Suppurative parotitis: Difference between revisions
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*Serious bacterial infection of parotid gland that occurs in patients with decreased salivary flow | *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 | **Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma | ||
**Usually caused by staph, strep, | **Usually caused by staph, strep, anaerobes | ||
===Risk factors=== | ===Risk factors=== | ||
*Dehydration | *[[Dehydration]] | ||
*Prematurity or advanced age | *Prematurity or advanced age | ||
*Sialolithiasis | *[[Sialolithiasis]] | ||
*Oral neoplasms | *Oral neoplasms | ||
*Salivary duct strictures | *Salivary duct strictures | ||
*Meds (cause systemic dehydration or decrease salivary flow) | *Meds (cause systemic dehydration or decrease salivary flow) | ||
**Diuretics | **[[Diuretics]] | ||
**[[Antihistamines]] | **[[Antihistamines]] | ||
**[[TCAs]] | **[[TCAs]] | ||
| Line 25: | Line 25: | ||
*Skin over parotid gland is red and tender | *Skin over parotid gland is red and tender | ||
*Purulent drainage from Stensen's duct | *Purulent drainage from Stensen's duct | ||
*Fever | *[[Fever]] | ||
*Trismus | *Trismus | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Facial swelling DDX}} | {{Facial swelling DDX}} | ||
{{Lymphadenitis DDX}} | |||
==Evaluation== | ==Evaluation== | ||
| Line 36: | Line 37: | ||
==Management== | ==Management== | ||
===Supportive Care=== | ===Supportive Care=== | ||
#Hydrate the volume-depleted patient | #[[IVF|Hydrate]] the volume-depleted patient | ||
#Massage and apply heat to the affected gland | #Massage and apply heat to the affected gland | ||
#Stimulate salivation using | #Stimulate salivation using sialogogues such as lemon drops | ||
===[[Antibiotic]] Options=== | ===[[Antibiotic]] Options=== | ||
{{Suppurative Parotitis Antibiotics}} | {{Suppurative Parotitis Antibiotics}} | ||
Latest revision as of 21:40, 9 September 2020
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)
- Chronic illnesses
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
- Ranula
- Sialoadenitis
- Sialolithiasis
- Superior vena cava syndrome
Lymphadenitis
Infectious
- Reactive adenitis
- Bacterial lymphadenitis
- Tuberculous lymphadenitis
- Cellulitis
- Cat-scratch disease
- Parotitis
- Lymphangitis
- Toxoplasmosis
- Tularemia
- Viral disease
- 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
- Postvaccination
- Sarcoidosis
- Salivary gland diagnoses
Evaluation
- Usually clinical
Management
Supportive Care
- Hydrate the volume-depleted patient
- Massage and apply heat to the affected gland
- 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