This article is mainly intedend for use by medical professionals.
Recurrent Parotitis of Childhood also known as Juvenile recurrent parotitis is second most common inflammatory disorder of salivary glands in childhood after mumps. It can occur at any age, but usual age of onset is 3-6 years. The condition is more common in boys.
Pathology
- Exact pathology of this clinical condition is unknown.
- The proposed causes are
- congenital ectasia of portions of the secondary ductal system of parotid ducts, which predisposes children to Staph. aureus and Step. viridans colonization
- Autosomal inheritance
- IgG3 and IgA deficiencies
- Juvenile onset primary Sjӧgren’s syndrome
- Viral etiology – Mumps parotitis, Epstein-Barr virus (EBV) and HIV.
Clinical features of Recurrent Parotitis of Childhood
- Rare case
- Recurrent Parotitis of Childhood is characterized by recurrent parotid inflammation usually associated with non-obstructive sialectasis of the parotid gland.
- The condition is usually unilateral, but can occur bilaterally with symptoms usually more prominent on one side.
- Fever and overlying erythema are common and occasionally white mucopus can be expressed from parotid duct.
- Localized pain and swelling that may last upto 14 days.
- Number of attacks vary from 1-5 per year, some may have even upto 20 episodes.
Bacteriology
- Although culture of saliva is often sterile, the most common organisms are Streptococcus pneumonia and H. influenzae.
Investigations
- Sialography – Revels calculi, sialectasis
- Ultrasonography (USG) – Enlarged gland with multiple small hypoechoic areas
- Culture and Sensitivity – In any acute case, a swab should be taken from saliva from the duct of affected gland and should be sent for Culture and Sensitivity.
- Rule out Sjogren’s syndrome, lymphoma and immunocompromised conditions like diabetes, Immunoglobulin deficiency, cystic fibrosis etc.
Natural history
- Recurrent Parotitis of Childhood is usually self-limiting and requires no surgery.
- Frequency of recurrence peaks between 5-7 years.
- Average number of attacks per year range from 1 to 20.
- 90% have resolution by puberty.
- In few severe cases there is progression leading to the destruction of the glandular parenchyma with a diminution of its functionality by 50%–80%.
Treatment of Recurrent Parotitis of Childhood
- Management is conservative in expectation of reduction in frequency and severity of episodes.
- Individual episodes should be managed by
- Adequate hydration
- Analgesia is the main stay of treatment
- Antibiotics are not indicated unless there is generalized malaise and fever. If given, it is based on Culture and Sensitivity report.
- Gentle external massage of the gland and application of warmth.
- Attention to good oral hygiene, use of chewing gum and sialogogic agents are helpful
- Surgical intervention is not recommended.
- If attacks don’t resolve, lavage of parotid duct, under general anesthesia, with normal saline and steroids (sialendoscopy) may reduce frequency of attacks.