Salivary gland infections Salivary gland infections

ViralViralFaisal Qahtani

431803127

Salivary gland infectionsSalivary gland infections

Inflammation of salivary gland – sialadenitis.

Can be viral (majority), bacterial and fungal

(minority).

Parotid glands are more commonly infected than

submandibular glands while accessory salivary

glands are very rare infected.

Majority of sialadenitis seen in adults.

Initiation and progression of salivary gland infections

depend upon the virulence of the causative organism

and the host resistance.

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Acute viral infection (AVI)Acute viral infection (AVI)

Mumps classically designates a viral

parotitis caused by the paramyxovirus.

However, a broad range of viral

pathogens have been identified as

causes of AVI of the salivary glands.

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AVIAVI

Derived from the Danish word

“mompen”

Means mumbling, the name given to

describe the characteristic muffled

speech that patients demonstrate

because of glandular inflammation and

trismus.

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Viral InfectionsViral Infections

As opposed to bacterial

sialadenitis, viral infections of the

salivary glands are SYSTEMIC

from the onset!

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Viral infectionViral infection

Mumps is a non-suppurative acute

sialadenitis

Is endemic in the community and

spread by airborne droplets

Communicable disease

Enters through upper respiratory

tract6

MumpsMumps

2-3 week incubation after exposure

(the virus multiplies in the URI or

parotid gland)

3-5day viremia

Then localizes to biologically active

tissues like salivary glands,

germinal tissues and the CNS.

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EpidemiologyEpidemiology

Occurs world wide and is highly contagious

Prior to the widespread use of the Jeryl

Lynn vaccine (live attenuated), cases were

clustered in epidemic fashion

Sporadic cases are observed today likely

resulting from non-paramyxoviral infection,

failure of immunity or lack of vaccination

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VirologyVirology

Classic mumps syndrome is caused by

paramyxovirus, an RNA virus

Others can cause acute viral parotitis:

◦ Coxsackie A & B, ECHO virus,

cytomegalovirus and adenovirus

HIV involvement of parotid glands is a rare

cause of acute viral parotitis, is more

commonly associated with chronic cystic

dz9

Clinical features:Clinical features:

Airborne droplets transmit mumps virus

It mainly effects the parotid gland.

Children between the ages of 5-18 years

are infected the most.

Once exposed the patient will develop the

disease within 2-3 weeks

There is rapid swelling of the parotids

bilaterally

There is an acute pain while salivation. 10

Physical examPhysical examGlandular swelling (tense, firm) Parotid

gland involved frequently, SMG & SLG

can also be affected.

May displace ispilateral pinna

75% cases involve bilateral parotids,

may not begin bilaterally (within 1-5

days may become bilateral)….25%

unilateral

Low grade fever11

HistopathologyHistopathologyThe acini develop cloudy swelling

making the connective tissue edematous

There is infiltration with plasma cells and the lymphocytes

The ductal lumens contain desquamated cell debris and leukocytes .

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Diagnostic EvaluationDiagnostic Evaluation

Leukocytopenia, with relative

lymphocytosis

Increased serum amylase (normal by

2- 3 week of disease)

Viral serology essential to confirm:

Complement fixing antibodies appear

following exposure to the virus

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SerologySerology

“S” or soluble antibodies directed

against the nucleoprotein core of

the virus appear within the first

week of infection, peak in 2 weeks.

Disappear in 8-9 months and are

therefore associated with active or

recent infection

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SerologySerology

Viral antibodies directed against the

outer surface hemagglutinin, appear

several weeks after the S antibodies

and persist at low levels for about 5

years following exposure.

Viral antibodies are associated with

past infection, prior vaccination and

the late stages of active infection

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SerologySerology

If the initial serology is noncontributory,

then a non-paramyxovirus may be

responsible for the infection.

Blood HIV tests should also be obtained

The mumps skin test is not useful in

diagnosis an acute infection because

dermal hypersensitivity does not develop

until 3 or 4 weeks following exposure.

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TreatmentTreatment

Supportive

Fluid

Anti-inflammatories and

analgesics

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PreventionPrevention

The live attenuated vaccine

became available in 1967

Commonly combined with the

measles and rubella vaccines, the

mumps vaccine is administered in a

single subcutaneous dose after 12

months of age. Booster at 4-6yr

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ComplicationsComplications

Orchitis, testicular atrophy and sterility

in approximately 20% of young men

Oophoritis in 5% females

Aseptic meningitis in 10%

Pancreatitis in 5%

Sensorineural hearing loss <5%

◦ Usually permanent

◦ 80% cases are unilateral

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Salivary gland disease in HIV Salivary gland disease in HIV infectioninfectionMay occur and the main

presentations of the disease of

the major salivary glands are:

xerostomia and /or enlargement

of the salivary glands.

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Other viral infectionsOther viral infections

Cytomegalovirus – causes

cytomegalic inclusion disease, in

newborns, children and adults and

has multiple systemic manifestations.

Parainfluenza types 2 and 3, echo

and coxsackie viruses – non-specific

suppurative sialadenitis .

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ReferencesReferences

1. McQuone, SJ: Acute viral and bacterial infections

of the salivary glands. Oto Clinics North America,

32:793,1999

2. Rice DH. Salivary Gland Disorders. Med Clin North

Am. 1999; vol 83, 197.

3. Williams MF. Salivary gland diseases: sialolithiasis.

Oto Clin North America. Vol 32, 819, 1999

4. Feinberg SE. Diagnosis and management of

salivary gland disorders. Ch.34

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