Suppurative parotitis: Difference between revisions
(→DDX) |
No edit summary |
||
| Line 3: | Line 3: | ||
**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, anerobes | **Usually caused by staph, strep, anerobes | ||
===Risk factors=== | |||
*Dehydration | |||
*Prematurity or advanced age | |||
*Sialolithiasis | |||
*Oral neoplasms | |||
*Salivary duct strictures | |||
*Meds (cause systemic dehydration or decrease salivary flow) | |||
**Diuretics | |||
**Antihistamines | |||
**TCAs | |||
**B-blockers | |||
*Chronic illnesses | |||
**HIV | |||
**Sjogren syndrome | |||
**Anorexia/bulimia | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 28: | Line 29: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Facial swelling DDX}} | {{Facial swelling DDX}} | ||
==Diagnosis== | |||
*Usually clinical | |||
==Treatment== | ==Treatment== | ||
| Line 38: | Line 42: | ||
==See Also== | ==See Also== | ||
[[Salivary | *[[Salivary gland diagnoses]] | ||
==References== | |||
== | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 14:41, 10 June 2015
Background
- Serious bacterial infection of parotid gland that occurs in pts w/ decreased salivary flow
- Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
- Usually caused by staph, strep, anerobes
Risk factors
- Dehydration
- Prematurity or advanced age
- Sialolithiasis
- Oral neoplasms
- Salivary duct strictures
- Meds (cause systemic dehydration or decrease salivary flow)
- Diuretics
- Antihistamines
- TCAs
- B-blockers
- Chronic illnesses
- HIV
- Sjogren syndrome
- Anorexia/bulimia
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
Diagnosis
- Usually clinical
Treatment
Supportive Care
- Hydrate the volume-depleted patient
- Massage and apply heat to the affected gland
- Stimulate salivation using sialagogues 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