Common Questions About Vaccines (for Parents) | Nemours KidsHealth
Parotitis (Parotid Gland Swelling)
Medically reviewed by John Carew, MD
Parotitis is inflammation of one or both parotid glands, two large salivary glands responsible for making approximately 50% of your saliva. The parotid glands are located in each cheek over the jaw and in front of the ears.
Saliva is important for health as it contains electrolytes, which support many bodily functions from transporting water in the body to supporting nerve and muscle function. Saliva also contains enzymes, such as salivary amylase which helps break down carbohydrates.
Parotitis occurs equally among all genders, but some types of parotitis, such as acute bacterial parotitis, are more common in older populations.
TypesThere are several types of parotitis, based on what causes the parotitis to develop and whether the parotitis is acute or chronic. Acute parotitis is when symptoms like pain and swelling come on suddenly while chronic parotitis is long-lasting and recurring, meaning the symptoms will come and go.
Acute Bacterial ParotitisAcute bacterial parotitis happens when a bacterial infection causes inflammation in the parotid glands. An infection of the bacteria Staphylococcus aureus, or Staph infection, is the most common cause of this type. This type of parotitis is uncommon among the general population. It most frequently affects older people but can affect people of any age, including infants.
Chronic Bacterial ParotitisChronic bacterial parotitis may be caused by stones (calculi), or concentrations of mineral salts, that become lodged in the salivary glands. It can also occur from an injury that causes narrowing of the salivary ducts. Another common cause of this type is decreased salivary flow, which can lead to inflammation that causes the infection.
Acute Viral ParotitisAcute viral parotitis occurs from a viral infection. Most often, the cause is mumps, a contagious paramyxovirus characterized by symptoms such as swelling of the salivary glands and a tender, swollen jaw. Other viral causes include influenza (the flu) and enteroviruses (viruses primarily transmitted via the intestines) such as Coxsackie A and echovirus.
Chronic ParotitisChronic parotitis, also known as autoimmune parotitis, happens as a result of a chronic disease. Conditions that can cause this type include autoimmune disorders such as rheumatoid arthritis (RA), Sjögren's syndrome (a disorder where the immune system attacks parts of the body that make moisture), and systemic lupus erythematosus (a condition where the immune system attacks tissue in the body). This type of parotitis is characterized by recurring infections and symptoms.
Parotitis SymptomsThe main symptom of parotitis is swelling of the parotid glands, but there are other symptoms that may indicate parotitis. These include:
Sore throat
Fever
Cloudy-appearing saliva
Unpleasant or abnormal tastes in the mouth
Redness over the upper neck or side of the face
Chronic, non-tender swelling in the gland (in parotitis caused by certain conditions)
Lump in the gland (in parotitis caused by tuberculosis)
In acute bacterial parotitis, increasingly painful swelling of the gland can occur. This pain is often made worse by chewing.
In acute viral parotitis, pain and swelling of the gland will typically last 5-9 days. Other symptoms include a lack of appetite, fever, and a general feeling of discomfort.
These are just some of the symptoms of parotitis. If you think you might have parotitis, visit a healthcare provider for diagnosis.
What Causes Parotitis?When you have parotitis, your parotid glands swell and may be accompanied by other symptoms such as pain, loss of appetite, and sore throat. Many different factors can lead to this inflammation of the glands, including:
Bacteria, such as staphylococcus aureus (staph), viridans streptococci, and escherichia coli (E. Coli)
Viruses, such as human immunodeficiency virus (HIV), influenza, and enteroviruses
Mumps
Decreased salivary flow
Salivary gland blockage from calculi, or salivary duct stones
Injury that causes narrowing of the salivary ducts
Malignant (cancerous) and benign (non-harmful) salivary gland tumors
Metabolic disorders, such as diabetes
Inflammatory diseases such as rheumatoid arthritis, Sjögren's syndrome, and sarcoidosis (a condition that causes growths in the lungs, lymph nodes, eyes, and skin)
Tuberculosis (TB), an infectious disease that mainly affects the lungs
Certain types of drugs, such as drugs containing iodines or propylthiouracil, used to treat Graves' disease and hyperthyroidism (overactive thyroid)
Risk factors of acute bacterial parotitis include dehydration, malnutrition, dental infections, and cystic fibrosis. There is also a higher risk of acute bacterial parotitis among older people, particularly as a complication after abdominal surgery or due to medication use. This demographic often takes medications that reduce salivary flow, which increases their risk of developing infected parotid glands.
