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Viral Parotitis - Causes, Symptoms, Diagnosis, and Treatment

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Acute viral parotitis is a systemic infection localized to the parotid gland, leading to inflammation and swelling of the gland.

Written byDr. Preetha. J

Medically reviewed byDr. Sneha Kannan

Published At March 1, 2022
Reviewed AtAugust 5, 2024

Introduction:

Parotitis is a medical term referring to inflammation of one or both parotid glands, the largest salivary glands located on the sides of the face, just in front of the ears. It can be caused by various factors, including viral infections, bacterial infections, autoimmune conditions, or obstruction of the salivary ducts.

What Are the Types of Parotitis?

  • Acute parotitis refers to sudden inflammation of one or both parotid glands, typically caused by infection, most commonly viral or bacterial.

  • Chronic parotitis is a long-lasting inflammation of one or both parotid glands, persisting for weeks, months, or even years. It is often characterized by recurrent episodes of swelling, tenderness, and pain in the affected glands.

What Are the Types of Salivary Glands?

The three major types of salivary glands are:

  • Parotid gland.

  • Submandibular.

  • Sublingual.

All three salivary glands are the most prominent salivary glands, with their duct. Salivary gland tumors occur very rarely. The parotid salivary gland, the largest among the three major salivary glands, is found in front of and below the ear. Salivary tumors usually occur in this gland.

The parotid gland has two parts or lobes, namely,

  • Superficial lobe.

  • Deep lobe.

The facial nerve is present between these two lobes. The facial nerve controls the ability to close the eyes, raise eyebrows, and smile. The other critical structures near the parotid salivary glands are:

  • The external carotid artery.

  • The retromandibular vein.

  • A branch of the jugular vein.

  • A major blood vessel that supplies the head and neck region.

Sublingual glands are present under the tongue on the floor of the mouth, and submandibular glands are found below the mandibular jawbone. It requires great precision because the surgeon has to locate and operate around these important structures.

What Is Parotitis?

The parotid glands are small exocrine glands located in front and around the ramus of the jaw. The parotid gland is rarely affected by diseases of any kind. Parotitis is the infection and inflammation in one of the salivary glands, namely the parotid gland. It can be acute or chronic. Parotitis is assumed to be caused by the ascending infection from the oral cavity. Based on the patient population, many risk factors are associated with acute parotitis, with dehydration being the most significant.

What Is Viral Parotitis?

The painful enlargement of the parotid gland occurs in children due to viral parotitis (mumps). The paramyxovirus disease, the mumps virus, is spread by droplets or direct contact. The prevalence of viral parotitis has drastically decreased since the introduction of vaccination in the 1970s. Viral parotitis is commonly seen in underdeveloped countries.

What Are the Causes of Viral Parotitis?

Viral parotitis can be caused by:

Children have the highest risk of acquiring viral parotitis, which is decreased after introducing the mumps vaccine.

What Are the Symptoms of Viral Parotitis?

Viral parotitis can cause swelling in the parotid glands on both sides of the face, giving the appearance of chipmunk cheeks. About 30 to 40 percent of salivary gland infections are commonly associated with mumps. Viral parotitis is a contagious disease. Children with viral parotitis can typically start with a few days of fever, headache, muscle aches, dry cough, body pain, tiredness, loss of appetite, and swelling of their salivary glands (puffy cheeks and a tender and swollen jaw).

What Are the Risk Factors for Viral Parotitis?

The risk factors for viral parotitis are:

  • Cystic fibrosis.

  • Sjogren syndrome.

  • Contact with the person infected with mumps.

  • HIV or AIDS (human immunodeficiency virus or acquired immunodeficiency syndrome).

  • Poor oral hygiene.

  • Dehydration.

  • Not being vaccinated with the MMR (measles, mumps, and rubella) vaccine.

  • Certain medications, such as antipsychotics, antihistamines, and anticholinergic.

Why Is It Essential to Know Whether Viral Parotitis Is Due to Influenza or Mumps?

The viral parotitis caused by both mumps and influenza virus is contagious and can be transmitted. If a person has a suspected mumps infection, the patient should be isolated and tested for mumps. If a suspected patient tests negative for mumps, it does not result in mumps as a diagnosis. But still, testing for alternative organisms, like influenza, should also be considered if influenza is circulating in the community. Mumps can be severe, but the majority of the people infected with mumps will recover completely within two weeks. The infected people may feel tired and have body pain, fever, and swelling in the salivary glands on the side of the face. Others may include feeling extremely ill and having difficulty eating because of jaw pain, and a few may also develop serious complications.

