Parotitis Clinical Presentation

Updated: Jan 17, 2017
  • Author: Jerry W Templer, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Presentation

History

Symptoms include the following:

  • Infectious parotitis
    • Acute bacterial parotitis: The patient reports progressive painful swelling of the gland and fever; chewing aggravates the pain.
    • Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement is present in most instances.
    • HIV parotitis: Nonpainful swelling of the gland occurs; otherwise, patient is asymptomatic.
    • Parotitis in tuberculosis: Chronic nontender swelling of one parotid gland occurs, or a lump is noted within the gland. Symptoms of tuberculosis are found in some cases.
  • Chronic punctate parotitis (chronic autoimmune parotitis) [18]
    • Mikulicz disease: This is a historical disease only; it should not be diagnosed today.
    • Sjögren syndrome: Recurrent or chronic swelling of one or both parotid glands with no apparent cause is noted. It is frequently associated with autoimmune disease. Discomfort is modest in most cases and is related to dry mouth and eyes.
    • Lymphoepithelial lesion of Godwin: This is a historical category that is not used today.
  • Diseases of uncertain etiology
    • Recurrent parotitis of childhood: Repetitious episodes of unilateral or bilateral mumps like episodes in a young child are indicative.
    • Sarcoidosis: Chronic nontender swelling of parotid gland occurs.
    • Chronic nonspecific parotitis: Most commonly, patients experience episodes of painful parotid inflammation that last for hours to weeks with relative asymptomatic periods between. Pain varies from mild to incapacitating.
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Physical

See the list below:

  • Physical examination of the parotid gland consists of visual examination for swelling and erythema of the overlying skin.
  • The acutely inflamed gland is exquisitely tender, while the gland is usually nontender in chronic autoimmune parotitis.
  • Massaging the gland from posterior to anterior expresses clear saliva from the parotid duct in normal glands.
  • Purulent saliva is expressed with bacterial parotitis, and clear saliva with small yellow curds is expressed in chronic punctate (autoimmune) parotitis.
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Causes

See the list below:

  • In the vast majority of instances, risk factors are unknown.
  • Occasionally, drugs such as iodides or guanethidine cause transient swelling of the gland.
  • Autoimmune disease causes most cases of chronic parotitis.
  • Recurring bacterial parotitis may be caused by stone formation or stenosis of the duct, but this also occurs in a minority of cases of chronic parotitis.
  • HIV may cause a type of indolent parotitis that suggests an autoimmune process.
  • Dehydration with stasis of salivary flow may cause of acute parotitis. Drugs with an atropine effect (eg, antihistamines) may precipitate parotitis on rare occasions.
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