Is Reflex Parotitis a Forgotten or an Unknown Pathology?

Reflex parotitis is a recurrent parotid inflammation caused by an imbalance in the parasympathetic innervation of the salivary gland. However, due to a poor understanding of its pathophysiology, it can go unnoticed. Causes of ignored norms can trigger these repetitive episodes of glandular disease with a difficult diagnosis and inadequate treatment.

A case of Kawasaki disease presenting with parotitis: A case report and literature review.

RATIONALE: Kawasaki disease affects multiple organ systems. Its typical symptoms include fever, rash, oropharyngeal mucosal erythema, bilateral non-exudative conjunctivitis, cervical lymphadenopathy, extremity changes, and membranous desquamation of the fingers and toes. In severe cases, cardiovascular, respiratory, musculoskeletal, gastrointestinal, neurological, and genitourinary complications may occur. In the early stage, Kawasaki disease is often manifested by uncommon symptoms, such as pyuria, meningitis, shock, and retropharyngeal or parapharyngeal abscess, which may delay diagnosis and treatment. We have reported a case of Kawasaki disease presenting with mumps and reviewed the clinical features of 14 other similar cases, in order to facilitate the early diagnosis and treatment of this unusual presentation of Kawasaki disease. PATIENT CONCERNS: A 10-year-old boy presented with persistent fever and parotitis and was diagnosed with suppurative parotitis. After antibiotic therapy, the parotid swelling reduced, but the fever persisted and other typical symptoms of Kawasaki disease appeared, including bilateral conjunctival hyperaemia, cervical lymphadenopathy, oropharyngeal mucosal erythema, membranous desquamation of the fingers, and left coronary artery widening. DIAGNOSES: The patient was diagnosed with Kawasaki disease 12 days after the onset of fever. INTERVENTIONS: The patient was administered γ-globulin 1.0 g/kg·d for 2 consecutive days and oral aspirin 5 mg/kg·d. OUTCOMES: The left coronary artery returned to a width of 3.8 mm after 1 month and of 3.1 mm after 3 months. The dose of aspirin was reduced to 3 mg/kg·d after 2 months and to 1.5 mg/kg·d after 3 months. LESSONS: Physicians should be aware that Kawasaki disease may develop after parotitis.

Parotiditis en el Hospital General de Agudos Parmenio Piñero y su Área Programática / Parotitis in the Acute General Hospital Parmenio Piñero and its programmatic area

La parotiditis epidémica (fiebre urliana) es una infección viral cuyo único huésped natural es el ser humano. La enfermedad es en general, benigna y autolimitada y un tercio de las personas afectadas tiene una infección subclínica. Puede producir una infección más grave en individuos que han pasado la pubertad que en los niños. Debido a que el diagnóstico de parotiditis es clínico en un 99%, algunos de los casos podrían corresponder a una etiología diferente a la urliana (enterovirus, Epstein Barr, virus Parainfluenza y Adenovirus). Se estima que el esquema de 2 dosis de vacuna triple viral tiene una efectividad de 88% (rango: 66-95%) en la prevención de enfermedad.Se analizaron casos de parotiditis, confirmados o sospechosos, notificados por el Hospital Piñero de la Ciudad de Buenos Aires y/o CeSAC del Área Programática. La fuente de información utilizada fue el SNVS (Módulo C2). Para los estudios etiológicos, se analizó el registro del laboratorio central del Hospital. (AU) .

Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis.

PURPOSE: Chronic recurrent parotitis (CRP) is a non-obstructive disease with episodes characterized by painful swelling of the parotid gland. It presents in both a juvenile and an adult form, with no clear information on its actual origin. Diagnosis is based on patient medical history and ultrasound examination but is frequently not correctly identified. Acoustic Radiation Force Impulse Imaging (ARFI) is a novel ultrasound elastography technology that has recently been implemented in the diagnostic work-up of patients with malignancies. This study aimed to answer whether ARFI can reasonably be employed in the initial examination and follow-up during therapy in patients with CRP. MATERIAL AND METHODS: Mechanical tissue properties of the salivary glands were analyzed by ARFI in 37 parotid glands of patients with CRP. RESULTS: Having integrated ARFI into our diagnostic protocol for CRP, affected parotid glands were found to exhibit lower tissue elasticity compared to both healthy contralateral glands in the same individuals as well as those of healthy individuals. Most importantly, this method enabled us to quantitatively assess the patient benefit of therapy regarding the recovery of the glands' diseased parenchyma. CONCLUSIONS: ARFI provides a quick, easy, and reliable diagnostic tool for the assessment of disease severity and progression in patients with CRP that can be seamlessly implemented into preexisting ultrasound protocols.