DiagnosisIf you think you may have parotitis, schedule an appointment with a healthcare provider. The provider will discuss your symptoms with you and perform a physical exam to look for enlarged glands. They will also look for any pus or drainage in the mouth.
In some cases, the provider may need to run certain diagnostic tests to properly diagnose stones in the salivary ducts or abscesses (pus-filled bumps). These include:
Computed tomography (CT) scan: An imaging test that uses X-ray technology to take detailed images of the inside of the body
Magnetic resonance imaging (MRI) scan: A medical imaging technique that uses radio waves and a powerful magnetic field to produce detailed, three-dimensional images of the inside of the body
Ultrasound: An imaging test that uses high-frequency sound waves to take pictures of the inside of the body
Sialendoscopy: A medical technique that uses a tiny camera and other instruments to diagnose and treat salivary gland infections such as parotitis
If you are experiencing drainage or pus, the provider may send a sample for medical analysis to test for a bacterial infection and confirm bacterial parotitis.
Treatments for ParotitisTreatment goals for parotitis are to kill bacteria, reduce swelling and pain, speed up healing, and reduce potential complications that could occur.
For milder cases, your provider may recommend the following:
Drink plenty of water
Apply warm compresses
Perform a gentle glandular massage from back to front to help alleviate symptoms and aid in healing
Take sialagogues, which are substances—usually lemons or sour candies—that help promote the production of saliva
Try Tylenol (acetaminophen) or Advil (ibuprofen) to reduce pain and inflammation
Treatment for acute bacterial parotitis typically requires a course of antistaphylococcal antibiotics. Treatment may also include gentamicin (an antibiotic), analgesics (pain-relief medications), or intravenous (IV) hydration. During these treatments, it is important to stay hydrated by drinking enough water.
For cases of parotitis caused by inflammatory conditions or other health conditions such as tuberculosis, treatment or management of the underlying health condition is essential to relieve symptoms.
PreventionYou can't completely prevent parotitis as it can be caused by bacteria, viruses, and underlying health conditions. However, you can implement a few habits to reduce your risk. Try to:
Drink plenty of water to stay hydrated
Limit or avoid smoking
Brush your teeth and floss at least twice per day, as good oral hygiene can help prevent bacterial parotitis
If left untreated, parotitis can result in a few potential complications. It's important to see a healthcare provider promptly if you experience any symptoms of parotitis to avoid complications. These complications include:
Chronic bacterial parotitis: Long-lasting bacterial parotitis with symptoms of inflammation can result from autoimmune diseases or bacterial infections that are not treated. In rare cases, fistulas, or an abnormal connection between the salivary gland and the skin, can form.
Xerostomia: Also known as dry mouth, xerostomia is a chronic condition where the mouth does not produce enough saliva to keep the mouth moist. It is a common side effect of Sjögren's syndrome and can lead to parotitis.
Facial paralysis or facial nerve injury: This rare complication can result from chronic inflammation caused by an inflammatory disorder such as Sjögren's syndrome or lupus. Also, while rare, one of the risks of surgery or biopsies on the parotid is facial nerve injury.
Septic thrombophlebitis: In rare cases, internal septic thrombophlebitis can occur. This is an extremely rare condition where a blood clot occurs, causing swelling or inflammation of the internal jugular vein. Thrombophlebitis is a serious condition that can be life-threatening if left untreated so it's important to get medical attention immediately.
Parotitis is the inflammation of one or more of the parotid salivary glands, located in front of the ears. There are various types of parotitis, including bacterial and viral parotitis.
