Salivary gland Viral infections


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Salivary gland Viral infections

  1. 1. Salivary gland infections ViralSalivary gland infections Viral Faisal Qahtani 431803127
  2. 2. 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. 2
  3. 3. 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. 3
  4. 4. 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. 4
  5. 5. Viral InfectionsViral Infections  As opposed to bacterial sialadenitis, viral infections of the salivary glands are SYSTEMIC from the onset! 5
  6. 6. 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 tract 6
  7. 7. 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. 7
  8. 8. 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 8
  9. 9. 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 dz 9
  10. 10. 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
  11. 11. Physical examPhysical exam Glandular 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 fever 11
  12. 12. HistopathologyHistopathology The 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 . 12
  13. 13. 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 13
  14. 14. 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 14
  15. 15. 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 15
  16. 16. 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. 16
  17. 17. TreatmentTreatment Supportive Fluid Anti-inflammatories and analgesics 17
  18. 18. 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 18
  19. 19. 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 19
  20. 20. Salivary gland disease in HIVSalivary gland disease in HIV infectioninfection May occur and the main presentations of the disease of the major salivary glands are: xerostomia and /or enlargement of the salivary glands. 20
  21. 21. 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 . 21
  22. 22. 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 22