Sore throats are common. Most people tough them out and they go away.
Rarely, they get worser and worser with progressive fevers, chills, myalgias and prostration. That’s a sore throat worth a visit to the ER and subsequent admission.
No past medical history of note, she has a painful, swollen knot at the angle of the jaw and a CT shows inflammation of the salivary gland.
I haven't seen one of these in ages. There was a time, at the dawn of the ICU era, when parotitis was not an uncommon cause of ICU infections, but good fluid management and oral care has made nosocomial parotitis disappear.
All her blood cultures are growing S. aureus, so I think this is a bacteremia from the salivary gland. Oddly, on the CT there is no stone, the usual cause of bacterial parotitis.
The last one of these I took care of died of the disease. The patient seeded her prosthetic valve and died of progressive endocarditis.
Part of therapy is to use antibiotics, the other is to get the saliva a flowin' with salivary-activating foods such as lemon, lemon drops, pickles and sauerkraut. Blech.
Is there data to support the use of salivary activating foods? Not that I can find. It is tradition. It does have a history going back to at least 1922, where, if you think you have it tough
"Fenwick, in an article entitled "The Prevention of Parotitis During Rectal Feeding" states that he had patients suck an India rubber teat about two inches long, which had the desired effect. Collins state that a good way to excite the secretion if the mouth and keep the current of saliva is to allow the patient to suck on a stick of lemon candy after the operation."
That was back in the days before antibiotics and parotitis had a 30% mortality rate, some dying from the embarrassment of rectal feeding. It was how Garfield was fed after he was shot; no wonder he died. The president, not the cat. Unfortunately.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1517239/?page=1
Oral Maxillofac Surg Clin North Am. 2009 Aug;21(3):269-74. The bacteriology of salivary gland infections.
Brook I.
Georgetown University School of Medicine, 4431 Albemarle Street NW, Washington, DC 20016, USA. ib6@georgetown.edu
The parotid gland is the salivary gland most commonly affected by inflammation. However, infection of the salivary glands can occur in any of the glands. The most common pathogens associated with acute bacterial infection are Staphylococcus aureus and anaerobic bacteria. The predominant anaerobes include: anaerobic Gram negative bacilli (eg, pigmented Prevotella and Porphyromonas); Fusobacterium spp; and Peptostreptococcus spp. In addition, Streptococcus spp (including Streptococcus pneumoniae) and aerobic and facultative Gram-negative bacilli (including Escherichia coli) have been reported. Aerobic and facultative Gram-negative bacilli are often seen in hospitalized patients. Organisms less frequently found are Haemophilus influenzae, Treponema pallidum, Bartonella henselae, and Eikenella corrodens. Mycobacterium tuberculosis and atypical mycobacteria are rare causes of infection. The choice of antibiotics should be guided by identification of the etiologic agent.
