Suppurative parotitis caused by anaerobic bacteria in newborns.

Staphylococci are the usual bacterial etiology of suppurative parotitis in newborns. This report describes for the first time recovery of anaerobic bacteria from aspirates of the infected gland in two infants with suppurative parotitis. Peptostreptococcus intermedius and Prevotella melaninogenica were isolated from one child and Prevotella intermedia from the other patient. Complete recovery occurred after 4 weeks of antimicrobial therapy.     

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.     

Acute suppurative parotitis caused by anaerobic bacteria: report of two cases.

Staphylococcus aureus is the predominant pathogen in acute suppurative parotitis. Although anaerobic bacteria are prevalent in the normal oral and upper respiratory tract flora and frequently are involved in oral and facial infections, they have seldom been isolated from patients with suppurative parotitis. It may be that a role for anaerobes in parotitis has not been documented because of inadequate specimen transport or anaerobic culture techniques. We describe two cases of acute suppurative parotitis in which cultures yielded anaerobic bacteria. In one case, no aerobes were isolated; in the other, the anaerobe was the predominant organism numerically.     

Selective IgA deficiency in children with recurrent parotitis of childhood

Recurrent parotitis of childhood is defined as the relapsing form of juvenile (idiopathic) parotitis and represents a rare inflammatory disorder of the parotid gland with potentially significant morbidity. We reviewed the charts of patients who were diagnosed with inflammatory parotid diseases in our institution between 1992 and 2002. There were 91 patients presenting with juvenile parotitis (1 of 6117 of all clinical visits). Of these 91 cases, 23 patients (28%) had the relapsing form of juvenile parotitis, and the median number of episodes was 5 (range, 2-20). Laboratory investigations revealed that 5 patients had selective IgA deficiency. The prevalence (22%) is different from the cumulative prevalence of IgA deficiency in a healthy population (0.3%; P < 0.001).     

Clinical, histopathologic and immunohistochemical studies of chronic sialectatic parotitis in childhood and adolescence]

Chronic sialectatic parotitis (CSP) causes problems in differential diagnosis and therapy. CSP shows the typical clinical features of chronic recurrent parotitis and will be investigated histopathologically only after ultimative parotidectomy. The etiology and pathogenesis of these unspecific inflammations is still unknown. Therefore no causal therapy is available and a lot of different trials (sialogoga, gland massage, infrared light, antibiotics, antiphlogistics, Trasylol, duct occlusion, duct ligation, gland denervation, radiotherapy) are not successful in the long run. MATERIAL AND METHOD: The salivary gland registry of the University of Hamburg (1965-1996) contains 22 infants and juvenile patients showing very severe courses of CSP. These cases have been investigated clinical (ultrasound, sialography), histopathological (paraffin embedded sections, histomorphometry of the ectatic duct lumina) and immunohistochemical (CK-MNF, AKTIN, KiM4) in a retrospective study to research the pathogenesis of CSP. RESULTS: Recurrent and always very dolent parotid swelling occurs between the age of 3 and 14 years for the first time. The courses vary from 3 months until 25 years. Local findings as well as ultrasound and sialographic features allow no certain differentiation of chronic recurrent parotitis. Conservative therapy fails in each case and leads to the necessity of surgical treatment. Histopathological three different stages of development can be observed: Initial stages show regular lobular architectonic structure of the parotid gland parenchyme with duct ectasies surrounded by slight inflammation of lymphocytes and plasmacells. Advanced stages are characterized by an increase of periductal inflammation and the appearance of lymphfollicels. Nearly complete lymphatic transformation of the parenchyme with destruction of the lobular formation dominates the terminal "immunologic" stage. Some cases show multiple myoepithelial islands within this lymphatic stroma typically observed in benign lymphoepithelial lesions. Whether bacteria nor primary obstructive changes can be observed. The histomorphometric analyses of the average and maximal luminal duct diameters show marked increase of 39% respectively 46% from and- vanced to terminal stages of CSP. Therefore the pathognomonic duct ectasies seem to depend on the progredient inflammation and are not due to a hereditary malformation of the duct system. Immunohistochemical terminal stages show follicular lymphatic hyperplasia (KiM4) expressing overshooting humoral immune reaction of MALT. CONCLUSION: Concerning the pathogenesis CSP corresponds to a immunopathological disorder of MALT and seems to be a prestage of benign lymphoepithelial lesion. Consequently important changes in the diagnosis and therapy of CSP lead to early histopathological investigation to differentiate the stage of inflammation. In stage III conservative parotidectomy should be carried out because spontaneous healing can not be expected. In contrast initial cases should be treated at first by glucocorticoids and immunosuppressives.     

