Bacterial Parotitis Research Articles

Bi-institutional analysis of microbiological spectrum and therapeutic management of parotid abscesses

BackgroundA parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting.MethodsA retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables.ResultsOverall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization.ConclusionThe results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.

Case Report: A Parotid Abscess With Otorrhea, Drainage via the Fissure of Santorini.

We report a case of a healthy 62-year-old male with no identifiable risk factors who presented with a 2-week history of progressive unilateral parotid gland enlargement and tenderness followed by subsequent otorrhea. A computed tomography scan and ultrasound confirmed a markedly enlarged posterior aspect of the parotid gland with the evidence of necrosis. The culture of aspirated fluid grew Staphylococcus aureus. Purulent fluid was then noted draining from the external auditory canal, via the fissure of Santorini. The patient was treated with antibiotics, pain management, and daily parotid massage with complete resolution of the parotitis. Acute bacterial parotitis with subsequent drainage and otorrhea through the fissures of Santorini is rare, with only a few reported cases in the literature.

Unilateral Parotitis in Neonatal and Young Children

Bacterial parotitis is a rare condition in newborns, typically occurring between the 7th and 14th days of life

ATYPICAL PAROTITIS AS A RESULT OF SEVERE COVID-19 INFECTION

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Parotitis occurs in extremes of age and is associated with infections or inflammatory conditions. Typical bacterial parotitis presents with a unilateral, tender enlarged parotid gland and fever whereas inflammatory parotitis presents with bilateral enlargement of the parotids without fever. Here, we present two atypical cases: bilateral parotitis likely secondary to bacterial infection and unilateral parotitis likely due to inflammation. CASE PRESENTATION: We present a 45-year-old male with history of obesity who presented with hypoxia and dyspnea. CT angiogram noted multifocal pneumonia, consistent with COVID-19. He was started on dexamethasone, remdesivir and baricitinib as well as community acquired pneumonia coverage. On day 5, he was placed on high-flow nasal cannula due to progressive hypoxia. Although initially afebrile, he developed a fever on day 12, with tachypnea and tachycardia. Acute swelling of the submandibular space with adjacent erythema and a lactic acid of 3.2 were noted. CT neck demonstrated enlarged parotid glands bilaterally with inflammatory changes indicative of parotitis, no abscess or mass was noted. He was started on vancomycin, with improvement of his erythema and swelling within 3 days. Blood cultures were positive for MSSA. Patient continued to deteriorate, requiring intubation on day 18 and died on day 34.The second case is a 79-year-old-male with history of COPD on 3L and type 2 diabetes mellitus who presented with hypercapnic respiratory failure, found to be COVID-19 positive. The patient required non-invasive ventilation for progressive respiratory failure, despite COVID-19 treatment. He developed a sudden swelling of the right mandibular area on day 7 of admission. CT neck identified an enlarged heterogenous enhancement of the right parotid gland and edema consistent with parotitis. Blood cultures were negative. The patient was started on vancomycin but had worsening oxygen requirements and encephalopathy, was ultimately made DNR and expired on day 9. DISCUSSION: There has been increased incidence of atypical disease presentation and reactivation of latent infections during the COVID-19 pandemic. In the above patients, parotitis occurred secondary to severe viral illness, immune suppression, increased inflammation and/or superimposed bacterial infection. COVID-19 has been shown to cause significant inflammatory response and immunosuppression with lymphopenia, thrombocytopenia and low complement levels. Both patients had elevated inflammatory markers and persistent leukopenia. CONCLUSIONS: The pathophysiology of atypical parotitis and other atypical disease presentations, in the setting of severe COVID-19, should further be investigated. REFERENCE #1: Tian W, Zhang N, Jin R, et al. Immune suppression in the early stage of COVID-19 disease. Nat Commun. 2020;11(1):5859. Published 2020 Nov 17. doi:10.1038/s41467-020-19706-9 REFERENCE #2: Fisher J, Monette DL, Patel KR, Kelley BP, Kennedy M. COVID-19 associated parotitis. Am J Emerg Med. 2021;39:254.e1-254.e3. doi:10.1016/j.ajem.2020.06.059 REFERENCE #3: Wilson M, Pandey S. Parotitis. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560735/ DISCLOSURES: No relevant relationships by Michael Bonk, source=Web Response No relevant relationships by Andrew Marcano, source=Web Response No relevant relationships by Ananya Nanduri, source=Web Response No relevant relationships by TAHMINA SALEEM, source=Web Response

The Long Wait for Diagnosis

Bacterial parotitis is most commonly due to oral or dental focus in non-immunocompromised patients. Ultrasonography and guided aspiration are the diagnostic tools, and appropriate antibiotics and supportive medications are the treatment modality. A diagnosis of tubercular parotitis is extremely rare and can be a cause for concern with regard to delayed diagnosis and the possibility of complications. The present case report is about such a case: a young lady with no comorbidities presenting with initial diagnosis of parotid abscess. Evolution and management of the case, with relevant literature, are discussed.

