Suppurative Parotitis in Children

Abstract

A 20-year experience with acute and recurrent suppurative parotitis involving 46 children is described, and the pertinent literature is reviewed. Acute suppurative parotitis (a single attack) occurs in the newborn period, sporadically throughout the remainder of childhood, and in association with terminal illnesses. Recurrent suppurative parotitis occurs throughout childhood. It is not a self-limited disease, but may extend beyond puberty into late adolescence and adult life. The presently acceptable form of treatment consists of appropriate antibiotic therapy and sialography.The acute and recurrent forms of suppurative parotitis are seen infrequently in the practice of pedi¬ atrics. The parotitis is characterized clinically by the enlargement of one or both parotid glands, purulent drainage from Stensen's duct, and systemic symptoms. The natural his¬ tory and etiology of this disorder are poorly understood, and approaches to treatment have varied extensive¬ ly. This study analyzed the data from the records of children seen at the Mayo Clinic with acute or re¬ current parotitis in an attempt to describe some of the features of its natural history, significant etiologic factors, and an approach to therapy. Methods and MaterialsThe present series represents a 20-year experience involving 46 children treated at the Mayo Clinic for acute or recurrent suppurative parotitis (four other children had suppurative paro¬ titis in association with a terminal ill¬ ness, eg, paraganglioma, carcinoma of the thyroid, abdominal teratoma, and bleeding duodenal ulcer). The records of these patients were reviewed, and a questionnaire was sent to the parents of the children or to those patients who had since become adults. Patients were included in the study only if the clini¬ cian . and reviewer thought that other causes of parotid sweUing were elimi¬ nated. ResultsAcute Suppurative Parotitis.-Tables 1 and 2 outline the features of acute suppurative parotitis (one attack) in 16 patients. Most patients were either less than 1 or more than 10 years old, and most were male pa¬ tients. Only two patients had bi¬ lateral involvement. The illnesses lasted an average of 9.4 days (range, 1 to 19 days). Among the newborn patients, streptococci of the viridans type and Staphylococcus aureus were the organisms isolated from the pus from Stensen's duct in one pa¬ tient, Streptococcus pyogenes from the second, and Strep pyogenes and viridans streptococci from the third.In four older children with acute suppurative parotitis for whom in¬ formation was available, streptococci of the viridans type were isolated from three and Staph aureus from one.Fourteen patients with acute sup¬ purative parotitis received antibi-

Acute Suppurative Parotitis: Uncommon Presentation in a Premature Infant

“…Other bacteria including Escherichia coli, Streptococcus viridans, Streptococcus pneumoniae, Streptococcus pyogenes, Pseudomonas aeruginosa, and anaerobic bacteria have been implicated as well. [1][2][3][4][5] Factors predisposing to parotitis include dehydration, low birth weight, immune suppression, ductal obstruction, oral trauma, and structural abnormalities of the parotid gland. Sepsis and malnutrition often are present in such neonates.…”

“…In most series, 35% to 40% of affected infants have been born prematurely. 4,5 Dehydration is considered an important predisposing factor. It causes salivary stasis, promoting bacterial ascent along the salivary duct.…”

“…The presence of purulent drainage from the duct as seen in our infant is considered pathognomonic of the condition. 1,4,5 The indicated diagnostic studies include cultures from the blood, urine, and cerebrospinal fluid. Culture of the purulent discharge will probably reveal the infectious agent.…”

“…Rare complications include facial palsy, salivary fistula, mediastinitis, and extension into the external auditory canal. [1][2][3][4][5][6] …”

Parotiditis aguda en recién nacido

“…En los últimas 3 décadas se han reportado tan solo 32 casos en la literatura mundial 1 , sin casos publicados en la literatura nacional. Se han descrito como factores predisponentes la prematuridad, la baja de peso, la deshidratación o la nutrición con sonda orogástrica 2,3 . Otro mecanismo patogénico descrito es la septicemia con extensión hacia la glándula parótida 4 .…”