Acute suppurative parotitis and parotid abscess in children

Treatment for parotid abscess: a systematic review

A parotid abscess is a dangerous complication of parotitis. In this study, we aimed to define current treatment concepts for parotid abscess, focusing on different management options. The authors performed a PRISMA-compliant systematic review across multiple databases including all original studies published until January 2021 focusing on treatment of parotid abscess. Studies specifying treatment modalities and treatment success rates were included based on abstract and full-text selection. The authors assessed study quality, demographics, success rates, management modalities and adverse events. Among 1,318 citations, 18 studies met our inclusion criteria. Twelve studies relied only on incision and drainage with antibiotic therapy; the remaining 6 compared different treatment modalities (incision and drainage versus exclusive medical therapy or ultrasound-guided drainage). Heterogeneity between studies precluded meta-analysis of data. The review showed that antibiotics remain the mainstay of treatment for parotid abscess. Conversely, the role of incision and drainage, and aspiration should be studied further. The higher rate of complications following incision and drainage suggests a more conservative approach is needed. Incision and drainage remain the main salvage option for conservative treatment failures.

Salmonella Typhi: a rare cause of parotid abscess

The incidence of extraintestinal infection caused by Salmonella spp has been increased during the past decade. Here we report a case of a parotid abscess caused by Salmonella enterica subspecies enterica serotype Typhi (S Typhi) in an individual without any significant abnormality of the parotid gland. A 68-year-old man presented to the surgical department with high-grade intermittent fever associated with painful swelling over the right side of the face, extending into the neck. An ultrasound of the neck revealed an abscess of the right parotid gland. S Typhi was isolated from the pus drained from the parotid gland. The patient was treated with intravenous followed by oral cephalosporin for a period of 7 days. This case gives an insight into one of the rarer aetiological agents causing parotid abscess.

Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study

The present study aimed to specify diagnostics for peritonsillar abscesses (PTAs) and to clarify the role of minor salivary glands. This prospective cohort study included 112 patients with acute tonsillitis (AT) and PTA recruited at a tertiary hospital emergency department between February and October 2017. All patients completed a questionnaire concerning their current disease. Serum amylase (S-Amyl) and C-reactive protein (S-CRP) levels, tonsillar findings, and pus aspirate samples and throat cultures were analyzed. Eight of 58 PTA patients (13.8%) had no signs of tonsillar infection. The absence of tonsillar erythema and exudate was associated with low S-CRP (p<0.001) and older age (p<0.001). We also observed an inverse correlation between S-Amyl and S-CRP levels (AT, r = -0.519; PTA, r = -0.353). Therefore, we observed a group of PTA patients without signs of tonsillar infection who had significantly lower S-CRP levels than other PTA patients. These findings support that PTA may be caused by an etiology other than AT. Variations in the S-Amyl levels and a negative correlation between S-Amyl and S-CRP levels may indicate that minor salivary glands are involved in PTA development.

Deep Parotid Lobe Abscess Presenting with Dysphagia and Trismus

An abscess of the deep parotid lobe is an uncommon complication of acute parotitis. Characterized by warm erythematous facial skin and ipsilateral cheek swelling, parotid abscesses have often been associated with decreased saliva production and immunodeficiency. We offer a case of a large deep parotid lobe abscess presenting similarly to a peritonsillar mass, causing significant odynophagia and difficulty swallowing. Computed tomography scan revealed an infected deep parotid lobe sialocele which was surgically drained transorally and treated expectantly with antibiotics.

Parotid abscess in children - A tertiary rural hospital experience

Parotid abscess is a rare complication of acute parotitis in children. Acute parotitis occurs due to infection of intra-parotid or para-parotid lymph nodes or glandular parenchyma of the parotid gland which may progress to parotid abscess.

OBJECTIVES

To document the causative organism, clinical behaviour and response to treatment in paediatric parotid abscess.

MATERIALS AND METHODS

A retrospective study was done in our tertiary rural hospital from May 2007 to May 2015 to identify and analyse paediatric parotid abscess in 80 unilateral parotitis cases.

RESULTS

7 cases of parotid abscess were identified. 4 cases were diagnosed clinically and in 3 cases ultrasound was done showing heterogenous, hyperechoic, solid and cystic areas. In 2 patients, abscess was extending to the submandibular space. Incision and drainage was done in all patients. The most common bacteria was Methicillin Sensitive Staphylococcus aureus. Escherichia coli was reported in one patient, and was rare in parotid region. 2 patients had House Brackmann grade 2 marginal mandibular nerve palsy, and they recovered within 4½ months.

CONCLUSION

Parotid abscess is an uncommon but life-threatening condition in paediatric age group. Poor orodental hygiene was most important predisposing factor. Abscess can be diagnosed clinically and ultrasound scan is also an important diagnostic tool. It is commonly caused by Gram positive cocci and responds well to incision and drainage followed by appropriate antibiotics. No fistula may result if treated early.

