4. Salivary Gland Infections

Question 1

Sialadenitis

Answer 1

• inflammation of salivary glands
• caused by virus (majority) or bacteria (minority)

usually in adults - except for mumps
parotid glands more commonly infected than submandibular

Question 2

Viral causes of Sialadenitis

Answer 2

• Mumps virus (most common)
• Cytomegalovirus
• Rarely: Parainfluenza (2&3), Echovirus, Coxsackie

Question 3

Mumps Structure & Proteins

Answer 3

same as measles
lipoprotein envelope w/ 2 spikes of transmembrane glycoproteins
nonsegmented linear +ssRNA
Proteins: N, P, L, M, H, F

Question 4

Mumps Transmission

Answer 4

Respiratory droplets
Natural host: Humans
Worldwide w/ peak in winter
Children have subclinical (inapparent) infection (30%) > immunity

Question 5

Mumps Pathogenesis

Answer 5

URT > Blood > Parotid gland, Testes, Ovaries, Pancreas & Meninges

Buccal mucosa > up Stensen’s duct > Parotid Gland

Long life immunity (occurs once) - 6 month protection to newborn
Subsequent parotitis by
	Other virus (Parainfluenza)
	Bacteria
	Duct stones

Question 6

Mumps Clinical Findings

Answer 6

• Incubation Period: 18-21 days
• Prodromal stage: fever, malaise, & anorexia > tender swelling of Parotid
• Citrus juices aggrevates parotid pain
• Disease is benign & resolves in a week

Question 7

Mumps Complications

Answer 7

1- Orchitis in postpubertal males (bilateral = sterility)
tunica albuginea resists expansion > pressure necrosis of spermatocytes

2- Meningitis: benign, self-limited & w/o sequelae

Question 8

Mumps Lab Diagnosis

Answer 8

1- Clinical Picture
2- Cell Culture
3- PCR
4- Fourfold rise in antibody titer
5- CF test: S antigen (for N&P protein) V antigen (for H protein)
	S indicates current infection
	V indicates past infection

Question 9

Actinomyces israelii Properties

Answer 9

• Anaerobic

- Gram+ filamentous branching rods

Question 10

Actinomyces israelii Transmission

Answer 10

-Habitat: human mouth (anaerobic cervices around teeth)
-Goes > tissues during
dental disease
local trauma (e.g. broken jaw or dental extraction)
-Aspiration into lungs causes thoracic actinomycosis

Question 11

Actinomyces israelii Pathogenesis

Answer 11

• Trauma causes mucosal entry
• Grows in anaerobic niche > inflammation (sinusitis)
  granules & pus drain to surface through sinus tracts
  -Slow hard non tender swelling spreads > neighbouring organs & bones

Question 12

Actinomyces israelii Clinical Findings

Answer 12

1- Cervicofacial disease
2- Thoracic actinomycosis
3- Abdominal actinomycosis
4- Genital actinomycosis

Question 13

Actinomyces israelii

1- Cervicofacial disease

Answer 13

• “Lumpy Jaw” (swollen erythematosus process)
• Progression > fluctuant mass producing fistulas
• Extends to contiguous tissue bone, LN, head, & neck

Question 14

Actinomyces israelii

2- Thoracic actinomycosis

Answer 14

• Symptoms resemble Subacute Pulmonary infection
  mild fever, cough, purulent sputum
• Lung tissue is destroyed, sinus tracts may erupt to chest invading ribs

Question 15

Actinomyces israelii

3- Abdominal actinomycosis

Answer 15

• Follows ruptures Appendix/Liver

- same pathology in peritoneal cavity (any organ)

Question 16

Actinomyces israelii

4- Genital actinomycosis

Answer 16

Rarely occurs in women w/retained intrauterine device for long time

Question 17

Actinomyces israelii Lab Diagnosis

Answer 17

1- Sulfure granules in pus from sinuses, sputum, or tissue specimen:
	Hard
	Lobulated
	Composed of tissue & bacterial filaments
	Club shaped at periphery
2- Gram staining (gram+)
3- Cell Culture
4- Immunofluorescence