The current case report described a 60-day-old female patient with acute bacterial parotitis initially presented with agitation and fever. Almost always, such cases in neonates or infants are diagnosed after apparent swelling and/or abscess formation, whereas the current case was diagnosed in early stages.
Table 2.
Some of Studies Concerning in Acute Parotitis/Abscess
Author | Journal | Title |
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Kolekar et al. | African Journal Pediatric Surgery, volume 13, issue 4, Oct - Dec 2016 | Acute neonatal parotid abscess: A rare case report |
Decembrino et al. | International Journal of Pediatric Otorhinolaryngology, volume 76, issue 7, July 2012 | Monolateral suppurative parotitis in a neonate and review of literature |
Khan et al. | Ear, Nose & Throat Journal, volume 89 issue 4, March 1, 2010 | Acute suppurative neonatal parotitis: Case report |
Zurina et al. | Medical Journal of Malaysia, volume 67, issue 6, December 2012 | Parotid abscess in a late premature infant: A case report |
Spiegel Ronen et al. | The Pediatric Infectious Disease Journal, volume 23, issue 1, January 2004 | Neonatal acute suppurative parotitis |
Vorrasi et al. | Journal of Oral and Maxillofacial Surgery, volume 75, issue 3, March 2017 | Concomitant Suppurative Parotitis and Condylar Osteomyelitis |
Acute bacterial parotitis is rare in newborns (2-4). The male to female prevalence ratio is 3:1 (5, 6). Although acute bacterial parotitis can be observed in normal healthy infants, it is reported more in dehydrated, premature, or immune-deficient ones (2, 3, 7). Also, congenital anomalies of the parotid gland or ducts and oral trauma are intended as the other risk factors (1). The most common bacterial agent is Staphylococcus aureus (2, 7), although some less common agents are other Gram-positive cocci, Gram-negative bacilli and, scarcely, anaerobic agents such as Peptostreptococcus spp., microaerophilic streptococci, and Actinomyces spp. (1, 5). The diagnosis was made by clinical findings; i.e., fever, agitation, tender erythematous, swollen parotid gland, and pathognomonic pus in the Stensen duct (5). Contrary to the current case, almost all of the reported cases of newborn or early infancy were diagnosed at the terminal stages and after pus outflow from Stenson duct or abscess formation. Therefore, parotid gland examination in the child with agitation is essential and reasonable. In the laboratory data, leukocytosis, neutrophilia, and elevation of C-reactive protein are expected (2, 3, 8).
Ultrasonography is a noninvasive and cost-effective technique used to confirm the diagnosis of acute bacterial parotitis; it may reveal generalized edematous and heterogeneous gland, or evidence of abscess formation (1, 2).
Intravenous antibiotic therapy is the main treatment, and antistaphylococcal antibiotics are suggested as the initial empirical ones. Based on B/C results or culture of the ductus exudate, antibiotic switch may be necessary (9); in addition, 7 - 10 days of antibiotic therapy is needed. Though incision and drainage are cardinal part of the intraparotid abscess, surgical intervention is rarely required (10, 11).
With the proper antibiotic therapy, the prognosis is favorable and complications such as salivary gland fistula, facial palsy, mediastinitis, and appositional inflammation of the external ear rarely occur (10, 12).
3.1. Conclusions
In conclusion, although acute bacterial parotitis is a rare condition in neonates and infants, due to its nonspecific initial presentations and importance of early diagnosis, it should be considered in the diagnosis of all children with causeless agitation. With timely diagnosis and appropriate antibiotic therapy, acute suppurative parotitis and its complications such as recurrent parotitis can be prevented.
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