Situación epidemiológica de las parotiditis / Epidemiological situation of parotiditis

La parotiditis epidémica (fiebre urliana) es una infección vírica aguda, sistémica, endémica en todo el mundo y los seres humanos son los únicos huéspedes naturales del virus. La enfermedad es en general, benigna y autolimitada y un tercio de las personas afectadas tiene una infección subclínica. Puede producir una infección más grave en individuos que han pasado la pubertad que en los niños. En este informe se describe esta enfermedad y sus agentes etiologicos, incubación y transmisibilidad, cuadros clínicos y complicaciones, diagnóstico, medidas de prevención y control, vigilancia, notificación del caso y toma de muestra, situación histórica en Argentina, y situación actual en la Ciudad de Buenos Aires

Inflammation following invasive procedures for Warthin's tumour: A retrospective case series.

OBJECTIVE: To determine the risk of inflammation associated with fine-needle aspiration during evaluation of Warthin's tumour. DESIGN: Retrospective case series. SETTING: Tertiary medical centre. PARTICIPANTS: All patients who underwent fine-needle aspiration followed by parotidectomy between 1992 and 2009 for the diagnosis/evaluation of a parotid gland tumour. MAIN OUTCOME MEASURE: Rate of fine-needle-aspiration-related parotitis in patients with Warthin's tumour or other parotid pathologies. RESULTS: A total of 593 parotidectomies were performed in 553 patients during the study period, 96 (16.2%) for Warthin's tumour (study group) and 497 for other parotid-related pathologies (control group). Parotid gland inflammation following fine-needle aspiration was observed in 16 cases in the study group (16.7%) and eight (1.6%) in the control group (P<.001). On multivariate regression analysis, parotitis following fine-needle aspiration was more common in patients with Warthin's tumour than other parotid-related pathologies even after adjustment for possible confounders (P<.007). Signs of inflammation were noted during surgery in six cases in the study group (6.3%) and none in the control group (P<.001); respective rates of postoperative inflammation (wound infection) were 1.04% and 3.3% (P=NS). Management of parotitis consisted of hospitalisation and systemic antibiotic therapy. CONCLUSIONS: Warthin's tumour is associated with a tenfold higher risk of inflammation compared to other parotid tumours following invasive procedures. Clinicians should be alert to this complication in order to initiate proper treatment and patients must be properly counselled.

[Neonatal suppurative parotitis in a six-day-old, mature boy].

Neonatal suppurative parotitis is a rare condition with approximately 50 cases reported in the literature in English since 1970. It is characterized by parotid swelling along with other local inflammatory sign, and some neonates present with fever and irritability. Pus secretion from the ipsilateral parotid duct is pathognomonic. The most common pathogen is Staphylococcus aureus, but other microorganisms are reported. We describe a case of a six-day-old, mature boy, previously healthy, who presented with fever, tender swelling of the right parotid and pus secretion from the parotid duct.

Tuberculous Lymphadenitis and Parotitis.

Tuberculous lymphadenitis is the most common extrapulmonary manifestation of disseminated tuberculosis (TB). It is considered to be the local manifestation of the systemic disease that has disseminated to local lymph nodes, but a high index of suspicion is needed for the diagnosis, because there are several infectious and noninfectious diseases that can mimic the same clinical picture. In recent years, different diagnostic methods have been introduced, including fine-needle aspiration cytology, which has emerged as a simple outpatient diagnostic procedure that replaced the complete excisional node biopsy, and a number of molecular methods which have greatly improved diagnostic accuracy. This chapter covers the most actual knowledge in terms of epidemiology, clinical manifestations, pathogenesis, and treatment and emphasizes current trends in diagnosis of tuberculous lymphadenitis. TB parotid gland involvement is extremely rare, even in countries in which TB is endemic. Because of the clinical similarity, parotid malignancy and other forms of parotid inflammatory disease always take priority over the rarely encountered TB parotitis when it comes to differential diagnosis. As a result, clinicians often fail to make a timely diagnosis of TB parotitis when facing a patient with a slowly growing parotid lump. This chapter highlights the most important features of this uncommon disease.

[STUDY OF SAFETY OF PAROTITIS VACCINE].

