Parotitis: Presentation and Management

Clinical Presentation

The Centers for Disease Control and Prevention recommends that parotitis presents with unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting ≥2 days, often accompanied by pain and fever 1, 2
Acute onset of unilateral or bilateral parotid swelling and tenderness is a typical symptom of parotitis 2
Pain on swallowing is a common symptom of parotitis 3
Fever, headache, malaise, myalgia, and anorexia may precede parotitis 2, 4
In mumps, parotitis typically develops 16-18 days after exposure 4

Mumps is most common in children aged 2-9 years 4
Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic 4
Bacterial parotitis is more common in patients with hyposalivation (e.g., Sjögren syndrome) 5

Viral: Mumps virus (most common viral cause) is a common cause of parotitis 1, 2
Sjögren syndrome (may present with recurrent parotitis) is a non-infectious cause of parotitis 5
Immune-related adverse events from checkpoint inhibitors can cause parotitis 6

For suspected mumps, serum mumps IgM antibodies (positive in acute infection) can be used for diagnosis 7
Paired acute and convalescent serum for mumps IgG (4-fold rise indicates recent infection) can be used for diagnosis 7
Buccal swab around affected parotid gland and Stensen's duct for viral culture or NAAT can be used for diagnosis 7
CT with IV contrast is useful for evaluating parotid inflammation and possible abscess formation 8
MRI with and without contrast provides comprehensive information about extent of disease 8
Ultrasound can differentiate between parotid and extraparotid masses 8

Supportive care with hydration is recommended for viral parotitis (mumps) 1, 2
Analgesics for pain relief are recommended for viral parotitis (mumps) 9
Isolation of infected individuals to prevent spread is recommended for viral parotitis (mumps) 1
Vaccination is the primary preventive measure for mumps 4

Orchitis in up to 38% of postpubertal men with mumps is a potential complication 4
Aseptic meningitis in 4-6% of clinical mumps cases is a potential complication 4
Sensorineural deafness (can be sudden, bilateral, and permanent) is a potential complication of mumps 4