Clinical characteristics that predict parotid abscess: An observational cohort study

BackgroundWe analysed clinical factors that are predictive of a diagnosis of parotid abscess among patients with bacterial parotitis. Material and methodsThis retrospective study included 64 hospitalised patients who were diagnosed with parotid abscess, or bacterial parotitis. Data on patient demographics, clinical characteristics, and clinical management were collected. Predictive factors for parotid abscess were evaluated using univariate and multivariate analysis. ResultsThere were 25 patients with parotid abscess and 39 with bacterial parotitis. All patients presented with moderate-to-severe disease, required parenteral antibiotics, or had indicators for surgical drainage. Patient profiles and immune status were not significantly associated with parotid abscess. However, parameters that were significantly related to parotid abscess were subacute presentation (approximate 10.4 days) (p value = 0.016), fluctuation (p value < 0.001), and normal (haemoglobin) Hb level >12–13 g/dL (p value = 0.035). Imaging indicated the abscess location, extension and evaluated the complications. Surgical drainage with small skin incision and antibiotic coverage for possible pathogens, in particular Staphylococcus spp. and Streptococcus spp. produced favourable patient outcomes. Complication was identified in 3 cases with included septicaemia and cellulitis of the face and parapharyngeal space. ConclusionsAmong bacterial parotitis patients, parotid abscess should be considered in whom presented with subacute duration of symptoms, enlarged glands with fluctuation, and non-anaemic problem. Instead of standard skin incision of parotidectomy, small vertical skin incision over a well localised abscess pocket or fluctuated area achieved the good results.

Acute Bacterial Parotitis in Early Infancy: A Case Report and Review of the Literature

Introduction: Acute parotitis is known as an uncommon disease in children and a rare condition in infancy. Dehydration, prematurity, immune deficiency, congenital anomalies of the parotid gland or ducts, and oral trauma are some of its important risk factors. The most common bacteria contributing to this condition is Staphylococcus aureus. Acute parotitis is managed with intravenous antibiotic therapy and surgery in complicated cases. Favorable prognosis is reported in early diagnosis and proper antibiotic therapy. Case Presentation: The present report presents the case of a 60-day-old breastfed female infant with a chief complaint of agitation referred to the Department of Pediatrics in a university-affiliated hospital in Tehran, Iran, in 2018. She underwent treatment for the infantile colic diagnosis. Conclusions: Timely diagnosis and treatment of acute bacterial parotitis prevented suppurative parotitis and formation of abscess.

Craniofacial and neck phlegmon with sepsis as a complication of the parotid gland abscess – a case report

The diagnosis of acute bacterial parotitis usually does not cause much clinical concern due to the characteristic clinical signs and symptoms, such as pain and swelling of parotid gland associated with fever and elevated inflammatory markers in laboratory tests. Early diagnosis and accurate treatment result in fast recovery without complications. In rare cases, acute bacterial parotitis may cause severe complications, such as parotid gland abscess or parapharyngeal space phlegmon. Parapharyngeal space phlegmon is a severe, life-threatening condition. It can spread to craniofacial and neck fascial spaces, mediastinum, and lead to sepsis and septic shock. Craniofacial and neck phlegmon requires prompt surgical treatment and intensive antibiotic therapy.&#x0D; In this case study, we present an 82-year-old woman with bacterial parotitis that resulted in multiple complications. The first complication was parotid gland abscess, which caused extended craniofacial and neck phlegmon that led to sepsis. As a result of immediate intensive treatment, which consisted of broad-spectrum antibiotic therapy, surgical drainage, and hydro-electrolyte imbalance management, the treatment ended in a success. The patient fully recovered and was discharged home in a good general condition.

Acute Bacterial Parotitis in Adult Hematologic Malignancy

Abstract Acute bacterial parotitis (ABP) is an uncommon condition in immunosuppressed adult cancer patients. Here, we report 2 cases of parotitis in immunocompromised patients; one with a diagnosis of extranodal marginal zone B-cell lymphoma and the other with acute myeloid lymphoma. Both patients were treated with antibiotics and local management with resolution of their parotitis. Per review of literature, this is the first article describing ABP in patients with bone marrow transplantation and hematologic malignancies. Moreover, this is also the first article reporting ABP due to Stenotrophomonas maltophilia, an opportunistic gram-negative rod bacterium.

