriologic examination of secretions expressed from the duct cultured Staphylococcus aureus in one case, Escherichia coli in one case (the parotitis was accompanied by urinary tract infection caused by E. Coli) and Streptococcus pneumoniae in two patients, one of which also had sepsis due to Streptococcus pneumoniae.
The diagnosis was confirmed by an ultrasound image which showed that the entire parotid gland was swollen and hyperaemic. In one case the duct was dilated but there was no calculi.
Two cases were treated with Ceftriaxone, one case with Cefuroxime and Clindamycin and one with Netilmicin and Clindamycin. The treatment continued for 10 to 14 days and and led to a marked improvement of the infants´ condition, of the inflammation parameters and the ultrasound image of the parotid glands.
DISCUSSION
Only about 100 cases of parotitis in infants were described in the literature. The clinical picture is typical and the disease is easy to diagnose on the basis of a physical examination and additional tests, mainly ultrasound imaging.
The analysis of the causes of parotitis in the cases discussed proves that it´s more common in premature infants – two cases in the study – and in babies born after complicated pregnancies, e.g. when the mother had diabetes or furunculosis. The parotitis in two cases was preceded by an infection in a member of the infants´ families. In two cases the parotitis was a secondary blood-borne infection caused by urinary tract infection due to E. Coli (one case) and by sepsis due to Streptococcus pneumoniae, which has been described in the literature. The infection in infants is accompanied by fever and causes dehydration and excessively thick saliva with decreased salivary flow, which in turn predisposes to ascending infection of the buccal cavity.
The literature mentioned Candida albicans as the cause in one case and Streptococcus viridans in several cases. But the most common aetiology in the literature is: Staphylococcus aureus (one case in our study), Streptococcus pneumoniae and anaerobic bacteria.
Abscess of the parotid gland during the infection was described in the literature, but the present study didn´t show such complication; it may be due to a prompt diagnosis and administration of appropriate intravenous antibiotics. The intravenous treatment should be continued for 10-14 days, until the inflammation parameters and the ultrasound image of the parotid glands return to normal.
CONCLUSIONS
1. An acute parotitis is confirmed by an ultrasound image
2. As an acute parotitis may be accompanied by sepsis, a bacteriologic blood analysis on admission is vital
3. An acute blood-borne parotitis may have an unusual aetiology, e.g. E coli
4. Intravenous antibiotics treatment should be continued for 10-14 days until the ultrasound image of the parotid glands and the inflammation parameters return to normal, to prevent from complications
5. Sialography should not be performed in acute parotitis. It is also difficult to perform in infants.
Piśmiennictwo
1. Ayala Curier J, et al.: Neonatal acute suppurative parotitis. An. Pediatr. (barc).2004; 60(3): 274-7.2. Chiu CH, Lin TY: Clinical and microbiological analysis of six children with acute suppurative parotitis. Acta Paediatr., 1996; 85(1): 106-8.3. Chmielik M (red.): Otorynolaryngologia Dziecięca. PZWL 2001. 4. Even-Tov E, et al.: Candida parotitis with abscess formation. Acta Otorynogol., 2006; 126(3): 334-6.5. Hammond A, Sijbrandij ES: Purulent parotitis in an infant. Tijschr Kindergeneeskd. 1991; 59(6): 216-8.6. Knobber D, et al.: Differential diagnostic observations on acute sialadenitis. Laryngorhinootologie. 1990; 69(6): 324-6.7. Kossowska E (red.): Otorynolaryngologia wieku rozwojowego. PZWL 1986; 140-1. 8. Mockel A, et al.: Neonatal suppurative parotitis. Klin. Padiatr., 2005; 217(2): 86-8.9. Raad II, et al.: Acute bacterial sialadenitis: a study of 29 cases and review. Rev. Infect. Dis., 1990;12(4): 591-601.
