Desai, Tasha, DO

Villalobos, Tibisay, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of PediatricsWhen Mumps is Not the Diagnosis: AcuteSialadenitis During Influenza SeasonTasha Desai DOLehigh Valley Health Network, Tasha.Desai@lvhn.orgTibisay Villalobos MDLehigh Valley Health Network, tibisay.villalobos@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/pediatricsPart of the Pediatrics CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtDesai, T., Villalobos-Fry, T. (2015, October 7). When Mumps is Not the Diagnosis: Acute Sialadenitis During Influenza Season. Posterpresented at: IDWeek 2015 ,San Diego, CA.Children’s Hospital at Lehigh Valley Health Network, Allentown, PennsylvaniaWhen Mumps is Not the Diagnosis: Acute Sialadenitis During Influenza SeasonTasha Desai, DO and Tibisay Villalobos-Fry, MDBackground ResultsDuring the winter of 2014-2015, there were a significant number of children diagnosed with acute sialadenitis or parotitis from the emergency department with presenting complaints of URI symptoms and sore throat. In recent years, several states have reported outbreaks of mumps cases, and initial work-up was aimed to rule out this particular viral infection. As several of these children were also diagnosed with Influenza, this led to the hypothesis of Influenza as the cause of sialadenitis/parotitis. Literature search wielded few prior reports describing association between Influenza A and acute parotitis in the pediatric population, with most recent published cases reporting acute parotitis secondary to Influenza H3/N2 subtype.Conclusion:© 2015 Lehigh Valley Health NetworkReferences:1.  Bastien N, Bowness D, et al: Parotitis in a Child Infected with Triple-Reassortant Influenza, A Virus in Canada in 2007. Journal of Clin Microbiology 47:1896-1898, 2009.2.  Battle S, Laudenbach J, Maguire J: Influenza Parotitis: A Case from the 2004 to 2005 Vaccine Shortage. So Society for Clin Investigation 333: 215-217, 2007.3.  Brill S, Gilfillan R: Acute Parotitis Associated with Influenza Type A. N Engl J Med 296:1391-1392, 1977. 4. Centers for Disease Control. Update – Influenza Activity. MMWR 2015; 64: 206-212.5.  Davidkin I, Jokinen S, et al: Etiology of Mumps-Like Illnesses in Children and Adolescents Vaccinated for Measles, Mumps, and Rubella. J Infect Dis 191: 719-723, 2005.ImagesPatient 1: 10 year old male •  Symptoms: facial swelling, mouth sores, fever, rhinorrhea, sore throat    •  Signs: bilateral parotitis; oral mucosal ulcers •  Diagnostic testing: CMV/EBV/Mumps titers, respiratory viral panel PCR  •  Result: Influenza AAcute parotitis or sialadenitis during the winter months can be due to Influenza A infection, even without the presence of systemic symptoms typical of Influenza. In fully vaccinated children in whom Mumps is ruled out, Influenza virus infection should be included in the list of differential diagnoses of acute sialadenitis.Figure 1. Bilaterally enlarged submandibular glands with intraglandular ducts (red arrows). Scattered jugular, submandibular, submental, and retropharyngeal reactive lymph nodes (orange arrows).  Acknowledgements:We thank Teresa Romano, MD and Kenneth Rachwal, PA-C for assisting in data collection. We also thank Alexander Kowal, MD for discussing radiology findings as depicted.MethodsInstitutional chart review was performed for pediatric cases of facial swelling, revealing 12 cases with diagnoses of acute parotitis or sialadenitis between October 2014 and January 2015. Due to the presence of URI symptoms and sore throat, 4 cases had diagnostic influenza testing. All 4 samples were nasopharyngeal swabs collected for PCR testing (Luminex panel - xTAG® 1 or Focus Simplexa2) performed by the same hospital-affiliated laboratory.Patient 2: 11 year old female with nephrotic syndrome •  Symptoms: facial swelling, jaw pain with mastication, fever •  Signs: bilateral parotitis •  Diagnostic testing: UA, CBC, CMP, respiratory viral panel PCR •  Result: Influenza A/H3Patient 3: 20 year old female with history of asthma •  Symptoms: fever, URI symptoms, cough, neck swelling, sore throat •  Signs: bilateral submandibular lymphadenopathy •  Diagnostic testing: CBC, CRP, Monospot, blood culture, CT neck, EBV/CMV/Baronella titers, respiratory viral panel PCR •  Result: Influenza A/H3   -  CT: bilateral sialadenitis, suspected transudate in the retropharynx, multiple reactive lymph nodesPatient 4: 14 year old male •  Symptoms: sore throat, cough, bilateral neck swelling, “congested voice” •  Signs: bilateral submandibular gland swelling  •  Diagnostic testing: CBC, BMP, blood culture, EBV titers, rapid Flu/RSV PCR, CT neck •  Result: Influenza A   -  CT: infectious inflammatory changes involving the retropharynx and danger space, with no abscess; edematous changes involving the aryepiglottic foldsFigure 2. Bilaterally enlarged submandibular glands with dilated intraglandular ducts (red arrows). Retropharyngeal fluid collection without rim enhancement (yellow arrows). Multiple reactive lymph nodes.Table 1. Patient Demographics and Symptoms Age Gender Time of Presentation Chief ComplaintCongestion/Rhinorrhea CoughSore Throat Fever Test Results5 Male October Post-auricular swelling - + - - N/A15 Male October Facial swelling - - - - N/A6 Male November Facial swelling - - - - N/A2 Male November Post-auricular swelling Croup + N/A16 Male December Facial swelling + - + - N/A7 Female December Facial swelling - - - - N/A10 Male December Facial swelling + - + + Influenza A11 Female November Facial swelling - - - + Influenza A/H320 Female December Neck swelling + + + + Influenza A/H314 Male December Neck swelling - + + - Influenza A10 Male December Neck swelling + + + + N/A12 Female January Jaw swelling + + + N/A  Differential Diagnosis of SialoadentitisViral • Coxsackie virus •  Influenza A virus •  Parainfluenza virus •  Cytomegalovirus •  Adenovirus •  Epstein-Barr virus •  Varicella-zoster virusBacterial •  Staphylococcus aureus •  Alpha-hemolytic Streptococcus •  Streptococcus pyogenes •  Haemophilus influenzae •  Escherichia coli •  Klebsiella pneumoniae •  Pseudomonas aeruginosa •  Pseudomonas pseudomallei •  Eikenella corrodens•  Adenovirus•  Epstein-Barr virus•  Varicella-zoster virus•  Peptostreptococcus•  Prevotella•  Fusobacterium•  Bacteroides•  Actinomyces•  Mycobacterium•  Bartonella•  Salmonella•  TreponemaAtypical Presentations of Influenza• Sialadenitis/parotitis•  Croup•  Bronchiolitis•  Pneumonitis/pneumonia•  Encephalitis•  PANDAs•  Myocarditis All 4 patients recovered without complications.Footnotes:1.  Luminex tests for Respiratory Syncytial Virus (RSV and A&B,  Influenza (A Matrix, H1 subtype, H3 subtype, B), Parainfluenza (A, B, C), Metapneumovirus, Adenovirus, Rhinovirus.2.  Focus Simplexa tests for Influenza (A, B), RSV.

When Mumps is Not the Diagnosis: Acute Sialadenitis During Influenza Season

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When Mumps is Not the Diagnosis: Acute Sialadenitis During Influenza Season

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