Parotid gland enlargement

Introduction The swelling of the parotid gland is often the first sign of the disease. It lasts for 7-10 days. The normal side is swollen for 2-3 days. The contralateral parotid gland also appears swollen. Sometimes the swelling is only unilateral, or the parotid gland enlarges and the submandibular gland enlarges. Or even the submandibular glands are swollen without parotid gland enlargement. Pain, chewing, especially when eating acidic foods.

Cause

Mumps virus and the parainfluenza, measles, respiratory syncytial virus and other viruses belong to the paramyxovirus, a ribonucleic acid (RNA) type, isolated from the patient's saliva in 1934, and successfully infected the monkey and "volunteer" By". The virus has a diameter of 85 to 300 nm and an average of 140 nm. It is sensitive to the effects of physical and chemical factors. 1% cresol soap solution, 70% ethanol, 0.2% formaldehyde solution, etc. can be inactivated within 2 to 5 minutes, and rapidly die when exposed to ultraviolet light. The viability can be maintained for 2 months at 4 ° C, 24 h at 37 ° C, and loses vitality after 10 to 20 min when heated to 55-60 ° C. It is quite resistant to low temperatures. The virus is found only in humans but can be proliferated in tissue culture of monkeys, chicken embryos, amnion and various humans and monkeys. Monkeys are most susceptible to this virus. The viral antigen is structurally stable and has only one serotype. But there are six genotypes, namely A to F. Chinese scholars discovered a new genotype in 1998, with nucleotide levels ranging from 0.8% to 4.5%, and amino acid levels ranging from 3.5% to 12.3%.

The nucleocapsid protein of mumps virus has a soluble antigen (S antigen), and its outer surface contains neuraminidase and hemagglutinin glycoprotein, which has a viral antigen (V antigen). ). The S antigen and the V antigen each have their corresponding antibodies. The S antibody appears on the 7th day after onset and peaks within 2 weeks, and then gradually decreases, and can be maintained for 6 to 12 months. It can be measured by the complement binding method, and the S antibody is not protective.

V antibody appears late, can be measured after 2 to 3 weeks of onset, peaks after 1 to 2 weeks, but exist for a long time, can be detected by complement binding, hemagglutination inhibition and neutralizing antibody detection, is the best indicator for detecting immune response , V antibody has a protective effect. Infection with mumps virus can produce an immune response regardless of whether it is ill or not, and re-infection is rare.

In the early stages of the disease, mumps virus can be isolated from saliva, blood, cerebrospinal fluid, urine or thyroid. The virus rarely mutates, and the antigenicity between the strains is very close.

an examination

Related inspection

X-ray lipiodol imaging head palpation

The incubation period is 8 to 30 days, with an average of 18 days. Most patients have no prodromal symptoms, and the first part of the ear is swollen. In a few cases, there may be transient non-specific discomfort (hours to 2 days), muscle soreness, loss of appetite, burnout, headache, hypothermia, conjunctivitis, Pharyngitis and other symptoms. In the past 10 years, the number of children with hooliganism has increased in the past 10 years, showing a long heat history and increased complications. The proportion of hospitalized children in outpatients has also increased.

Most of the onset is more urgent, fever, chill, headache, sore throat, poor appetite, nausea, vomiting, body aches, etc. After a few hours to 1 to 2 days, the parotid gland is significantly enlarged. The fever varies from 38 to 40 °C, and the symptoms are very inconsistent. Adult patients are generally more severe. The swelling of the parotid gland is the most characteristic. One side is swollen first, but it also has swelling on both sides. Generally, it is centered on the earlobe, and develops forward, backward, and downward. It is shaped like a pear and has a toughness and an unclear edge. When the gland enlarges, the pain and hypersensitivity appear. It is even worse when chewing and chewing into an acidic diet. The local skin is intense and the surface is hot, but it is not red, and there is light tenderness. The cellulite around the parotid gland can also be edematous, up to the ankle and humeral arch, down to the jaw and neck, and the sternocleidomastoid can also be affected (occasionally edema can occur in front of the sternum), thus making The face is deformed.

Usually one side of the parotid gland is swollen 1 to 4 days (occasionally 1 week later) involving the contralateral side, and bilateral swelling accounts for about 75%. Submandibular glands or sublingual glands can also be affected at the same time. The submandibular glands are swollen when the neck is swollen. The submandibular canal and the flexible and lightly tender elliptical glands: the sublingual glands can also be involved at the same time. Sublingual gland When the time is big, the tongue and neck are swollen and there is difficulty in swallowing. The mouth of the parotid gland (located on the buccal mucosa next to the second molar) is often red and swollen at an early stage. Salivary secretion increased initially, followed by retention, but dry mouth symptoms were generally not significant. The swelling of the parotid gland mostly reaches the peak in 1 to 3 days, and gradually subsides and returns to normal after 4 to 5 days. The entire course of disease is about 10 to 14 days. Atypical cases may be caused by swelling of the parotid gland and symptoms of simple orchitis or meningoencephalitis, as well as swelling of the submandibular gland or sublingual gland.