Uncommon effects of clozapine

IntroductionClozapine is the first option for treatment-resistant schizophrenia, affecting about 20–30% of all patients. Weight gain, sedation, hypotension and hypersalivation are common and well-known adverse effects associated with clozapine. However, it is also important to be aware of uncommon adverse effects, like parotitis.ObjectiveWe report a case of clozapine-induced parotitis.MethodsLiterature was accessed through Pudmed, using the search terms parotitis and clozapine.ResultsA 36-year-old male with paranoid schizophrenia, whose psychotic symptoms have responded only slightly to two antipsychotic trial, with both haloperidol and olanzapine. Therefore, he began treatment with clozapine with the dose titrated to 400 mg/day. At first, the only registered adverse effect was hypersalivation. Eventually, after 3 months of treatment, he developed a unilateral swelling of the left parotid gland. Bacterial and viral parotitis were ruled out and the diagnosis of clozapine-induced parotitis was evoked. Patient scored 5 in the Parotitis-Specific Criteria Modified Naranjo Probability Scale. Symptomatic medication was initiated with paracetamol and a non-steroidal anti-inflammatory with a favorable outcome.ConclusionThere are few reports of clozapine-induced parotitis, a very rare and poorly known adverse effect with an unknown pathophysiology. Early recognition and proper management are essential to reduce morbidity associated with the treatment. There is no consensus how to manage these adverse effect, however, generally it is not necessary to discontinue the treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Acute Bacterial Parotitis in Intensive Care Patients: Four Case Reports

Acute Bacterial Parotitis in Intensive Care Patients: Four Case Reports

An Unusual Presentation of Parotid Abscess: Otorrhea

Acute suppurative parotitis and parotid gland abscess are infrequently seen in children. Ductal ectasis, primary parenchymal involvement or from a suppurative infection of the lymph nodes cause suppurative changes and leads to abcess formation. Various bacteria have been reported to be involved in the bacterial parotitis and abscesses; Staphylococcus aureus plays a major role both in adults, and in pediatrics patients, while in infant recurrent parotitis, Streptococcus spp. are the most recurrent isolated organisms. The pus may penetrates the capsule, invades the surrounding tissue, and extends into the deep fascial planes, backward into the external auditory canal as in our case, or outward into the facial skin.

Current Bacteriology and Antibiotic Management of Acute Suppurative Parotitis in the Hospitalized Patient: A Retrospective Study and Literature Review

Current Bacteriology and Antibiotic Management of Acute Suppurative Parotitis in the Hospitalized Patient: A Retrospective Study and Literature Review Background: Acute bacterial suppurative parotitis warrants prompt diagnosis and efficacious treatment with empiric broad spectrum antibiotics and maintenance of hydration. Patients can quickly deteriorate leading to increased morbidity and mortality. Bacterial parotitis has increasingly shown resistance to many traditionally recommended empiric antimicrobial agents. Aim: The aim of this study was to analyze empiric treatment for patients hospitalized with acute bacterial suppurative parotitis. Methods: A retrospective chart review was conducted over a one year time period on all patients hospitalized with acute bacterial suppurative parotitis, analyzing patient demographics, bacterial cultures, and antibiotic sensitivities. Findings: Nine patients were identified over a one year time period hospitalized with acute bacterial suppurative parotitis. Fourteen cultures were isolated made up of eight unique bacterial species. Staphylococcus aureus made up 43% (6/14) of all pathogenic bacteria, four of which were methicillinresistant Staphylococcus aureus. Three patients in the cohort failed antibiotic treatment at some point due to bacterial resistance. Multi-drug resistant organisms made up 75% (6/8) of all isolates in which sensitivities were obtained. Conclusion: As multidrug-resistant organisms, specifically Staphylococcus aureus, continue to become more prevalent, empiric antibiotics must be appropriately selected to treat for these organisms until culture and sensitivity results become available.

Klebsiella pneumoniaeCervical Necrotizing Fasciitis Secondary to Bacterial Parotitis: A Case Report

Journal of Case Reports in Medicine,2015,4,1,1-3.Published:September 2015Type:Case ReportAuthors:Chien-wei Pan, and Chung-ching Hung Author(s) affiliations:Chien-wei Pan and Chung-ching Hung Department of Otolaryngology, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City 802, Taiwan Abstract:Cervical necrotizing fasciitis is a fulminant infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression and systemic toxicity. Dental infection is the most common nidus of cervical necrotizing fasciitis. Streptococcus and Staphylococcus species are found to be the most commonly isolated organisms in many bacteriological analyses of cervical necrotizing fasciitis. We describe a case of a 29-year-old female who was diagnosed with acute suppurative parotitis first. After admission, her illness progressed to cervical necrotizing fasciitis. She underwent surgery of incision and drainage, and pus culture yielded Klebsiella pneumoniae (K. pneumoniae). To the best of our knowledge, cervical necrotizing fasciitis is seldom secondary to bacterial parotitis, and rarely caused by K. pneumoniae. Keywords:Bacterial parotitis, Cervical necrotizing fasciitis, Ddiabetes mellitus, Klebsiella pneumoniaView:PDF (612.08 KB) PDF Images Computed tomography with contrast exhibited heterogeneous right parotid gland and peripheral enhancement

