Acute Bacterial Parotitis in Early Infancy: A Case Report and Review of the Literature

Abstract

Introduction: Acute parotitis is known as an uncommon disease in children and a rare condition in infancy. Dehydration, prematurity, immune deficiency, congenital anomalies of the parotid gland or ducts, and oral trauma are some of its important risk factors. The most common bacteria contributing to this condition is Staphylococcus aureus. Acute parotitis is managed with intravenous antibiotic therapy and surgery in complicated cases. Favorable prognosis is reported in early diagnosis and proper antibiotic therapy. Case Presentation: The present report presents the case of a 60-day-old breastfed female infant with a chief complaint of agitation referred to the Department of Pediatrics in a university-affiliated hospital in Tehran, Iran, in 2018. She underwent treatment for the infantile colic diagnosis. Conclusions: Timely diagnosis and treatment of acute bacterial parotitis prevented suppurative parotitis and formation of abscess.

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“…In cases of parotitis, the main route of infection for SA is ascending through the Sténon canal after oral cavity colonization. This can explain the frequent occurrence of purulent drainage through the duct in cases of staphylococcal parotitis, as observed in the cases presented here [1][2][3][4][5][6][7][8]. In the first clinical report, no risk factors were identified for its occurrence.…”

“…Since the implicated agent was already known, cefotaxime was discontinued, and flucloxacillin monotherapy was maintained. Surgical drainage of the gland is rarely necessary, as supported by literature [2,4,5].…”

“…This may be accompanied by systemic symptoms such as fever (occurring in approximately one-third of cases), irritability, refusal to eat, and clinical signs of sepsis. The discharge of purulent content through the duct is a pathognomonic sign of this pathology [1,2,4,5]. Analytically, leukocytosis with neutrophilia and an increase in acute phase reactants such as PCR and amylase may be present, although these laboratory tests are non-specific and may be normal [2,4,5].…”

“…The discharge of purulent content through the duct is a pathognomonic sign of this pathology [1,2,4,5]. Analytically, leukocytosis with neutrophilia and an increase in acute phase reactants such as PCR and amylase may be present, although these laboratory tests are non-specific and may be normal [2,4,5]. To confirm the diagnosis and guide therapy, it is essential to collect exudate and blood cultures to identify the etiological agent [4].…”

“…The initial empiric treatment for acute bacterial parotitis consists of intravenous broad-spectrum antibiotic therapy with coverage for the most frequently implicated agents, namely Streptococcus aureus, for example, a combination of a penicillin resistant to penicillinases and an aminoglycoside or third-generation cephalosporin. The treatment is modified according to the antibiogram [1,2,4,5,7]. An increase in methicillin-resistant SA may require the use of vancomycin; in the presence of an anaerobe, treatment may include a combination of metronidazole with a macrolide, or a penicillin associated with a β-lactamase inhibitor such as clavulanate.…”