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Recurrent parotitis of childhood
C M Leerdam1, H C O Martin, D Isaacs
1Department of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Westmead, New South Wales, Australia. carol_leerdam@yahoo.com
Insights
Recurrent parotitis (RP) in children presents with swelling and pain, often misdiagnosed. Early diagnosis and ultrasound confirmation are key, as antibiotics are ineffective for this condition.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Immunology
- Diagnostic Imaging
Background:
- Recurrent parotitis (RP) is a rare childhood condition with an unclear cause, likely immune-related.
- It presents with recurrent episodes of parotid gland swelling and pain.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and management of recurrent parotitis in children.
- To identify key diagnostic features and treatment approaches for childhood RP.
Main Methods:
- A retrospective study of 53 children diagnosed with RP between 1983 and 2004.
- Data collection included clinical symptoms, diagnostic methods, and treatment outcomes.
Main Results:
- RP shows a biphasic age distribution (2-5 years and 10 years).
- Common symptoms include swelling (100%), pain (92.5%), and fever (41.5%), with delayed diagnosis common (>1 year in 70%).
- Ultrasound confirmed sialectasis in 81% of patients; antibiotics were used in over half without clear benefit. Associated conditions included hypogammaglobulinaemia and Sjogren's syndrome.
Conclusions:
- Recurrent parotitis is characterized by recurrent episodes and lack of pus, distinguishing it from other parotid swellings.
- Ultrasound is valuable for diagnosis, and antibiotics are not indicated.
- Screening for immune deficiencies and Sjogren's syndrome is recommended for affected children.
Background:
Recurrent parotitis (RP) of childhood is a rare condition of unknown aetiology, probably immunologically mediated.
Objective:
To review the clinical presentation, diagnosis and management of RP of childhood.
Methods:
Retrospective study from 1983 to 2004 of children diagnosed with RP of childhood at a tertiary children's hospital.
Results:
We identified 53 children, 37 (70%) male and 16 (30%) female. The age of onset was biphasic, with peaks at 2-5 years of age and at 10 years. The commonest symptoms were swelling (100%), pain (92.5%) and fever (41.5%). Symptoms usually lasted 2-7 days with a median of 3 days. The mean frequency was 8 episodes per year. The diagnosis was often delayed, >1 year in 70% of patients, maximum 8 years. The most common diagnoses, before the definitive diagnosis of RP, were mumps (21%), 'infection' (15%) and stones (11%). Sialogram (57%) and/or ultrasound (41%) showed sialectasis in 81% of patients. Over half the patients (54%) were given antibiotics at least once to treat the parotitis. Two children had hypogammablobulinaemia, one child had human immunodeficiency virus infection, and one child had Sjogren's syndrome. Two children had high titre antinuclear antibodies.
Conclusions:
Recurrent parotitis had a biphasic age distribution. The major clinical features that distinguish it from other causes of parotid swelling are the lack of pus and recurrent episodes. A clinical diagnosis can often be confirmed by ultrasound. Antibiotics do not have a role in treatment. Affected children should be screened for Sjogren's syndrome and immune deficiency.
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