Inflammation of the salivary glands?

Question

Hello,
My son (7 years old) suffers from CF and has an inflammation of the salivary gland for 4 weeks, he has been given antibiotics and it did not help. We have been to the ENT doctor and he said that this would rather be a typical finding in CF.?????
An ultrasound has been done, however there it could only be seen that they are enlarged on both sides, a swab from the secretion has not been done, however, there is no pus coming out.
However, any time my son eats something the salivary glands start to swell on both sides and they get very hart and then it hurts him and about 20 minutes after the meal the swelling decreases. Drinking is no problem, about 3-4 liters a day.
Now my son should get Botox (botulin toxin) injected into the salivary glands, I am still very skeptical about it. Do you have any idea what can be done in this case and did you ever hear about it that it is typical for CF?
Many thanks.

Answer

Hello,
you report, that your son suffers from an inflammation of the salivary gland (question: inflammation of the parotid gland) for 4 weeks, that has been treated without success with antibiotics. Your ENT doctor told you that such an inflammation would be typical for CF. The ENT doctor proposed an injection with botulin toxin. You are skeptical about this treatment and ask, if first of all such an inflammation of the salivary gland is typical for CF and if there are any other treatment options.
First of all it has to be said, that an inflammation of the salivary gland in case of CF is everywhere mentioned in the literature as a known accompanying disease respectively complication. From my own experience however, I have to state that the frequency is seemingly barely 1%.
One has to distinguish between an acute unilateral inflammation of the salivary gland, mostly caused by bacteria and between a rather chronic inflammation. The latter is often caused by accumulation of secretion, formation of stones or stenosis of the ducts.
As a treatment option antibiotics are in the foreground like at any other patients with an acute inflammation. Before starting the treatment, preferably a swab of the purulent secretion should be done, that comes out of the duct of the salivary gland, in order to be able to initiate a targeted treatment. In most cases such an inflammation is caused by Staphylococcus aureus. An antibiotic therapy should be performed for 14 days. Accompanying special measures of oral hygiene, like an absolutely consequent performance of cleaning the teeth several times a day and oral rinsing with antiseptic preparations are recommended. Sucking of e.g. pieces of lemons increase the salivary flow and should be performed if there is no increase of pain in the region of the salivary gland.
In case no swab of the salivary secretion has been done to your son before beginning of the antibiotic treatment one has to consider that the treatment was unsuccessful because the causing bacteria were resistant to the chosen drug. One should in this situation consider the known oral/pharyngeal flora of your son (result of throat swab and nasal swab) and possibly use again a broader antibiotic. A treatment duration that has been too short can of course also lead to treatment failure.
Before the recommended treatment with botulin toxin, the mentioned diagnostic measures have to be performed consequently and if necessary a second, probably also intravenously given, antibiotic therapy with a broad spectrum antibiotic has to be implemented.
Your information, that the inflammation of the parotid gland of your son has occurred on both sides at the same time, strikes me a lot. In general, the for CF typical inflammation of the salivary gland is only a unilateral inflammation. The bilateral inflammation speaks with high probability for an underlying viral disease and here above all for the illness of mumps. Your son has assumingly be vaccinated against mumps. This does not exclude an acute illness of mumps with security. So-called vaccination failures are known at a percentage of up to 5%. The illness of mumps can last longer until the symptoms go away completely. You should discuss with your CF center if probably blood tests are still sensible to further clarify the situation.
We wish your son a quick recovery.
Best regards,
Dr. H.-G. Posselt

30.04.2014