Monolateral suppurative parotitis in a neonate and review of literature

Neonatal Suppurative Parotitis: Case Report and Review of Literature

Neonatal suppurative parotitis is a rare condition that is diagnosed primarily through clinical evaluation. The prognosis is generally good. In this report, we present the case of a 21-day-old female infant who was treated in our ENT department for neonatal suppurative parotitis. The patient presented with a feverish, hard, red, and tender swelling of the parotid loge which displaced the right earlobe outward. In addition, purulent exudate was observed from Stensen's duct. A computed tomography scan of the cervical and cerebral regions revealed a swollen right parotid gland with heterogeneous density and enhancement, but no detectable collection. The patient received intravenous antibiotics for 48 hours, resulting in a favorable outcome without the need for surgical treatment. The aim of this study is to emphasize the diagnostic and therapeutic aspects of this clinical condition. Suppurative parotitis should be suspected by the clinician in newborns who present with an inflammatory preauricular swelling, with or without contributing factors. The outcome is generally favorable, and complications are rare with timely and appropriate medical treatment.

Neonatal Parotitis: A Case Report and Review of the Literature

BACKGROUND

Neonatal parotitis is a rare disease. Between 1970 and 2011 only 44 cases have been reported in the English literature.

METHODS

In this case report, we describe a case of neonatal parotitis caused by Group B streptococcus (GBS). Additionally, we performed a review of the recent literature. We found 18 new cases published between 2011 and 2020. These cases were analyzed together with the 44 cases published before 2011.

RESULTS

All patients presented with swelling over the parotid area, with varying degrees of local inflammation and general symptoms. Purulent discharge from the Stensen's duct was present in 85% of the patients. The swelling was usually unilateral (84%). In total 70% of the patients were male. Prematurity was reported in 29% of the cases. The most common isolated pathogen was Staphylococcus aureus (68%). Only 5 cases were found describing GBS as the causative pathogen in neonatal parotitis. In most of the cases treatment with intravenous antibiotics was successful, 27% of the patients needed surgical drainage. The reported outcomes were good.

CONCLUSIONS

When comparing GBS cases and non-GBS cases there seems to be a difference in presenting symptoms and pathophysiology, with GBS patients presenting without purulent discharge form the Stensen's duct and with more severe generalized symptoms. Additionally, all GBS patients had a positive blood culture, compared to 27% of the non-GBS patients, which indicates that in GBS cases the major route of parotid infection is hematogenous, compared to a retrograde flow from the oral cavity to the parotid gland in non-GBS cases.

Polymicrobial Acute Suppurative Parotitis in a 33-Day-Old Infant: A Case Report and Review of the Literature

BACKGROUND

Acute suppurative parotitis (ASP) of neonates is a rare condition characterized by irritability, erythema, and tenderness of the affected gland.

METHODS/RESULTS

Only few cases have been reported in Engilsh literature, mostly in male neonates, in a unilateral fashion. In our case, a polymicrobial etiology (Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter ursingii, and Acinetobacter junii) was found. Based on the review of the microbiological findings of cases of ASP in English literature for the years 1970 to 2020, S. aureus is the most commonly isolated microorganism (47% of the total 65 patients). Our patient was born with a C-section procedure and was not breast-fed, making dysbiosis along with the usage of the feeding bottle, possible risk factors for the development of ASP.

CONCLUSIONS

ASP may be due to polymicrobial etiology. Initial presentation in neonates may not include typical signs and symptoms, like fever. Aseptic technique of oral procedures is of utmost importance also in immune-competent neonates.

Neonatal Parotitis: A Case Report

Introduction

Acute suppurative parotitis is a rare finding in the neonate. It is commonly caused by Staphylococcus aureus, but other bacterial isolates may be emerging. It is a novel disease for this age group and requires unique management. Only 32 cases of neonatal suppurative parotitis have been described in the English-language literature over the last 35 years.

Case Report

We describe a case of a 14-day-old male who presented to the pediatric emergency department with a 24-hour history of swelling and redness of the right cheek. On examining him, purulent material was seen inside his oral cavity. He was subsequently hospitalized with a diagnosis of neonatal suppurative parotitis and received five days of parenteral antibiotics with improvement in swelling and redness. He was discharged home with oral antibiotics.

