Clinical Microbiology Fifth Year

1. Salivary gland infections
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Introduction
Different Types of infections – Bacterial, Viral
Pathogenesis – etiology
Microbiology(bacteria)
Signs and Symptoms
Management
Complications
Prevention

2. Salivary Glands
• There are 3 paired salivary glands in humans
1. Parotid - largest of the major salivary glands
Two Lobes divided by facial nerve
2. Submandibular deep to mylohyoid, superficial
to hyoglossus
3. Sublingual - Smallest of the salivary glands
• Common surgical disease; infection/calculi

3. Salivary glands

4. Salivary gland infections
• Viral - Mumps (commonest)
• Bacterial - Acute parotitits
- Chronic parotitis
- Recurrent parotitis of childhood
- Submandibular sialadenitis
- Tuberculosis
- Actinomycosis

5. Factors in salivary gland infections
Oral microorganisms
Reduced salivary flow
Drugs - opiates, irradiation
Sjogren’s syndromme
Dehydrtion
Abnormal gland architecture
Sialoths(stones)
Strictures
Sialectasis
Salivary gland infection

6. Acute bacterial parotitis
• Pathogenesis
- Retrograde infection in reduced salivary flow
- Local abnormalities in gland architecture
• Microbiology - Staph aureus,
- Streptococci (alpha hemolytic)
- Haemophylus species
are the common ones isolated.
• Exact causative organism is difficult to isolate as
sample collection is difficult.

7. Symptoms
• Redness (erythma) over the side of the face or
the upper neck
• Swelling in pre and post auricular areas
extending to angle of mandible
• Breathing or swallowing difficulty (these may
be emergency symptoms).
• Extreme mouth or facial pain especially when
eating

8. Symptoms
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Thick purulent discharge (pus) on milking.
Dry mouth, Fever with chills,.
Abnormal tastes, foul tastes
Decreased ability to open the mouth
Swelling of the face (particularly in front of the ears,
below the jaw, or on the floor of the mouth)

9. Investigations
• WBC COUNT - Leucocytosis
• Milk the exact pus from gland and do culture
and sensitivity, Gram stain.
• X- ray or CT scan or ultrasound may be done if
there is an abscess.

10. Management
• Warm salt water rinses (1/2 teaspoon of salt in 1 cup
of water) may be soothing and keep the mouth
moist.
• Massaging the gland with heat may help.
• Hydration- Drink lot of water and use sugar-free
lemon drops to increase the flow of saliva and
reduce swelling.
• If there is an abscess, surgery to drain it or aspiration
may be done.

11. Management
• Appropriate antibiotic therapy (Flucloxacillin,
Erythromycin)
• Severe cases - Antibiotics +surgical intervention
• Treat the cause – Sialography (imaging) stones or
strictures, any abnormalities.
• Sialography is contraindicated in acute
infection.

12. Possible Complications
• Abscess of salivary gland
• Infection returns
• Spread of infection (cellulitis, Ludwig's angina)

13. Chronic bacterial parotitis
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Recurrent episodes of parotitis
Persistent infection
Damaged glands (Sjogren’s syndrome)
Clinical course - intermittent exacerbations
and remissions
• Destroys the gland
• Parotidectomy for long term infection and
good results

14. Recurrent parotitis of childhood
• Repeated acute episodes of painful
enlargement of one or both parotid glands.
• Etiology - Unclear,
• Suggested congenital abnormalities of ductal
system( mumps, foreign bodies, trauma from
orthodontics)
• Most will resolve by puberty, Remove
identified predisposing factor, Antibiotics.

15. Prevention
• Good oral hygiene may prevent some cases of
bacterial infection.
• Drink plenty of water, keep mouth wet.

16. Uncommon infections
• Tuberculosis secondary to pulmonary
infection.
• M. tuberculosis and Atypical mycobacteria
• Rarely seen
• Parotids are commonly affected
• C/F - Firm non tender swelling, rarely facial
paralysis.
• Management – Skin tests, ATT.

17. Uncommon infections
• ACTINOMYCOSIS
• A.israeli is implicated.
• Salivary glands may be infected in upto 10% of
cervicofacial actinomycosis
• MANAGEMENT – diagnose and treat.

18. Mumps virus
• Family-paramyxoviridae , genus - Rubulavirus
• Mumps is acute contagious non suppurative
inflammation on one or both salivary glands
• Mild childhood disease with serious
complications in adults
• Humans are only the natural hosts
• 1/3 of infections are asymptomatic

19. Pathogenesis
• Acquired via repiratory route by saliva and
respiratory secretions
• Replicate in respiratory epithelium
• Viremia spread virus to salivary gland
• Virus is present in saliva 2 days before and 9
days after salivary gland swelling
• Infect kidney, viruria may persist 2 wks

20. Clinical presentation
 IP= 2-4wks
 1/3 are asymptomatic
 Prodromal period
 Malaise, nausea
 Painful swelling of parotid
glands (50% of cases) unior bilateral
 Aseptic meningitis (15%)
 Meningoencephalitis
(0.3%)

21. Clinical presentation
• Unilateral deafness (5/100,000)
• Orchitis (20-50%) of males affected
– Painful swelling
– Rarely sterility
• Oophoritis (5%) of females affected
• Pancreatitis (4%)

22. Diagnosis
• Virus isolation
– Saliva, CSF, urine within few days of illness
– Monkey kidney cells
– Shell vials, 2-3 day IF
• Serology
– 4x rise in Ab in paired serum
– IgM detection ELISA