Parotitis is defined as acute or chronic inflammation of the parotid gland. Triggering parotitis can include microbial agents (bacterial or viral), allergies, autoimmune diseases, such as Sjögren syndrome, and genetic/hereditary factors. Acute bacterial parotitis- sudden firm and tender swelling of the glands with occasional purulent discharge. Chronic bacterial parotitis is characterized by recurrent infections lead to progressive acinar destruction, fibrosis, and sialectasia.
Staphylococcus aureus is the most common, S. pneumoniae and S. pyogenes have also been implicated. Hydration, sialagogues, salivary gland massage, and stimulation of salivary flow with the use of sugar-free gums or sour candy, are the first steps. Augmentin PO antibiotic can be useful. IV antibiotics and IV hydration for sever cases. Surgical excision or drainage of the infected gland in antibiotic-refractory cases.
CASE 1:
82-year-old woman with Sjögren syndrome reported non-tender bilateral swelling of the cheeks with draining discharge from both parotid glands. Manipulation of the glands, a green-yellowish purulent discharge bilaterally Stensen’s duct, symptoms more on the right gland. Pus cultures were performed on 2 occasions and were shown to contain mixed bacteria. Previous IV antibiotic. Multiple trials of oral antibiotics, such as clindamycin, doxycycline, amoxicillin/clavulanate (Augmentin), trimethoprim/ sulfamethoxazole (Bactrim), and ciprofloxacin, either as single agents or in combination. Purulent discharge never resolved, although septicemia or systemic complications had not been seen for more than 3 years. Therefore, antibiotic was discontinued and followed by conservative nightly local application of superficial moist heat, periodic pus drainage (every 3 months) by manipulating the parotid glands at the oral medicine clinic, and use of sialagogues. The patient was followed up every 3 months for 2 years, and experienced no further episodes of CRP.
CASE 2:
77-year-old woman with Sjögren syndrome reported mild tenderness and discharge from both the parotid glands.
CASE 3:
47-year-old woman with Sjögren syndrome reported tenderness and swelling of both parotid glands, predominantly the left gland, unpleasant purulent discharge from both glands. Periodic manipulation of the parotid gland at the clinic and management of hyposalivation with cevime-line, moist heat, and home massage. Purulent discharge from the gland cleared up, absence of facial tenderness and systemic infection.