Parotitis and acute pancreatitis in a patient with ulcerative colitis

Ulcerative colitis (UC) has been associated with a number of extraintestinal manifestations, but an association with salivary gland involvement has never been reported. We describe a patient with UC who developed acute pancreatitis and parotitis. Some autoantibodies against common antigens presenting in both the parotid gland and the pancreas might have induced pancreatitis and parotitis in our patient with UC.     

Recurrent parotitis

(1) Recurrent parotitis is probably caused by a congenital abnormality of the salivary gland ducts with recurrent attacks of ascending infection, perhaps aided by dehydration. The parotid gland is predominantly affected probably because of its lower rate of secretion compared with the submandibular gland. (2) The condition mainly affects children between the ages of 3 and 6, with males being more commonly affected. The symptoms peak in the first year of school, and usually, but not invariably, begin to subside at puberty. By the age of 22, most patients are completely symptom-free. When the disease starts after puberty, females are predominantly affected. (3) Ultrasound is the appropriate initial investigation, and is usually supplemented by sialography. The sialography may itself cause a resolution of symptoms. (4) Treatment is conservative in the first instance, and an expectant policy is indicated. More aggressive treatment is justified only for those adults with persistent problems. This may be parotid duct ligation, parotidectomy, or tympanic neurectomy, depending upon the preference and experience of the treating physician.     

Primary Gougerot-Sj?gren syndrome in a 13-year-old girl]

Sj?gren's syndrome is uncommon in children, and occurs most often in association with autoimmune diseases (secondary Sj?gren's syndrome). We describe the clinical and biological features of a 13-year-old girl with primary Sj?gren's syndrome, revealed by recurrent parotitis. CASE REPORT: This adolescent girl was referred for investigation of multiple episodes of bilateral parotid swelling since age nine, without systemic symptoms. Examination was unremarkable except for enlarged and painless parotid glands. Laboratory investigations, measurement of saliva production, parotid sialography, labial salivary gland biopsy, revealed Sj?gren's syndrome without associated disease. Hydroxychloroquine was prescribed with clinical improvement. CONCLUSION: Recurrent parotitis in children is an uncommon condition. The onset of parotid swelling at five years or over deserves screening for dysimmune disorders, sarcoidosis or Sj?gren's syndrome. Diagnosis of Sj?gren's syndrome is based on laboratory evidence of autoimmune disorders and minor salivary gland biopsy.     

Neonatal suppurative parotitis: a study of five cases

Suppurative parotitis is uncommon in newborns. During a 9-year study period, five cases of neonatal suppurative parotitis were detected in 3,624 hospital admissions. The relative risk of developing neonatal suppurative parotitis in admitted infants was 5.52 (0.62–49.35). Staphylococcus aureus was the causative organism most commonly detected in the hospital-acquired cases. Antimicrobial therapy was effective in all cases; surgery was not required. Conclusion Although neonatal suppurative parotitis is now uncommon in the newborn, it cannot be considered a “vanishing disease”. Received: 31 July 1997 / Received in revised form: 30 May 1998 / Accepted: 6 June 1998     

Neonatal acute suppurative parotitis

Acute suppurative parotitis is highly uncommon in neonates. Approximately 100 cases have been reported in the literature. Dehydration and prematurity are important predisposing factors. Diagnosis is based on clinical signs. White blood cell count and parotid ultrasonography are useful. The most commonly isolated causative organism is Staphylococcus aureus. Initial treatment consists of antistaphylococcal empiric antimicrobial therapy for 7-10 days. The prognosis is good. The illness is not usually associated with recurrences. We describe two 12-day-old newborn infants who presented with fever, unilateral swelling of the parotid region with erythema, warmness and pain, and purulent discharge from Stensen's duct. We also provide a literature review.     

MRI and MR sialography of juvenile recurrent parotitis

Background  

Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders.     

Recurrent parotid swelling in children: clinical features useful for differential diagnosis of Sjögren''s syndrome

Immunological evaluations were performed in 59 children with at least five episodes of parotid swelling. Autoantibody(ies) was transiently or persistently detected in 12 (20%) of 59 patients with recurrent parotitis. Three of the 12 children with autoantibodies were diagnosed as having Sj?gren's syndrome. The mean age at onset of parotid swelling in Sj?gren's syndrome was significantly higher than that of recurrent parotitis of unknown etiology. The present study and the review of the literature suggest that patients with the onset of parotid swelling at age five years or over deserve screening for underlying systemic immune disorders.     

