Parotitis

Excerpt

Parotitis, the most common inflammatory condition affecting the major salivary glands, refers to swelling or inflammation of the parotid glands and may present as a localized issue or a manifestation of a systemic illness. This condition arises from various causes, including infections, ductal obstruction, autoimmune or metabolic diseases, medications, and structural abnormalities. Clinically, parotitis is typically painful and presents with unilateral glandular swelling and reduced salivary flow, except in cases associated with HIV, metabolic causes, and some salivary gland tumors. Additional symptoms may include fever, chills, headache, sore throat, fatigue, and loss of appetite.

Viral or bacterial infections are typically the primary cause of acute parotitis. Common viral pathogens include mumps, influenza, parainfluenza, coxsackievirus, echovirus, and HIV. Staphylococcus aureus and Streptococcus species are the most common bacterial causes. Additional causes of acute parotitis are mechanical obstruction from salivary stones or ductal strictures, external beam radiation, contrast exposure, and radioiodine treatment. Chronic parotitis often results from recurrent infections; autoimmune conditions, such as Sjögren disease or sarcoidosis; tumors; and metabolic disorders, such as diabetes mellitus. Additional risk factors include tuberculosis, inflammatory disorders, dehydration, malnutrition, immunosuppression, and medications that reduce salivary flow. Although uncommon, complications may include facial nerve palsy, sepsis, Lemierre syndrome, osteomyelitis, and multiorgan failure.

Diagnosis is primarily clinical but supported by imaging, with ultrasound commonly used to confirm glandular inflammation and detect underlying issues such as stones, abscesses, or tumors. Additional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is necessary in suspected cases of malignancy or sialolithiasis. Gram stain and culture of purulent material, obtained by gland massage or ultrasound-guided aspiration, can guide antibiotic selection. Laboratory testing is generally unnecessary and reserved for patients with likely underlying autoimmune disorders. Treatment is guided by the underlying etiology. Suppurative parotitis warrants hospitalization and intravenous (IV) antibiotics due to the risk of deep tissue involvement. Supportive care may include warm compresses; nonsteroidal anti-inflammatory drugs; sialogogues, such as pilocarpine to stimulate salivary flow; and sialendoscopy to clear ductal debris. In cases that are chronic or refractory, parotidectomy may be necessary.