2025 – PAGE 324 – INFECTIOUS DISEASES

PAROTIDITIS (AKA PAROTITIS)

Parotiditis (AKA parotitis) has multiple possible causes.

• MUMPS VIRUS: See VIRUSES above. Look for orchitis, pancreatitis, or meningitis.
• STONE: Obstruction leads to INTERMITTENT parotid swelling.
• STAPHYLOCOCCUS AUREUS: Look for PUS at Stensen’s duct or a child that has HIGH fevers or is toxic-appearing.
• RECURRENT IDIOPATHIC PAROTIDITIS: This is idiopathic and occurs for several days every 3–4 months.
• CHRONIC PAROTIDITIS: Look for evidence of odd infections, including Mycobacterium tuberculosis (TB), Bartonella henselae (cat scratch disease), and even HIV.
• SJOGREN’S SYNDROME: Dry eyes, dry mouth, and parotiditis.

MASTOIDITIS

Look for pain, swelling, and redness in the posterior auricular area as an indication of mastoiditis. The most commonly isolated organisms in acute mastoiditis are Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Diagnose by doing a tympanocentesis, sending pus for culture, and getting a CT scan. Treat with IV antibiotics and surgical debridement.

OTITIS EXTERNA (AKA SWIMMER’S EAR)

Otitis externa (AKA swimmer’s ear) results in pain with manipulation of the PINNA. Treat with OFLOXACIN drops (a quinolone) or neomycin-polymyxin-hydrocortisone (Cortisporin) drops. These will cover both Pseudomonas and Staphylococcus, the two most common pathogens. Alcohol and/or acetic acid (vinegar) drops can be used after swimming for prevention. Properly fitting earplugs, or simply cotton covered with petroleum jelly, also help prevention.

PEARL: Treat with topical antibiotics. Topical steroids may decrease the time to symptom resolution by approximately 1 day, but are not required. There’s no significant increase in cure rate to add on topical steroids.

ACUTE AND RECURRENT OTITIS MEDIA

HIGH dose amoxicillin (90 mg/kg/d) is the first line of treatment for otitis media if  a beta-lactam antibiotic was not used in the previous month and the patient does not also have a purulent conjunctivitis. Suspect nontypeable H. influenzae infection if there is a purulent conjuctivitis. Both nontypeable H. influenza and Moraxella are beta-lactamase producing organisms. Do NOT give a macrolide since they don’t do much for beta-lactamase producing organisms. Give AMOXICILLIN-CLAVULANATE or a CEPHALOSPORIN instead.

• PEARLS: For uncomplicated OM in children over 6 months old, you can choose to withhold antibiotics for up to THREE days. Once the patient is on antibiotics, THREE days is the maximum time you can wait to change antibiotics when there is no improvement. Meningitis is the most common intracranial complication of OM.
• PEARL: Thanks to the pneumoccal vaccine, strep pneumoniae is no longer the most common organism to cause acute otitis media. Now, the most common organism is nontypeable H. influenzae.
• CHRONIC MIDDLE EAR EFFUSION: If the patient is healthy and hears well, treat with watchful waiting.
• RECURRENT OTITIS MEDIA: Three separate episodes within a 6-month span, or four separate episodes within a 12-month span may warrant myringotomy If the child is predisposed to effusions and infections, s/he may still get otorrhea with URIs. A possible complication of tube placement is a bloody granuloma.