AIM: Monitoring of post-vaccinal complications in children immunized with a parotitis vaccine. MATERIALS AND METHODS: Observation of 198 945 children, immunized with 16 lots of parotitis vaccine with Leningrad-3 strain (L-3), was carried out for 3 years. Paired samples of sera and saliva were obtained from children, in whom adverse events were registered for 42 days after vaccination. Titers of specific IgM and IgG were determined in blood sera. Analysis of nucleotide sequences of genes F, SH and NH of RNA of parotitis virus was carried out from samples of blood and saliva. RESULTS: Intensive parameter of vaccine-associated aseptic meningitis under the conditions of the experiments was 0 for 100 000 immunized. Frequency of occurrence of post-vaccinal parotitis was 0.06% from the number of vaccinated--18 cases of vaccine-associated parotitis were registered and laboratory confirmed. A significant difference in specific activity was detected for 3 lots of the vaccine, that were associated with cases of development of parotitis, relative to that of 13 lots of vaccine, development of parotitis was not registered after administration of those. CONCLUSION: The study carried out confirmed low neurovirulence of the parotitis vaccine with the L-3 strain of parotitis virus, as well as a low degree of its reactogenicity. A relatively high immunization dose of the used vaccine could be one of the reasons of development of post-vaccinal complications in part of the immunized children.

Viral etiology of mumps-like illnesses in suspected mumps cases reported in Catalonia, Spain.

We investigated the etiology of reported sporadic suspected mumps cases with a negative RT-PCR result for the mumps virus in the Barcelona-South region in 2007-2011. Samples from mumps virus-negative patients presenting unilateral or bilateral parotitis or other salivary gland swelling were tested for Epstein-Barr virus (EBV) by real-time PCR and for respiratory viruses by two multiplex-PCR-based assays to detect parainfluenza virus (PIV) 1-4, influenza virus (InV) A, B and C, respiratory syncytial virus (RSV), enterovirus, coronavirus 229E, coronavirus OC43, and rhinovirus. 101 samples were analyzed in persons aged 8 months to 50 years. Oral samples were collected on the first day of glandular swelling in 53 patients (52.5%), and on the first two days in 74 patients (73.3%). Viruses were detected in 52 (51.5%) of samples: one virus (25 EBV, 8 PIV3, 4 adenovirus, 4 PIV2, 1 PIV1, 1 InVA, and 1 enterovirus) was detected in 44 patients (84.6%), two viruses in 7 patients, and three viruses in one patient. In 58 patients (57.5%) whose sample was collected in the first 2 days after onset of parotitis and had received two doses of MMR vaccine and in 15 patients (14.8%) whose sample was collected on the first day, it is very likely that the cause was not the mumps virus. This would mean that 72.3% (73/101) of the reported sporadic suspected mumps cases were not mumps cases. The timing of oral-sample collection is crucial to correctly interpret the negative results for mumps virus RNA, especially when suspected cases occur in vaccinated persons.

[Parotid involvement in Churg-Strauss syndrome]. / Atteinte parotidienne et syndrome de Churg-Strauss.

INTRODUCTION: Churg-Strauss syndrome is a rare systemic vascularitis. This disease causes eosinophilic tissue infiltration. The most frequent manifestations are cortico-dependent asthma, mono- or polyneuropathy, paranasal sinus polyposis, and digestive and renal dysfunction. Salivary glands are very rarely involved. OBSERVATION: We describe a case of CSS in a patient presenting with bilateral parotid swelling. The morphological study of salivary glands revealed an unusual thickening of the salivary duct walls. DISCUSSION: Salivary gland involvement in Churg and Strauss syndrome can be difficult to demonstrate histologically; it does not usually present in the clinical foreground of the disease, and can be a source of misdiagnosis. The biopsy should be performed in the symptomatic gland, away from any previous corticoid treatment.

Expression of so-called adhesion proteins and DNA cytometric analysis in malignant parotid tumours as predictors of clinical outcome.

Tumours of the salivary glands are rare, and account for only 0.5-1% of all tumours. We have analysed the cytoarchitectural structure of such tumours by studying 3 binding proteins that act on different parts of the glandular epithelial architecture: e-cadherin, laminin, and CD44. We analysed the DNA using image cytometry to evaluate ploidy, S-phase, and 5c exceeding rate, and to compare the biological aggressiveness of the proteins. Our goal was to correlate the degree of structural integrity and the histological grade of the injury, and to try to find new biological factors that would help to predict the evolution of disease in the salivary glands. The immunoexpression pattern of the so-called adhesion proteins of the salivary glands, when combined, yields important data about the aggressiveness of malignant neoplasms, and provides useful tools with which to predict the biological evolution of malignant lesions.

Obstructive parotitis from extraorally introduced foreign body in the Stensen duct.

A rare phenomenon, the extraoral traumatic penetration of a foreign body into the lumen of the parotid duct, is described. The ensuing obstructive symptomatology and its diagnostic approach and therapy are reviewed.