What Is the Differential Diagnosis of Viral Parotitis?

Differential diagnosis of an enlarged parotid gland may include:

  • Acute bacterial parotitis (painful swelling of the parotid gland).

  • HIV parotitis(painless swelling of the gland in HIV-positive patients).

  • Parotitis related to tuberculosis (non-tender swelling of the parotid gland seen in tuberculosis).

  • Mikulicz disease (abnormal enlargement of all the glands in the head and neck).

  • Sialolithiasis (stones in the salivary gland).

  • Chronic recurrent parotitis (repeated infection of the salivary gland due to decreased flow of saliva).

  • Sarcoidosis (formation of granulomas in different parts of the body).

  • Benign (non-cancerous) and malignant (cancerous) tumors.

  • Bilateral parotitis (inflammation of both parotid glands).

  • Viral infections.

  • Parainfluenza (a respiratory disease caused by the human parainfluenza virus).

  • Coxsackievirus.

  • Influenza A.

  • Epstein-Barr virus.

  • Adenovirus.

  • Cytomegalovirus.

  • Bacterial infections like Staphylococcus aureus.

  • Salivary calculi.

  • Sjögren’s syndrome (autoimmune disorder causing enlargement of the gland and reduced salivation).

  • Thiazide diuretics.

What Are the Features of Sjogren’s Syndrome Parotitis?

In Sjogren’s syndrome, the immune system mistakenly attacks and damages the salivary glands, leading to chronic inflammation and dysfunction. This can result in reduced saliva production (hyposalivation) and an increased risk of infections, including parotitis.

It presents as recurrent episodes of swelling, tenderness, and pain in one or both parotid glands. The swelling may worsen with eating or drinking, and there may be a feeling of dryness or discomfort in the mouth.

How to Diagnose Viral Parotitis?

The doctor will inquire about your symptoms and medical history, if any. Followed by a physical examination of the parotid gland, which may be enough to make a diagnosis. Tests for viral parotitis may include a blood test and a fluid sample from the parotid gland. The other tests to be conducted are:

  • Mumps immunoglobulin (IgM and IgG) or PCR (polymerase chain reaction).

  • Testicular ultrasound if concerned for orchitis (inflammation of one or both the testicles).

  • Lumbar puncture is to be done if associated with meningitis or encephalitis.

How to Treat Viral Parotitis?

There is no medical cure for mumps, but the MMR vaccine can prevent it. Treatment involves the management of symptoms like:

  • Relieving pain.

  • Preventing dehydration.

  • Rest as much as possible.

  • Cold compress.

  • Over-the-counter pain relievers like Ibuprofen and Acetaminophen.

MMR Vaccine: The MMR (measles, mumps, rubella) vaccine is highly effective in preventing mumps. It is typically given in two doses during childhood, with the first dose administered at 12-15 months of age and the second dose at four- six years of age.

The immune system will work to clear the infection from the body.

How to Prevent Viral Parotitis?

Parotitis can be prevented by taking specific self-care tips:

  • Practice good oral hygiene.

  • Brushing the teeth at least twice a day.

  • Flossing the teeth daily to prevent and clear infections.

  • Rinsing the mouth with salt water regularly.

What Are the Complications of Viral Parotitis?

The complications of viral parotitis are:

  • Mastitis - Inflammation of the mastoid process.

  • Pancreatitis - Inflammation of the pancreas.

  • Myocarditis - Inflammation of the cardiac muscles.

  • Aseptic meningitis - Inflammation of the meninges covering the brain.

  • Polyarthritis - Inflammation of the joints.

  • Hearing loss.

  • Hemolytic anemia.

  • Osteomyelitis - Infection of the bones caused by bacteria or fungi.

  • Lemierre syndrome - A consequence of the sore throat, and the infection spreads to the bloodstream.

  • Sepsis - A life-threatening infection throughout the body.

  • Organ failure - Infection causing dysfunction of the organ.

  • Facial paralysis - Unable to move the muscles of the face either one side or two sides.

