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Acquired, continued
Parotitis
Parotitis is the clinical term for inflammation and swelling of the parotid gland. The parotid gland is tender to palpation and the opening to Stenson’s duct appears inflamed and swollen. If the clinician is unclear if the swelling noted is actually the parotid gland and not another structure, an elevated serum amylase can be confirmatory.

Etiologies of parotitis include:


Infectious Causes

1. Viral
 
Mumps is the classic virus known to cause parotitis. Although mumps is less common in this age of universal immunization with MMR vaccine, there have been many well-documented outbreaks in the United States in the recent past. Mumps parotitis is bilateral in 70% of cases and usually follows a 1-2 day prodrome of fever, headache, emesis, and myalgias.
 
Other viruses that may cause parotitis include parainfluenza, influenza, CMV, EBV, enteroviruses, and HIV.

2. Bacterial
 
Called “purulent parotitis”, bacterial infection of the parotid gland is typically unilateral and extremely painful with visible pus draining from Stenson’s duct. The patient often appears ill.
 
Most commonly caused by S aureus, either as a primary infection or super-infection of parotitis of another cause (most commonly a duct obstruction).
 
The patient should be empirically treated with antibiotics after a culture is obtained.

Obstruction
Most commonly the result of a salivary stone (called a sialolith), which is expected to be unilateral. If the patient is not ill, expectant management for passage of the sialolith is appropriate. Rarely, parotid duct obstruction can result from a tumor, which is usually benign.

Other Conditions
Other conditions that can result in parotid gland enlargement, with or without inflammation, include bulimia or other causes of chronic emesis, diabetes, collagen vascular diseases, and local radiation treatment.
 
 
Mumps parotitis is typically bilateral and associated with systemic symptoms.
 
Staph aureus is the most common cause of bacterial parotitis.
 
Parotitis from a sialolith does not require any specific treatment unless superinfection occurs.


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