© Borgis - New Medicine 4/2007, s. 102-103
Parotitis acute in infancy
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Parotitis in infants is a rare illness. The most characteristic symptoms include swelling of he parotid glands, erythema, pain, fever and poor suckling. The differential diagnosis has to rule out such diseases as inflammation of the cervical lymph nodes, erysipelas, inflammatory angioma and others. The observation was carried out on four children aged 2 weeks to 10 months. In each case the symptoms were similar, general symptoms include: fever, loss of appetite and topical: swelling of the parotid gland, hyperaemia and skin redness. In the bacteriological examination of purulent secretion from the parotid gland Staphylococcus aureus, Escherichia coli and Streptococcus pneumoniae in two cases were found. In one case of Streptococcus pneumoniae aetiology a sepsis was stated. The diagnosis was easy to make and was based on clinical symptoms and ultrasound image. Intravenous antibiotics treatment due to bacteriological culture was used and continued for ten to fourteen days with good effect. In no case the abcess of the parotid gland was observed. There are no indications for sialography in acute parotitis and also it is difficult to perform this kind of examination in infants.
Parotitis in infants is a rare illness characterized by inflammatory swelling of the parotid glands, erythema, pain and general signs and symptoms like fever, fussiness, poor suckling and poor general condition. It is usually described as a secondary infection, affecting infants with lowered immunity (after infectious diseases or surgeries) or with chronic diseases like renal failure, diabetes and other metabolic disorders.
A differential diagnosis has to rule out inflammation of the cervical lymph nodes, Caffey Silverman Disease, inflammation of soft tissues due to erysipelas or infection due to H. Influenzae, swelling of odontogenic origin, infection of the parotid gland due to CMV, HBV, HCV, echovirus, Coxsackie A virus, flue, mumps and tumours of the parotid gland, e.g. inflammatory angioma.
The aim of the present paper is to analyse the causes, the course of disease and the treatment of parotitis in infants in the Warsaw Children´s Hospital in Litewska Street.
THE OBJECT AND THE METHODS
The observation was carried out on four infants aged 2 weeks to 10 months, hospitalized in the Warsaw Children´s Hospital and its branch in 2006 and 2007. The research is based on the analysis of medical history, physical examinations results as well as additional tests and outcome of the infants´ treatment.
The observation was carried out on 4 infants, two male and two female, aged 2 weeks to 10 months (mean 5 months). Two of them were premature infants with birth weight of 1500 g and 1800 g, 2 were born after an uncomplicated pregnancy. Before the symptoms of parotitis occurred in two of the infants, an infection of the upper respiratory tract was diagnosed in their families.
All the infants were admitted due to fever. The parents of two patients observed a painful swelling in the submandibular area. In the other two cases, it was a doctor who recognised the swelling of the parotid gland. During a laryngologic examination, apart form the painful swelling of the parotid gland (left in two cases and right in two), were also observed: hyperaemia and skin redness. All the infants had an inflammatory swelling of the ducts of the parotid glands and the pus expressed from the duct underwent a bacteriologic examination. In each case blood tests were performed on admission.
The children had slightly elevated inflammation parameters:
Blood leukocyte levels ranged from 12300 to 16900 (mean 15100), blood smears showing granulocytic cells
ESR value ranged from 5 to 35mm, mean 21
CRP levels ranged from 3,3 to 10 mg/dl, mean 6,2
All the patients were CMV IgM negative and their level of amylase was in the normal range.
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