Current Bacteriology and Antibiotic Management of Acute Suppurative Parotitis in the Hospitalized Patient: A Retrospective Study and Literature Review

Current Bacteriology and Antibiotic Management of Acute Suppurative Parotitis in the Hospitalized Patient: A Retrospective Study and Literature Review Background: Acute bacterial suppurative parotitis warrants prompt diagnosis and efficacious treatment with empiric broad spectrum antibiotics and maintenance of hydration. Patients can quickly deteriorate leading to increased morbidity and mortality. Bacterial parotitis has increasingly shown resistance to many traditionally recommended empiric antimicrobial agents. Aim: The aim of this study was to analyze empiric treatment for patients hospitalized with acute bacterial suppurative parotitis. Methods: A retrospective chart review was conducted over a one year time period on all patients hospitalized with acute bacterial suppurative parotitis, analyzing patient demographics, bacterial cultures, and antibiotic sensitivities. Findings: Nine patients were identified over a one year time period hospitalized with acute bacterial suppurative parotitis. Fourteen cultures were isolated made up of eight unique bacterial species. Staphylococcus aureus made up 43% (6/14) of all pathogenic bacteria, four of which were methicillinresistant Staphylococcus aureus. Three patients in the cohort failed antibiotic treatment at some point due to bacterial resistance. Multi-drug resistant organisms made up 75% (6/8) of all isolates in which sensitivities were obtained. Conclusion: As multidrug-resistant organisms, specifically Staphylococcus aureus, continue to become more prevalent, empiric antibiotics must be appropriately selected to treat for these organisms until culture and sensitivity results become available.

A rare presentation of hepatitis a infection with extrahepatic manifestations.

Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M (IgM). He was initially started on antibiotics for concerns of bacterial parotitis but did not show any improvement. A punch biopsy of his mandibular rash and swelling was done which showed lymphohistiocytic infiltration with a few eosinophils. A trial of prednisone resulted in improvement of his symptoms. Clinicians should be aware to look for hepatitis A infection in a patient with atypical clinical picture causing a widespread systemic inflammatory response. Treatment with prednisone may result in resolution.

Parotidite bactérienne chez une patiente immunodéprimée en réanimation adulte

Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult – particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.

Infections Following Facial Composite Tissue Allotransplantation—Single Center Experience and Review of the Literature

We reviewed medical records of all patients (n = 4) who underwent facial composite tissue allotransplantation (FCTA) at our center between April 2009 and May 2011; data were censored in June 2012. We searched for FCTA publications and reviewed them for infectious complications and prophylaxis strategies. Three patients received full and one partial FCTA at our institution. Two recipients were cytomegalovirus (CMV) Donor (D)+/Recipient (R)- and two CMV D+/R+. Perioperative prophylaxis included vancomycin, cefazolin and micafungin and was adjusted based on peritransplant cultures. Additional prophylaxis included trimethoprim-sulfamethoxazole and valganciclovir. Two recipients developed surgical site infection and two developed pneumonia early after transplantation. Both CMV D+/R- recipients developed CMV disease after discontinuation of prophylaxis, recovered with valganciclovir treatment and did not experience subsequent rejection. Other posttransplant infections included bacterial parotitis, polymicrobial bacteremia, invasive dermatophyte infection and Clostridium difficile-associated diarrhea. Nine publications described infectious complications in another 9 FCTA recipients. Early posttransplant infections were similar to those observed in our cohort and included pulmonary, surgical-site and catheter-associated infections. CMV was the most frequently described opportunist. In conclusion, infections following FCTA were related to anatomical, technical and donor/recipient factors. CMV disease occurred in D+/R- recipients after prophylaxis, but was not associated with rejection.

Acute bacterial suppurative parotitis of the neonate: A case report and review

Acute bacterial suppurative parotitis of the neonate: A case report and review

Acute bacterial suppurative parotitis of the neonate: A case report and review

We report a case of acute suppurative parotitis in a 16-day old infant presenting to an Emergency Department. Only 32 cases have been reported in English literature in the last 35 years. This is the first documented case in the United Kingdom. Clinical diagnosis was made on the basis of parotid swelling with purulent discharge from Stensen's duct. Samples sent for culture grew methicillin-resistant Staphylococcus aureus . The aetiology, pathogenesis and management of this infection are discussed.