Symptoms of parotitis may include sore throat, swelling, fever, and an unpleasant or abnormal taste in the mouth. Causes include bacteria such as E. Coli and viruses such as HIV and mumps. Health conditions such as autoimmune and metabolic disorders can also lead to parotitis, as can injuries that cause narrowing of the salivary ducts.
It isn't always possible to prevent parotitis, but it is possible to reduce your risk by limiting or avoiding smoking and maintaining good oral hygiene to prevent bacteria growth. You should see a healthcare provider if you think you may have parotitis. Leaving parotitis untreated can lead to chronic or serious complications so get it treated as soon as possible.
Frequently Asked QuestionsWill parotitis go away on its own?
In some cases, parotitis will resolve on its own with self-care at home, but certain types (such as bacterial parotitis) will require treatment with antibiotics or further medical care. It is important to treat bacterial parotitis promptly to avoid further health complications.
How contagious is parotitis?
Parotitis caused by inflammation is not contagious. However, viral or bacterial parotitis is caused by infectious viruses or bacteria and can be spread from person to person.
Is it OK to massage the parotid gland?
Yes, it is safe to self-massage the parotid glands. When massaging the parotid glands to help treat parotitis, make sure to use gentle pressure and massage in the direction of back to front. A healthcare provider may also perform the massage to extract sialolithiasis (salivary stones), one of the causes of parotitis.
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Tackling A Pathogen That Leaves A Lasting Impression
Staphylococcus aureus (S. Aureus) has a complicated relationship with humans. While this commensal bacterium colonizes approximately 20-30 percent of human nasal cavities and is a member of the human skin microbiome, S. Aureus is also a major opportunistic pathogen, which often causes deadly infections in immunocompromised patients.1,2 Further complicating this relationship is the emergence of several multidrug-resistant strains, which are key threats to public health globally.3 Consequently, a vaccine against S. Aureus is of grave importance. However, despite numerous attempts over multiple decades, none of the vaccine candidates effectively prevented S. Aureus infections in humans, baffling researchers.
In a recently published Cell Reports Medicine paper, researchers determined that previous exposures to the pathogen affect vaccine efficacy, where they could predict a vaccine's success by evaluating the antigen type and the pre-existing titer of antibodies against that antigen.4 This information will guide scientists to develop improved vaccines for humans.
"One of the big dilemmas in the field was that we have this vaccine problem," said George Liu, an immunologist and infectious disease researcher at the University of California, San Diego School of Medicine and author of this study. "There have been probably close to 30 [clinical] trials [with] about 10 or more of these phase two and phase three trials where they really study the efficacy of the vaccines. And all of these wonderful vaccines that work in mice, when they take them to humans, they fail."
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The Scientist Speaks - Virulence Meets Metabolism: The Unique Evolution of Staphylococcus aureus
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This unsolved problem drove Liu and his team to interrogate the differences between human and mice responses. They suspected that these variations resulted from dissimilar exposure rates. Scientists keep laboratory mice in a relatively sterile environment where they infrequently encounter S. Aureus. Conversely, more than 50 percent of infants carry S. Aureus in their nasal cavities by the age of two months with exposure continuing throughout their lifetime.5
George Liu and his team examine the interaction between Staphylococcus aureus and the host's immune system to develop effective vaccines and therapies against the pathogen.