Conclusion:

Viral parotitis, also known as mumps, is a contagious viral infection characterized by swelling and inflammation of the parotid glands, which are located on the sides of the face, just below and in front of the ears. It is caused by the mumps virus, which is spread through respiratory droplets or direct contact with an infected person’s saliva. Overall, while mumps is generally a mild and self-limiting illness, vaccination remains the most effective way to prevent its spread and potential complications.

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Frequently Asked Questions

Parotitis is the inflammation of the parotid gland. Through droplets of saliva (spit), parotitis caused by a viral or bacterial infection can easily spread to others. Therefore, towels, eating utensils, cups, and other personal items should not be shared during infectious parotitis.
In acute bacterial parotitis, the patient typically presents with gradual, painful gland swelling, which worsens when chewing. The symptoms of acute viral parotitis, also known as mumps, which is pain and swelling of the gland, range from five to nine days in duration. Anorexia, moderate malaise, and fever are present.
The most common cause of parotitis includes infection due to viruses or bacteria. However, it can also be caused due to other conditions, including -
- Sialolithiasis (obstruction of the parotid gland ducts).
- Sjogren's syndrome (immune system disorder with characteristic dry eyes and dry mouth).
- Rheumatoid arthritis (autoimmune disorder affecting joints).
- Systemic lupus erythematosus (inflammatory and autoimmune disorder).
- Sarcoidosis (inflammatory cells growth in any body part).
In community-acquired cases of parotitis, the first line of treatment usually involves-
- First-generation cephalosporin (Cefazolin).
- Antistaphylococcal penicillin (Oxacillin and Nafcillin).
- Clindamycin and Vancomycin for suspected methicillin-resistant S. aureus.
The majority of cases of parotitis resolve after ten days, with an average duration of five days. Infection with the mumps may also only cause nonspecific or primarily respiratory symptoms. In some cases, however, it may be asymptomatic.
Children between the ages of 2 and 12 who have not been immunized against the disease are most likely to develop parotitis. Be that as it may, the disease can happen at whatever stage in life and may likewise be found in college-age students. The incubation period, or time between exposure to the virus and illness, is approximately 12 to 25 days.
To treat parotitis at home, below are some common remedies that one try-
- Rinsing the mouth with warm salt water to keep the mouth moist and ease the pain.
- Drinking lots of water and using sugar-free lemon drops increases saliva flow and reduces swelling.
- Stop smoking to speed up the healing.
Coronavirus disease (COVID) symptoms include respiratory and gastrointestinal problems and fever. Atypical manifestations of COVID-19 have been reported, despite the fact that the virus most commonly causes symptoms in the respiratory tract. In addition, it has been established that acute parotitis is a COVID-19-related clinical manifestation. To prevent disease transmission, clinicians must be familiar with these unusual presentations.
The mumps virus, a member of the paramyxoviruses family, is the cause of viral parotitis, also known as mumps. It is best known for swelling of the parotid glands, but it can infect many body parts. It is a very common infection known to recur in most cases.
Mumps, also known as viral parotitis, is a contagious illness. It begins with mild symptoms like headache, fever, and tiredness. However, it typically results in severe parotitis, or swelling of some salivary glands, which causes a tender, swollen jaw and puffy cheeks.
The face will be visually examined by a healthcare professional. They might press lightly on the skin along the jawline and in front of the ears. The provider may also massage from the back to the front of the parotid gland to confirm a parotitis diagnosis. This helps them determine whether the saliva contains pus or drainage.
With treatment, people with parotitis typically have a favorable outlook. Usually, the condition lasts between seven and ten days. Most people fully recover without complications, even without treatment.
Rapid swelling is more likely to indicate a malignant tumor or infection, while slow swelling typically indicates a benign tumor. Facial nerve palsy, or difficulty moving one side of the face, can indicate a malignant, advanced tumor, principally in the parotid gland.
Pain in the area of the gland that is swollen is one of the most common parotitis symptoms. The parotid glands of the majority of people with acute parotitis are extremely tender. Most of the time, people who have chronic parotitis do not feel much pain or discomfort. Other symptoms may include fever with chills, sore throat, headache, tiredness, and loss of appetite.
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Dr. Preetha. J from iCliniq
Dr. Preetha. J

Dentistry

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