salivary gland viral infections
TRANSCRIPT
Salivary gland infections Salivary gland infections
ViralViralFaisal Qahtani
431803127
Salivary gland infectionsSalivary gland infections
Inflammation of salivary gland – sialadenitis.
Can be viral (majority), bacterial and fungal
(minority).
Parotid glands are more commonly infected than
submandibular glands while accessory salivary
glands are very rare infected.
Majority of sialadenitis seen in adults.
Initiation and progression of salivary gland infections
depend upon the virulence of the causative organism
and the host resistance.
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Acute viral infection (AVI)Acute viral infection (AVI)
Mumps classically designates a viral
parotitis caused by the paramyxovirus.
However, a broad range of viral
pathogens have been identified as
causes of AVI of the salivary glands.
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AVIAVI
Derived from the Danish word
“mompen”
Means mumbling, the name given to
describe the characteristic muffled
speech that patients demonstrate
because of glandular inflammation and
trismus.
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Viral InfectionsViral Infections
As opposed to bacterial
sialadenitis, viral infections of the
salivary glands are SYSTEMIC
from the onset!
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Viral infectionViral infection
Mumps is a non-suppurative acute
sialadenitis
Is endemic in the community and
spread by airborne droplets
Communicable disease
Enters through upper respiratory
tract6
MumpsMumps
2-3 week incubation after exposure
(the virus multiplies in the URI or
parotid gland)
3-5day viremia
Then localizes to biologically active
tissues like salivary glands,
germinal tissues and the CNS.
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EpidemiologyEpidemiology
Occurs world wide and is highly contagious
Prior to the widespread use of the Jeryl
Lynn vaccine (live attenuated), cases were
clustered in epidemic fashion
Sporadic cases are observed today likely
resulting from non-paramyxoviral infection,
failure of immunity or lack of vaccination
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VirologyVirology
Classic mumps syndrome is caused by
paramyxovirus, an RNA virus
Others can cause acute viral parotitis:
◦ Coxsackie A & B, ECHO virus,
cytomegalovirus and adenovirus
HIV involvement of parotid glands is a rare
cause of acute viral parotitis, is more
commonly associated with chronic cystic
dz9
Clinical features:Clinical features:
Airborne droplets transmit mumps virus
It mainly effects the parotid gland.
Children between the ages of 5-18 years
are infected the most.
Once exposed the patient will develop the
disease within 2-3 weeks
There is rapid swelling of the parotids
bilaterally
There is an acute pain while salivation. 10
Physical examPhysical examGlandular swelling (tense, firm) Parotid
gland involved frequently, SMG & SLG
can also be affected.
May displace ispilateral pinna
75% cases involve bilateral parotids,
may not begin bilaterally (within 1-5
days may become bilateral)….25%
unilateral
Low grade fever11
HistopathologyHistopathologyThe acini develop cloudy swelling
making the connective tissue edematous
There is infiltration with plasma cells and the lymphocytes
The ductal lumens contain desquamated cell debris and leukocytes .
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Diagnostic EvaluationDiagnostic Evaluation
Leukocytopenia, with relative
lymphocytosis
Increased serum amylase (normal by
2- 3 week of disease)
Viral serology essential to confirm:
Complement fixing antibodies appear
following exposure to the virus
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SerologySerology
“S” or soluble antibodies directed
against the nucleoprotein core of
the virus appear within the first
week of infection, peak in 2 weeks.
Disappear in 8-9 months and are
therefore associated with active or
recent infection
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SerologySerology
Viral antibodies directed against the
outer surface hemagglutinin, appear
several weeks after the S antibodies
and persist at low levels for about 5
years following exposure.
Viral antibodies are associated with
past infection, prior vaccination and
the late stages of active infection
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SerologySerology
If the initial serology is noncontributory,
then a non-paramyxovirus may be
responsible for the infection.
Blood HIV tests should also be obtained
The mumps skin test is not useful in
diagnosis an acute infection because
dermal hypersensitivity does not develop
until 3 or 4 weeks following exposure.
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TreatmentTreatment
Supportive
Fluid
Anti-inflammatories and
analgesics
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PreventionPrevention
The live attenuated vaccine
became available in 1967
Commonly combined with the
measles and rubella vaccines, the
mumps vaccine is administered in a
single subcutaneous dose after 12
months of age. Booster at 4-6yr
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ComplicationsComplications
Orchitis, testicular atrophy and sterility
in approximately 20% of young men
Oophoritis in 5% females
Aseptic meningitis in 10%
Pancreatitis in 5%
Sensorineural hearing loss <5%
◦ Usually permanent
◦ 80% cases are unilateral
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Salivary gland disease in HIV Salivary gland disease in HIV infectioninfectionMay occur and the main
presentations of the disease of
the major salivary glands are:
xerostomia and /or enlargement
of the salivary glands.
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Other viral infectionsOther viral infections
Cytomegalovirus – causes
cytomegalic inclusion disease, in
newborns, children and adults and
has multiple systemic manifestations.
Parainfluenza types 2 and 3, echo
and coxsackie viruses – non-specific
suppurative sialadenitis .
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ReferencesReferences
1. McQuone, SJ: Acute viral and bacterial infections
of the salivary glands. Oto Clinics North America,
32:793,1999
2. Rice DH. Salivary Gland Disorders. Med Clin North
Am. 1999; vol 83, 197.
3. Williams MF. Salivary gland diseases: sialolithiasis.
Oto Clin North America. Vol 32, 819, 1999
4. Feinberg SE. Diagnosis and management of
salivary gland disorders. Ch.34
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