II. Pathophysiology
- Mechanism
- Bacterial Infection with seeding via retrograde infection from the oral cavity
- Stasis due to volume depletion or Xerostomia allows for Salivary GlandBacterial parenchymal infection
- Most common in age >50 years
- Contrast with Viral Sialoadenitis
-
Parotid Gland is most commonly affected Salivary Gland
- Less bacteriostatic secretions than submandibular
III. Causes: Bacterial
- See Viral Sialoadenitis
- Staphylococcus aureus (most common, cultured in >50% of cases)
- Streptococcus species (esp. Streptococcus Pyogenes)
- Haemophilus Influenzae
- Gram Negative Bacteria
- Anaerobic Bacteria
IV. Risk Factors
- Advanced age
- Volume depletion
- Diabetes Mellitus
- Hypothyroidism
- Renal Failure
- Sjogren Syndrome
- Debilitated or recently post-operative or post-hospitalization
- Anticholinergic Medications causing Xerostomia
- Secondary to Salivary Gland Calculus
- Known as Obstructive Sialadenitis
V. Symptoms
- Acute pain and swelling localized over affected Salivary Gland
- High fever with chills often present
VI. Signs
- Ill appearing patient
- Exquisitely tender, warm, swollen Salivary Gland (usually Parotid Gland)
- Regional Lymphadenopathy
- Pus at affected Salivary duct orifice
- Affected gland may be massaged to express pus for culture
- Parotid duct (Stensen's Duct) at upper second molar
- Submandibular duct (Wharton's Duct) at frenulum
VII. Labs
- Gram Stain and culture of Salivary duct discharge
VIII. Imaging
- CT Scan if not improving within 3-4 days
- Avoid sialography in acute Bacterial Sialoadenitis
IX. Differential Diagnosis
X. Management
- Precautions
- Acute Parotitis and other severe Sialadenitis may require initial inpatient Parenteral antibiotics (e.g. Nafcillin and metronizadole)
- MRSA coverage should be considered in cases failing to improve or Immunocompromised patients (e.g. Vancomycin)
- Start antibiotic coverage for Staphylococcus aureus and other Gram Positive organisms (as well as Anaerobes)
- Total treatment course: 10-14 days
- Oral agents (non-toxic patient)
- Parenteral agents
- Use broad spectrum coverage instead for immunosuppressed patients (e.g. Zosyn and Vancomycin)
- Clindamycin 600 mg IV every 6-8 hours OR
- Nafcillin 2 g IV every 4 hours AND Metronidazole 500 mg IV every 6 to 8 hours
- Increase Saliva production
- Increase fluid intake
- Lemon drops to increase Saliva secretion
- Stop Anticholinergics and other Xerostomia causes
- Symptomatic therapy
- Analgesics
- Warm compresses over affected Salivary Gland
- Attempt to milk gland of discharge
- Otolaryngology Consultation
- Surgical drainage may be required
- Consider early intervention or if no improvement in 3-4 days
XI. Complications
- Salivary Gland abscess (rare)
XII. References
- (2018) Sanford Guide, accessed on IOS 12/24/2019
- Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
- Chow in Mandell (2000) Infectious Disease, p. 699-700
- Walner in Cummings (1998) Otolaryngology, p. 5-121
- Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]