A 70-year-old man, dehydrated after emergency laparotomy, develops sudden painful swelling of the right parotid gland with fever. The overlying skin is erythematous, and massage expresses pus from the right Stensen duct orifice. Which organism is the most common cause?

• A Streptococcus viridans
• B Pseudomonas aeruginosa
• C Haemophilus influenzae
• D Staphylococcus aureus ✓

Explanation

Acute bacterial sialadenitis occurs classically in debilitated, dehydrated postoperative patients whose reduced salivary flow allows retrograde ascent of oral flora into the parotid duct. Staphylococcus aureus is the most frequently isolated organism. Treatment is hydration, sialogogues such as lemon drops, and antistaphylococcal antibiotics. Streptococcus viridans and Haemophilus influenzae are less common causes, and Pseudomonas is mainly seen in neonates and immunocompromised patients rather than as the classic postoperative pathogen.

Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.

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