salivary gland infections? Flashcards
what are the two types of salivary gland infections ?
> bacterial infections
> viral infections
what are the general features of bacterial salivary gland infections?
> not as common as viral infections however not uncommon
> affects all age groups
> endogenous opportunistic infection
what are the common bacteria that cause bacterial salivary gland infections?
> Staphylococcus aureus
> Steptococci
> Some anaerobes
> Usually mixed infection
what are the predisposing factors of bacterial salivary gland infections?
> Any process that reduces salivary gland flow
> Any process that reduces host immunity
what pathogenies of bacterial salivary gland infections?
> Reduced salivary flow permits ascending infection from the mouth
what are examples of predisposing factors?
> Local duct obstruction – see later
> Previous radiotherapy
> Sjogrens syndrome
> Systemic drug therapy
> Immunosuppressants
> Dehydration
what is the onset like in a B SGI?
> gradual over a view days
what is the duration of a B SGI?
> may become persistent
what is a B SGI unilateral or bilateral?
> unilateral
is a B SGI recurrent? (frequency)
> yes it may be
what sites are affect by a B SGI?
> one major salivary gland
do you experience systemic upset during a B SGI?
> no
what are the clinical features of a bacterial salivary gland infection?
> Painful gland swelling
> Pus expressed from duct
> May have regional lymphadenopathy
how do you diagnose a bacterial salvary gland infection?
> Clinical findings
> Culture of microorganisms
> Plain radiographs
> Exclude other causes
what is the management of a bacterial salivary gland infection?
> Antibiotic therapy
> Ensure adequate hydration
> Consider predisposing factors
> Review
> Specialist referral if recurrent / signs of spreading infection
what antibiotic therapy is used for treatment of bacterial salivary gland infections?
> Initially empirical prescription (one antibiotic to cover a wide range of bacteria)
> May need to be revised in light of microbiological results
> Suggested protocol – co-amoxiclav 625mg (5 day course)
what are the causes of salivery obstruction?
> Benign Stricture
> Mucus plug
> Calculus (AKA sialolith or stone)
- Submandibular > Parotid
> Extraductal Compression
> obstruction increases the risk of infection due to reduced salivary flow
how can you tell the difference between a salivary infection rather than an obstruction?
> Initially may cause symptoms of obstruction rather than acute infection, e.g. swelling at mealtimes that resolves over the next few hours
what are sialoliths ?
> Sialoliths form by calcification of a mucus plug over time
> May be multiple, and within salivary gland duct or deep within gland itself
> usually sub mandibular
how do you manage a sialoliths?
> Patient self management
> Removal in clinic using probe
> Lithotripsy (ultrasound)
> Basket retrieval (sialendoscopy)
> Excision
what are are the complications of salivary gland infections?
> Recurrence of infection
> Spread of infection
> Fistula formation
> Compromised gland function
what is sialogrpahy?
> An anatomical investigation of major salivary gland structure
> Specialist investigation
what are the indications to use sialography?
> Obstructive symptomatology
> Sjogrens syndrome
what is the technique for taking sialography?
> A radio-opaque dye is introduced into the gland via the duct
> Two radiographs at 90o to each other
what are the contraindication to carrying out sialogrpahy?
> During acute phase of salivary gland infection
> Hypersensitivity to iodine
what viruses may be present in patients ?
> herpes simplex
> HIV and hepatitis B may be present in the saliva of asymptomatic patients
what are the general features of salivary gland infections?
> Common
> Occurs via droplet spread
> Principally occurs in children
what are the common viruses that causes viral salivary gland infections?
> Paramyxovirus
> Influenza virus
> Echo viruses
> Epstein Barr virus
during removal of salvery stones do you suture?
> no as this could cause stricture
> encouraging the patient to drink lots of water
> leads to larger duct
what is the pathogenesis behind viral salivary gland infections?
> virus enters and replicates in epithelial cells
what is the onset of V SGI? (paramyxovirus)
> incubation period = 21 Days
what is the duration of a V SGI? (paramyxovirus)
> two to three weeks
is viral infections severe in salivary glands? (paramyxovirus)
> only 10% of cases are severe
what’s the frequency of a V SGI? (paramyxovirus)
> once only infection
> if a person is immunosuppressed it can reoccur
what sites are infected by a V SGI? (paramyxovirus)
> usually the parotid
> bilateral
is there systemic upset in V SGI? (paramyxovirus)
> variable
> worse in adults
what are the clinical features of viral salivary gland infections ? (paramyxovirus)
> “Mumps”
> Pyrexia
> Painful parotid swelling
> Regional lymphadenopathy
> Clear saliva expressed
how do you diagnose viral salivary gland infections?
> clinical findings
> serological techniques (viral titres)/ PCR
what is the management of viral salivary gland infections?
> Symptomatic treatment (hydration, pain relief)
> Review
what are the complications of mumps? (paramyxovirus)
> More likely in adults
> Pancreatitis,
> orchitis
> oophoritis
> can affect fertility
what are the public health aspects surrounding mumps?
> Endemic infectious disease, reportable condition, can be outbreaks
> Vaccination