Ultrasonographic features of recurrent parotitis in childhood

Six children with recurrent parotitis were studied by ultrasound. Of the 12 parotid glands thus observed, 5 were swollen and 7 were not enlarged. Multiple round hypoechoic areas measuring 2–4 mm in diameter were seen in all 5 enlarged parotid glands and in 5 nonenlarged glands. These small hypoechoic areas were larger than the punctate pools of contrast medium shown by sialography. We consider that these hypoechoic areas represented both peripheral sialectasis and surrounding lymphocytic infiltration. We propose that ultrasonography may be useful for the diagnosis and follow-up of recurrent parotitis in childhood.     

Acute neonatal suppurative parotitis: case reports and review

We describe two cases of neonatal suppurative parotitis caused by Staphylococcus aureus. Only 32 cases of neonatal suppurative parotitis (72% male) have been described in the English literature in the last 35 years. Thirty-eight percent were premature babies, only 41% were febrile and the causative agent in most cases was S. aureus. Recovery was achieved in 78% of the patients with antibiotic therapy without drainage.     

Neonatal suppurative parotitis

This report describes the case of a 10 days old newborn of a diabetic mother with gestosis, who developed erythema and swelling of the right cheek. A diagnosis of acute suppurative parotitis due to S. aureus was made. Following this case report the most important facts of epidemiology, pathogenesis, clinical manifestation, diagnostics, and therapy of suppurative parotitis are discussed.     

Mucoepidermoid Carcinoma of the Parotid Gland in Childhood Survivor of Acute Lymphoblastic Leukemia With Need of Radiotherapy for Treatment and Review of the Literature

Diagnosis of secondary malignancies began with the increasing survival in childhood cancer. Children treated for acute lymphoblastic leukemia (ALL) have an increased risk for developing mucoepidermoid carcinoma (MEC) of the parotid gland. The latent period ranges from 5 to 16 years. A 2 6/12-year-old girl was treated for pro-B ALL. Treatment included multidrug chemotherapy, prophylactic intrathecal methotrexate, and cranial radiotherapy. MEC of the left parotid gland was diagnosed at the age of 8 years, 3 years after completing treatment. She was treated with multiple surgery and radiotherapy. The authors aimed to emphasize the need for concern about second cancers of the parotid gland in children treated for ALL.     

Mucoepidermoid carcinoma of the parotid gland in childhood survivor of acute lymphoblastic leukemia with need of radiotherapy for treatment and review of the literature

Diagnosis of secondary malignancies began with the increasing survival in childhood cancer. Children treated for acute lymphoblastic leukemia (ALL) have an increased risk for developing mucoepidermoid carcinoma (MEC) of the parotid gland. The latent period ranges from 5 to 16 years. A 2 6/12-year-old girl was treated for pro-B ALL. Treatment included multidrug chemotherapy, prophylactic intrathecal methotrexate, and cranial radiotherapy. MEC of the left parotid gland was diagnosed at the age of 8 years, 3 years after completing treatment. She was treated with multiple surgery and radiotherapy. The authors aimed to emphasize the need for concern about second cancers of the parotid gland in children treated for ALL.     

Acute neonatal parotitis due to 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.     

Eikenella corrodens as a cause of thyroid abscess

Acute suppurative thyroiditis in children is rarely reported. It is generally associated with upper respiratory tract infections and is manifest as an acute febrile illness with swelling of the thyroid gland. Diagnosis is established by aspiration of the affected area, and cultures for both aerobic and anaerobic bacteria should be carried out. Therapy is based on drainage of the abscess and treatment with specific antimicrobial drugs, as determined by culture results. We describe a 3 1/2-year-old girl with a thyroid abscess from whom Eikenella corrodens, in addition to mixed flora, was recovered. No disturbance in thyroid function was observed. We review the pathogenesis of acute bacterial infections of the thyroid gland and the literature regarding the specific cause of these infections.     

Diabetic ketoacidosis following mumps

A-13-year-old girl presented with diabetic ketoacidosis with convincing clinical signs of parotitis (fever, drooling of saliva, inability to swallow with development of bilateral parotid swelling) and pancreatitis (fever, abdominal pain and vomiting), along with high serum amylase and positive mumps IgM titer. This suggests that mumps virus may have been the causative factor, probably as a result of concomitant involvement of the pancreas.