Exam 4 Salivary Gland Infections Flashcards
What is sialadenitis?
Inflammation or infection of the salivary glands
What are the characteristics of sialadenitis?
- Can be acute or chronic/recurrent
- Can be infectious or non-infectious
- Can be viral or bacterial
Which salivary gland is more commonly infected in sialadenitis?
Parotid gland (compared to submandibular)
Who is affected by majority of sialadenitis cases?
Adults
Which form of sialadenitis is more frequent in children?
Mumps
_____ can cause autoimmune sialadenitis
Sjogren’s syndrome
Sjogren’s syndrome autoimmune sialadenitis causes:
Inflammation of the salivary glands due to lymphocytic infiltrate
Clinical signs and symptoms of Sjogren’s syndrome autoimmune sialadenitis
- Dry eyes
- Dry mouth
What two things are required for Sjogren’s syndrome diagnosis?
- Sjogren’s syndrome autoimmune antibodies (SSA antibodies)
- Positive salivary gland biopsy
Sjogren’s syndrome may be ____ or ____ in presentation
Unilateral or bilateral
Sjogren’s syndrome is most likely to develop in:
Middle aged or older women
What does Sjogren’s syndrome increase the risk for?
Non-Hodgkin lymphoma
Sjogren’s syndrome: _____ is contraindicated
Anti-histamines
Pharmacologic (____) immunosuppression can be used for prevention of ____ and treatment of ______
Induced; Graft vs host disease; Autoimmune disorders
What are four main treatments to prevent GvHD?
- Methotrexate
- Cyclosporin
- Tacrolimus
- Glucocorticoids
Methotrexate is often used to treat ____ and ____
Chemotherapy and autoimmune disorders
Methotrexate competitively inhibits _____
Dihydrofolate reductase (DHFR)
tetrahydrofolate synthesis
Methotrexate selectively inhibits ____
IL-1 beta binding
Methotrexate interactions
- Penicillin
- Aminoglycosides
- NSAIDs (potentially fatal interactions)
- Nitrous oxide (induces hematologic toxicity)
What effect does penicillin have on methotrexate?
Decreases elimination of methotrexate, increases toxicity risk
What effect do aminoglycosides have on methotrexate?
Reduces absorption of methotrexate
Cyclosporin is mainly used to treat:
- Autoimmune diseases
- Autoimmunity and prevention of GvHD
Cyclosporin blocks:
Inflammatory cytokines (IL-2)
____ inhibits T-lymphocyte activity
Cyclosporin
Tacrolimus has similar properties to cyclosporin in that it inhibits ____
IL-2 production
True or false: Tacrolimus is a much more potent immunosuppressant
True
Tacrolimus is used to treat:
Autoimmune disorders and prevention of GvHD
____ has a wide range of interactions and contraindications
Tacrolimus
Tacrolimus has interactions with:
- Macrolides
- Anti-fungals of azole class
compete for cytochrome P450 liver enzymes CYP3A
Tacrolimus is influenced by ____. CYP3A5 G/G make ____, which ____ risk of drug toxicity.
Genetics; non-functional CYP3A5 protein; increases
____ are steroid hormones
Glucocorticoids (prednisone)
Glucocorticoid mechanism: blocks some nuclear translocations, inhibits ____ and inhibits cytokines such as ____
NfKB (B and T cells); IL-2, IL-4, IL-8
Glucocorticoids (Prednisone) in ___ doses cause immunosuppression. This may result in ___ and ___
High; T cell or humoral immune deficiency, neutropenia
Viral sialadenitis is caused by ____
- HIV-associated CMV sialadenitis
- Mumps
DOC for CMV sialadenitis
Gancyclovir
____ is an important opportunistic pathogen in immunocompromised patients, such as those who have ____
CMV; HIV/AIDS, transplant patients
CMV as an opportunistic pathogen can cause:
- Pneumonia
- CMV retinitis
- parotitis
CMV has ___ transmission and is ___ in myeloid cells (____) such as in ____
Horizontal; latent; macrophages; saliva
____ is used to treat life- and sight-threatening CMV infections
Gancyclovir
In children, ____ is the most frequent cause of acute viral sialadenitis. ____ is most commonly affected
Mumps (MuV); Parotid (epidemic parotitis)
Mumps most commonly occur in:
Unvaccinated kids (vaccine is highly effective)
In children, mumps is the most frequent cause of ____
Acute non-suppurative sialadenitis
Complications of mumps
- Permanent deafness
- Orchitis
- Oophoritis
Bacterial sialadenitis (acute suppurative) is most common in the ____ gland. Most common causes are _____ and presents as ___ at duct opening
Parotid; S. aureus; Suppurative (pus)
Sialolithiasis in submandibular gland occurs in 2/3 - 3/4 of _____
Chronic recurrent sialadenitis
Bacterial sialadenitis treatment
- Penicillinase-resistant antibiotics
- Sialagogues (pilocarpine, gum, lemon drops)
Sialolithiasis
___ form in submandibular gland
___ submandibular sialoliths are radio___
___ parotid stones are radio___
80%
90%; radiopaque
90%; radiolucent
Treatment of sialolithiasis may involve:
Lithotripsy or surgery
_____ are the most common type of salivary gland malignancy in adults
Mucoepidermoid carcinomas
Those with Sjogren’s syndrome is high risk for _____
non-Hodgkin lymphoma (RR=20)
What is an MZL? E-MZL?
Marginal zone lymphoma
Extra-nodal marginal zone lymphoma
A small fraction of E-MZL may involve _____
Salivary glands
E-MZL is associated with _____ (autoimmune disease)
Sjogren’s syndrome
Primary salivary gland-EMZL mainly involves the:
Parotid gland
_____ may be indicated for salivary gland tumors. _____ is the most frequently reported side effect of radiotherapy for tumors involving salivary glands.
Radiotherapy; xerostomia
What can be used to stimulate unaffected salivary glands?
Salivary stimulants like pilocarpine
Many ____ drugs induce xerostomia
Chemotherapeutic
In those with GVHD:
____ occurs in approximately 60% chronic GVHD
____ and ____ common >50%
Xeropthalmia
Xerostomia and chronic bacterial sialadenitis