Conclusion

Although neonatal suppurative parotitis is rare, it should be suspected in newborns presenting with an erythematous pre-auricular mass with or without any predisposing factors. We describe a rare case of acute suppurative parotitis in a neonate and review the published literature.

Assessment of continuous pain in newborns admitted to NICUs in 18 European countries

AIM

Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.

METHODS

A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission.

RESULTS

Only 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p < 0.001). Daily assessments for continuous pain occurred in only 10.4% of all neonates (TrV: 14.0%, NiV: 10.7%, NoV: 7.6%; p < 0.001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions and surgical admissions (all p < 0.01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anaesthetics (O-SH-GA) (all p < 0.001), or surgery (p = 0.028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1.60, p < 0.001) and NiV groups (OR:1.40, p < 0.001).

CONCLUSION

Assessments of continuous pain occurred in less than one-third of NICU admissions and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.

Acute neonatal parotid abscess: A rare case report

Acute suppurative parotitis is uncommon in children and is very rare in neonates. Most common organism isolated is Staphylococcus aureus. We present a 15-day-old full-term breast-fed female neonate with left-sided acute parotid abscess. The baby presented with a left preauricular swelling, pain and redness. Pus was exuded from left Stensen's duct on compression of the gland externally. Early diagnosis and proper intravenous antibiotics are the keys to the treatment.

Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis?

Neonatal sialadenitis is a rare condition. The vast majority of cases are caused by Staphylococcus aureus with predominant involvement of the parotid gland and need for long-term antimicrobial therapy. We reviewed three distinct cases of submandibular sialadenitis in preterm infants from monochorionic pregnancies. The association with neonatal sialadenitis is unproven. We speculate about the role of fetal distress and circulatory compromise in monochorionic twins as a risk factor in the development of this serious condition.

Group B streptococcal neonatal parotitis

Acute neonatal parotitis (ANP) is a rare condition, characterised by parotid swelling and other local inflammatory signs. The most common pathogen is Staphylococcus aureus, but other organisms can be implicated. We describe the case of a 13-day-old term newborn, previously healthy, with late-onset group B Streptococcus (GBS) bacteraemia with ANP, who presented with irritability, reduced feeding and tender swelling of the right parotid. Laboratory evaluation showed neutrophilia, elevated C reactive protein and procalcitonin, with normal serum amylase concentration. Ultrasound findings were suggestive of acute parotitis. Empiric antibiotic therapy was immediately started and adjusted when culture results became available. The newborn was discharged after 10 days, with clinical improvement within the first 72 h. Although S. aureus is the most common pathogen implicated in ANP, GBS should be included in the differential diagnosis.

Suppurative parotitis in a girl: a case report from ahvaz, iran

INTRODUCTION

Neonatal parotitis is a rare disease. Neonatal suppurative parotitis commonly presents with facial swelling, irritability, tenderness of parotid region, and with or without fever. Acute neonatal suppurative parotitis is one of the differential diagnoses of facial swelling with a prevalence of 3.8/10'000 of neonatal admission.

CASE PRESENTATION

A 32-day-old girl with fever and restlessness was admitted in the hospital. Left facial swelling was found during physical examination. Redness was observed in the face. Prenatal history was normal. Birth weight was 3500 g. Body weight, length, and head circumference were 4300 g (75 th percentile), 52 cm (50 th percentile), and 38 cm (75 th percentile), respectively. She was breastfed. Pulse and respiratory rates were 130/min and 50/min, respectively. Axillary temperature was 37.8°C. Head examination revealed normal sized fontanel (1.5 × 1.5 cm) without bulging. Eye and ear were normal. Abdominal examination revealed no abnormal findings. Results of urine analysis and culture were normal. Blood urea nitrogen, sodium, potassium, and blood sugar were normal. Blood amylase was 10 U/L. Bilateral multiple reactive lymph node (size = 6 × 10 mm) at anterior cervical chain with a left facial swelling was observed in ultrasonography report. Pus was obtained following gentle pressure on Stensen's duct. Staphylococcus aureus was detected in the microscopic and microbiological evaluations.The patient received a seven-day treatment course with vancomycin and amikacin. Neonate was discharged in a good condition.

CONCLUSIONS

Acute suppurative parotitis should be suspected in infants with fever, and irritability in pre-auricular region; and should be treated with appropriate antibiotics.

[Bacterial parotitis in an immunocompromised patient in adult ICU]

Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult--particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.