Diagnosis is not difficult based on prevalence and exposure history, as well as the characteristics of parotid swelling. In the case of atypical suspicious cases, the diagnosis can be further confirmed by the above laboratory test methods.

Differential diagnosis

Differential diagnosis of parotid swelling:

Suppurative mumps

Often one side, local redness and tenderness is obvious, and there is a sense of fluctuating in the late stage. When squeezed, pus flows out from the parotid gland, and the total number of white blood cells and neutrophils in the blood is significantly increased.

2. Neck and pre-auricular lymphadenitis

The swelling is not centered on the earlobe, and is confined to the neck or the anterior region of the ear. It is a nucleus, which is hard, has a clear edge, and has tender tenderness. It can be found that the tissues associated with the lymph nodes in the neck or anterior region have inflammation, such as angina, ear scab, etc., and the total number of white blood cells and neutrophils are increased.

3. Symptomatic parotid swelling

In diabetes, malnutrition, chronic liver disease, or the application of certain drugs such as iodide, phenylbutazone, isoproterenol, etc. can cause parotid swelling, symmetry, no swelling and pain, soft touch, tissue examination Mainly for steatosis.

4. Mumps caused by other viruses

It is known that type 1.3 parainfluenza virus, influenza A virus, type A Coxsackie virus, herpes simplex virus, lymphatic choroidal meningitis virus, cytomegalovirus can cause parotid swelling and central nervous system symptoms, requiring pathogenic diagnosis .

5. Parotid swelling caused by other causes

Allergic mumps and parotid duct obstruction have a history of recurrent episodes, and the swelling is sudden and the swelling is rapid. Simple parotid gland is mostly seen in adolescent males due to increased functional secretion, compensatory parotid swelling, and no other symptoms.

6. Meningoencephalitis caused by other viruses

Mumps meningoencephalitis can occur before the parotid gland enlargement (some have never been swollen from the parotid gland), and it is difficult to distinguish it from those caused by other viruses. It can be confirmed by the above serological examination, virus isolation and epidemiological investigation.

The incubation period is 8 to 30 days, with an average of 18 days. Most patients have no prodromal symptoms, and the first part of the ear is swollen. In a few cases, there may be transient non-specific discomfort (hours to 2 days), muscle soreness, loss of appetite, burnout, headache, hypothermia, conjunctivitis, Pharyngitis and other symptoms. In the past 10 years, the number of children with hooliganism has increased in the past 10 years, showing a long heat history and increased complications. The proportion of hospitalized children in outpatients has also increased.

Most of the onset is more urgent, fever, chill, headache, sore throat, poor appetite, nausea, vomiting, body aches, etc. After a few hours to 1 to 2 days, the parotid gland is significantly enlarged. The fever varies from 38 to 40 °C, and the symptoms are very inconsistent. Adult patients are generally more severe. The swelling of the parotid gland is the most characteristic. One side is swollen first, but it also has swelling on both sides. Generally, it is centered on the earlobe, and develops forward, backward, and downward. It is shaped like a pear and has a toughness and an unclear edge. When the gland enlarges, the pain and hypersensitivity appear. It is even worse when chewing and chewing into an acidic diet. The local skin is intense and the surface is hot, but it is not red, and there is light tenderness. The cellulite around the parotid gland can also be edematous, up to the ankle and humeral arch, down to the jaw and neck, and the sternocleidomastoid can also be affected (occasionally edema can occur in front of the sternum), thus making The face is deformed.

Usually one side of the parotid gland is swollen 1 to 4 days (occasionally 1 week later) involving the contralateral side, and bilateral swelling accounts for about 75%. Submandibular glands or sublingual glands can also be affected at the same time. The submandibular glands are swollen when the neck is swollen. The submandibular canal and the flexible and lightly tender elliptical glands: the sublingual glands can also be involved at the same time. Sublingual gland When the time is big, the tongue and neck are swollen and there is difficulty in swallowing. The mouth of the parotid gland (located on the buccal mucosa next to the second molar) is often red and swollen at an early stage. Salivary secretion increased initially, followed by retention, but dry mouth symptoms were generally not significant. The swelling of the parotid gland mostly reaches the peak in 1 to 3 days, and gradually subsides and returns to normal after 4 to 5 days. The entire course of disease is about 10 to 14 days. Atypical cases may be caused by swelling of the parotid gland and symptoms of simple orchitis or meningoencephalitis, as well as swelling of the submandibular gland or sublingual gland.

Diagnosis is not difficult based on prevalence and exposure history, as well as the characteristics of parotid swelling. In the case of atypical suspicious cases, the diagnosis can be further confirmed by the above laboratory test methods.

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