JR Caldera
Liu and his team previously replicated a vaccine candidate's failure by exposing mice to S. Aureus before immunization.6 Although the vaccine, which targeted a cell-wall-associated antigen (CWA), induced the animals to make protective antibodies against the pathogen, nonprotective antibodies were also produced and directly competed for antigen binding. These ineffective antibodies were originally generated following earlier encounters with the bacterium, which suggested that this vaccine failed because it prompted the mice to recall a nonprotective immune memory. Additionally, these results correspond to the original antigenic sin hypothesis, which proposed that antibodies produced against a dominant antigen following infection with one influenza strain will predetermine the antibodies generated against a new influenza strain even if they are not protective.7
To establish if this hypothesis could also explain other failed vaccines, Liu and his colleagues examined the characteristics of the pre-existing antibodies and their corresponding antigens in mice that had previously encountered the bacterium. They specifically focused on antibodies against the main CWA or bacterial toxins, which included antigens that were the targets of failed vaccine candidates. The researchers noticed that the antibody titers varied within the sera and considered an antigen to be dominant or subdominant depending on its associated antibody abundance. Then they purified the antibodies and employed in vitro assays to test the ability of the CWA antibodies to opsonize the bacterium and lead to phagocytosis-mediated killing; they also used toxin antibodies to protect cells against toxin-induced lysis. They observed that the CWA antibodies did not effectively facilitate S. Aureus killing, which suggested that they were nonprotective. However, the researchers found that the toxin antibodies efficiently neutralized the bacterial toxin.
George Liu, JR Caldera, and their colleagues established that the concentration of existing protective and nonprotective antibodies generated following earlier exposures to Staphylococcus aureus can affect the success of vaccination.
JR Caldera
To determine how these properties affected vaccine efficacy, the researchers immunized mice with and without prior exposure to S. Aureus with the major antigens. On challenging these mice with the bacteria, the researchers observed that vaccines against dominant toxin antigens protected both naïve animals and those previously exposed to the bacterium. These results suggested that protective imprints do not interfere with active vaccination and that immunization against toxins could be an effective strategy. They also determined that vaccination with dominant CWA antigens reduced the bacterial load in naïve mice but had no effect in experienced mice because the vaccine induced the animals to recall a nonprotective imprint. In contrast, immunization against subdominant CWA antigens successfully protected both experienced and inexperienced mice, which indicates that these antigens could be ideal targets for future vaccines.
"People might have existing antibodies to certain antigens of S. Aureus, but the fact that the existing repertoire could actively inhibit a protective response to me was quite surprising," said Dane Parker, an immunologist and microbiologist at Rutgers New Jersey Medical School who was not involved in the study. "[This study] could potentially shape how people do these types of studies moving forward," Parker stated.
Liu is optimistic that this work will help scientists develop effective vaccines against S. Aureus or challenging diseases, such as malaria or tuberculosis. "We are hoping that folks would also explore in their own systems or their own [chosen] pathogens whether this type of immune evasion mechanism could be at work," Liu said.
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ReferencesA Vaccine To Combat Antibiotic Resistance
A team of researchers at Michigan State University have outlined an approach to combating a prevalent public health issue: the development of treatment-resistant infections, particularly staph and MRSA infections. The solution? A vaccine, which is described in a recent article published in Nature Communications.
Antibiotic resistant infections, or infections that do not respond appropriate treatment, is been a public health issue for some time. However, many have started raising the alarm on antibiotic resistant infections as a much more concerning public health issues, with some estimates suggesting it could be just decades before many of the life-changing treatment options that we've come to depend on will no longer be effective at combating otherwise treatable infections. This is especially true of staph and methicillin-resistant Staphylococcus aureus (MRSA), which are among the most common causes of infections. That urgency has led researchers to strive for new options to combat antimicrobial resistance.
Researchers at Michigan State University have turned to vaccine technology as a possible solution for combatting antibiotic resistant infections. Specifically, the vaccine is a carbohydrate-based vaccine that could offer people immunity to these types of infections in the first place, reducing the need for antibiotic treatment. While most vaccines are designed to target specific antigens associated with a virus or bacteria, researchers took a different approach by developing vaccines that target carbohydrates as the "target" antigen.
The challenge is that these carbohydrates, or sugars, are structured in a very unique way to different types of bacteria, making it difficult to design vaccines that can cover multiple targets. These kinds of vaccines, however, would expand the type of coverage available. Researchers focused specifically on Polysaccharide poly-β-(1−6)-N-acetylglucosamine, or PNAG, which is found on staph bacteria as well as several other types of bacteria, making it a promising target for developing robust vaccines that can cover multiple bacteria.
Sources: Science Daily; Nature Communications
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