Bilateral acute neonatal suppurative parotitis: A rare finding in neonatal age

Acute suppurative parotitis is a rare entity in neonates. Bilateral involvement is extremely rare. Low birth weight, prematurity, gavage feeding, dehydration, sepsis are all known risk factors. Staphylococcus aureus is the most common organism, other organisms responsible for parotitis are streptococcus, E. coli, pseudomonas and klebsiella. We report a neonate suffering from bilateral acute suppurative parotitis with an unusual causative association. CPAP and its association for acute suppurative parotitis has been proposed.

Parotid abscess: mini-pictorial essay

Bacterial and viral infection of the intraparotideal and periparotideal lymph nodes, or of the glandular parenchyma, can lead to inflammatory and subsequently suppurative changes, which can result in abscess formation. Sonography allows a detailed morphological evaluation of the gland and has an important value, complementary to clinical examination, in the study of parotid inflammatory diseases. Specifically, sonography defines lesion's characteristics and, in a large number of cases, also its nature and, among the various imaging techniques, it is considered first-line imaging for the evaluation of parotid abscesses, which are characterized by hypo-anechoic lesions, with irregular margins. Color Doppler signals are peripheral to the abscess. If combined with color Doppler, sonography is important not only in diagnosis, but also in the evaluation of therapeutic efficacy and as a guide to the aspiration and drainage of abscesses. The rarity of some of these lesions led us to publish this mini-pictorial essay.

The clinical picture of juvenile parotitis in a prospective setup

AIM

To characterize the features of juvenile parotitis in a prospective setup and epidemiology.

METHODS

All children with parotitis admitted to Helsinki University Central Hospital 2005-2010 were recruited. Clinical characteristics, given treatment, outcome, blood leukocyte count, C-reactive protein, serum amylase and trypsinogen, SPINK-1 genotype and mumps antibodies were recorded. To map the epidemiology, a questionnaire was sent to 1000 randomly selected 13-year-old children.

RESULTS

The prospective study included 41 children (aged ≤ 17) with acute parotitis, all in good general condition. Serum amylase, but not trypsinogen, was elevated in majority of the cases (79%) and C-reactive protein in 68%. Eleven (27%) children had an elevated blood leukocyte count. None had acute mumps. Most children recovered well, 51% being treated symptomatically only. Seven children were treated on ward. Seventeen (46%) children had recurrent symptoms. One child (2.4%) had SPINK P55S mutation. According to the epidemiological questionnaire, 1.1% of the respondents (8/728, response rate 73%) reported a verified episode(s) of parotitis.

CONCLUSION

Juvenile parotitis has a frequency close to 1%. In the majority, the general condition is good during the episode. Serum amylase serves as an additional marker for the disease. Parotitis has a tendency to recur in almost half of the cases.

Clinical ultrasound of the salivary glands

Ultrasound investigation of the major salivary glands has been routinely used for the past 25 years. Ultrasound provides an immediate diagnosis in acute or chronic inflammatory salivary diseases and can visualize sialolithiasis as small as 0.4 mm. Ultrasound is also an important imaging modality for salivary gland tumors, guiding fine needle aspiration (FNA) for cytological diagnosis. It is particularly sensitive in detecting suspicious lymph nodes in the neck and helps to guide FNA. Ultrasound is a first-line tool for diagnosis of salivary pathology. It is simple to use, noninvasive, and well tolerated, even in children.

[Recurrent abcesses of the parotid gland in Sjögren's syndrome]

We report on a 48-year old female patient suffering from recurrent suppurative sialo-adenitis. Resections of both parotid and the left submandibular glands had to be performed due to abscesses. The woman had suffered from recurrent swelling of the salivary glands as well as xerostomia and xerophthalmia for years. Sjögren's syndrome was diagnosed with a delay of 17 years. The current case implicates recurrent bacterial suppurative sialo-adenitis caused by longstanding Sjögren's syndrome. In every case rheumatic disorders have to be considered in the differential diagnosis of recurrent suppurative parotitis. A detailed anamnesis, ultrasound, a differential hemogram, testing for rheumatoid factor and anti-nuclear antibodies (ANA) as well as SS-A and SS-B ENAs can give early information years before Sjögren's syndrome becomes clinically apparent.

Parotiditis aguda neonatal por Streptococcus agalactiae

We report two cases of group B streptococcal acute neonatal parotitis. Both patients showed late-onset infections in association with acute parotid swelling, without cellulitis or purulent drainage from Stensen's duct. Neither of the infants had meningitis, and Streptococcus agalactiae was isolated from blood cultures. Differential diagnosis with cellulitis-adenitis syndrome was based on clinical manifestations with supporting radiographic findings, which revealed parotid swelling with increased vascularization. Both infants were treated with a 2-week-course of intravenous cefotaxime, with complete recovery. Although the most common cause of acute neonatal bacterial parotitis is Staphylococcus aureus, Streptococcus agalactiae should be included in the differential diagnosis, especially in infants with late-onset sepsis.

