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
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.
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.
Viral InfectionsViral Infections
As opposed to bacterial sialadenitis,
viral infections of the salivary glands are
SYSTEMIC from the onset!
Viral infectionViral infection
Mumps is a non-suppurative acute
Is endemic in the community and
spread by airborne droplets
Enters through upper respiratory tract
2-3 week incubation after exposure (the
virus multiplies in the URI or parotid
Then localizes to biologically active
tissues like salivary glands, germinal
tissues and the CNS.
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
Classic mumps syndrome is caused by
paramyxovirus, an RNA virus
Others can cause acute viral parotitis:
◦ Coxsackie A & B, ECHO virus, cytomegalovirus
HIV involvement of parotid glands is a rare
cause of acute viral parotitis, is more
commonly associated with chronic cystic dz
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.
Physical examPhysical exam
Glandular swelling (tense, firm) Parotid gland
involved frequently, SMG & SLG can also be
May displace ispilateral pinna
75% cases involve bilateral parotids, may not
begin bilaterally (within 1-5 days may become
Low grade fever
The acini develop cloudy swelling making
the connective tissue edematous
There is infiltration with plasma cells and
The ductal lumens contain desquamated
cell debris and leukocytes .
Diagnostic EvaluationDiagnostic Evaluation
Leukocytopenia, with relative
Increased serum amylase (normal by 2-
3 week of disease)
Viral serology essential to confirm:
Complement fixing antibodies appear
following exposure to the virus
“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
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
If the initial serology is noncontributory, then a
non-paramyxovirus may be responsible for the
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
Anti-inflammatories and analgesics
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
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
Salivary gland disease in HIVSalivary gland disease in HIV
May occur and the main presentations
of the disease of the major salivary
glands are: xerostomia and /or
enlargement of the salivary glands.
Other viral infectionsOther viral infections
Cytomegalovirus – causes cytomegalic
inclusion disease, in newborns, children
and adults and has multiple systemic
Parainfluenza types 2 and 3, echo and
coxsackie viruses – non-specific
suppurative sialadenitis .
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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