Cases presenting as parotid abscesses in children

BACKGROUND

A parotid abscess is a rare complication of acute suppurative parotitis which most often requires hospitalization, intravenous antibiotic therapy, and surgical drainage.

OBJECTIVE

To investigate the clinical picture, treatment, and prognosis of children with a parotid abscess in a search for optional clinical guidelines for treatment.

METHODS

A retrospective chart review was performed for 10 children (age<or=17) with a parotid abscess between January 1996 and December 2005.

RESULTS

Of the 10 cases of parotid abscess found, 4 children had had parotid-related symptoms before; bacterial culture was positive in 6; 4 had aerobic Gram-positive pathogens, and 1 girl had parotid tuberculosis. All patients received intravenous antibiotic therapy. The initial diagnostic method was ultrasound in nine cases and MRI in one. Four children underwent surgical drainage, and in three cases there was an ultrasound guided needle aspiration of the abscess. Neither surgical drainage nor aspiration led to fistula formation or any other complication. The abscess ruptured spontaneously through the skin of the periauricular area in two cases and into the ear canal in one. During follow-up, all were symptom-free except for two girls diagnosed with first brachial cleft fistulas. One of these also had a reoccurrence of the parotid abscess. Both later underwent superficial parotidectomy due to persistent symptoms.

CONCLUSIONS

Most parotid abscesses in children are acute multi-bacterial infections not necessarily related to other parotid gland pathologies. Intravenous antibiotic therapy is the cornerstone of treatment, but surgical drainage assists in recovery and should not lead to fistula formation.

New insights into juvenile parotitis

AIM

We inquired about the possibility of a familial trend in juvenile parotitis and evaluated the role of SPINK1 mutations in juvenile parotitis.

METHODS

The clinical records of all children admitted to the Helsinki University Hospital during 1995 to May 2003 because of swelling in the parotid gland were reviewed. A questionnaire on possible recurrences and on familial cases was mailed. As disturbances in trypsin inhibition might be involved in the pathogenesis, we assessed the SPINK1 gene encoding for Kazal-type trypsin inhibitor in voluntary patients. The study group comprised 133 children (boys 82 girls 51) with juvenile parotitis. The median age at presentation of first symptoms was 6.0 y (range 1-19 y).

RESULTS

Recurrent symptoms in the parotid gland were common (57%), and 29% of the children (38/133) had suffered from four or more episodes. A young age at the first episode of symptoms increased the likelihood of recurrences (p<0.0001). Familial cases of parotid swelling were common (22%; response rate 67%). A total of 47 patients (35%) agreed to testing for SPINK1 status. Four children had a major mutation (N34S or P55S), corresponding to an 8.5% (4/47) prevalence, but this was not different from the controls (5%).

CONCLUSION

It is likely that inherited factors are involved in the manifestation of juvenile parotitis in a subset of patients. It is tempting to speculate that disturbed proteolytic balance may play a role in the development of symptoms.

Sonography of soft tissue masses of the neck

In many clinical conditions, high-resolution sonography and color (power) Doppler sonography can be used as the first-line modality for evaluating cervical soft tissue masses. Cervical cysts, lipomas, paragangliomas, neurogenic tumors, hemangiomas, and lymphangiomas often exhibit characteristic sonographic appearances. Sonography can be used for lymph node assessment, and most salivary gland diseases can be diagnosed sonographically. Sonography can be used to guide needle biopsy of soft tissue neoplasms and lymph nodes. In addition, the relationship between a cervical mass and the great vessels can be evaluated.

Microbiology of recurrent parotitis

BACKGROUND

Infantile chronic recurrent parotitis (ICRP) is characterized by episodes of recurrent swelling of the parotid gland with decreased salivary flow and purulent secretion. The etiology of this little unknown clinical condition has been attributed to multiple causes such as canalicular system malformations, ascending bacterial infection, hyposialia, parotitis sequelae, viral infections and immunologic disorders, among others.

METHODS

We studied the types (with counts) of microorganisms involved in ICRP. Saliva samples were obtained from 56 patients and 20 controls, inoculated onto enriched media and incubated under aerobic and anaerobic conditions. Antimicrobial susceptibility and serotyping of the isolated organisms isolated were performed.

RESULTS

Of 57 saliva samples from ICRP patients, 52 (91%) were culture-positive. The most frequently isolated microorganisms were Streptococcus pneumoniae and Haemophilus influenzae. Thirteen of twenty (65%) samples were also culture-positive, mostly for viridans streptococci. However, colony counts were lower than in clinical samples (P < 0.004). Approximately one-third of S. pneumoniae strains resistant or moderately resistant to penicillin, and all H. influenzae strains were susceptible to all of the antimicrobials tested.

CONCLUSIONS

S. pneumoniae or H. influenzae were isolated in high concentrations in IRCP cases but not in controls, suggesting that these microorganisms may have a role in the development of this clinical entity. Quantitative cultures are very important in assessment of the pathogenic role of these microorganisms in patients but not in controls.