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Parotitis-Like Symptoms Associated with COVID-19, France, March-April 2020

Authors:
Jérôme R. Lechien at University of Mons
Jérôme R. Lechien
Annaelle Chetrit
Annaelle Chetrit
Annaelle Chetrit
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Younes Chekkoury-Idrissi
Younes Chekkoury-Idrissi
Younes Chekkoury-Idrissi
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Lea Distinguin
Lea Distinguin
Lea Distinguin
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Abstract

We report the clinical features of 3 patients in France who had parotitis (inflammation of the parotid salivary glands) as a clinical manifestation of confirmed coronavirus disease. Results from magnetic resonance imaging support the occurrence of intraparotid lymphadenitis, leading to a parotitis-like clinical picture.
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... Mumps-negative cases can be due to a plethora of viruses and bacteria, but they are often left undiagnosed because differential diagnosis with other infectious agents is not routine [3][4][5][6][7][8]. ...
... Viruses such as the parainfluenza virus (PIV), Epstein-Barr (EBV), influenza virus (InV), Rhinovirus, Adenovirus, and other viruses have been reported to cause parotitis [1][2][3][4][5][6][7][8]. ...
... Of importance, mumps-like illness can be caused by PiV, EBV, InV, Rhinovirus, Adenovirus, and others [8][9][10][11][12]. ...
Coronavirus OC43 and Influenza H3N2 Concomitant Unilateral Parotitis: The Importance of Laboratory Tests in Mumps-Like Parotitis
Article
Full-text available
  • Nov 2023
Mumps is an acute generalized infection caused by a Paramyxovirus. Infection occurs mainly in school-aged children and adolescents and the most prominent clinical manifestation is nonsuppurative swelling and tenderness of the salivary glands, unilaterally or bilaterally. Negative serology for mumps requires a differential diagnosis with other infectious agents, but it is not routine. An 11-year-old girl presented with fever and right-sided parotitis and a negative serology for Mumps. A respiratory panel revealed the presence of Coronavirus OC43 and influenza virus H3N2. Parotitis may be caused by the parainfluenza virus, Epstein-Barr virus, influenza virus, rhinovirus, adenovirus, or other viruses in addition to noninfectious causes such as drugs, immunologic diseases, or obstruction of the salivary tract as predisposing factors. In this case, Coronavirus OC43 and influenza virus H3N2 were detected. The H3N2 has been already reported in the literature, whereas Coronavirus OC43 has never been associated with parotitis before; although, in the present case, the association of the two viruses does not let us conclude which of the two was responsible for the disease.
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... According to the data available to date, the timing of salivary gland swelling is not related to specific phases of the infectious disease. However, some authors have suggested that the swelling of the salivary gland is an early sign of viral uptake [19][20][21][22]. Other Authors highlighted how the salivary infection was detected some days after Sars COV-2 infection [1,15,21,[23][24][25][26][27][28][29]. ...
... However, some authors have suggested that the swelling of the salivary gland is an early sign of viral uptake [19][20][21][22]. Other Authors highlighted how the salivary infection was detected some days after Sars COV-2 infection [1,15,21,[23][24][25][26][27][28][29]. ...
Clinical and diagnostic features of salivary glands disease related to COVID-19 infection: A systematic review of the literature
Article
Full-text available
  • Sep 2024
ABSTRACT Purpose: Coronavirus disease 2019 (COVID-19) results from primary infection by severe acute respiratory syndrome coronavirus 2 (Sars COV-2). The transmission thereof is based on mucosal inoculation of infected droplets or direct contact from carriers. However, coronavirus viral loads can be found in throat wash and saliva specimens. The aim of this work is to make an overview about clinical and diagnostic information of patients affected by sialadenitis related to Sars COV-2 infection. Methods: A systematic literature review has been performed following PRISMA 2020 checklist statement. A computerized search has been carried on by an extensive set of queries on the Embase/Pubmed, Scopus and Cochrane databases, relating to articles published from January 2020 to February 2024. Results: Information reported within ten papers has been processed in this review. The total amount of patients included was 27 (55% females), with a mean age of 35.6 years. All patients showed a parotid gland infection, which was described bilaterally in 45% of cases. However, submandibular and sublingual gland infections were reported only as of a single patient. Sialadenitis diagnosis was made through clinical examination, radiological tools and laboratory tests. The diagnosis of parotitis was contextual or delayed to COVID-19 detection in 78% and 22% of cases, respectively. The therapeutic management thereof consisted of symptomatic therapies as in Sars COV-2 infection. Antibiotics were reserved in a few cases (12%). Conclusions: Sialadenitis in patients affected by Sars COV-2 is an uncommon manifestation of COVID-19 infection. Its treatment and prognosis do not differ from those used to treat patients affected by Sars COV-2.
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... MRI was done for three cases and intraparotid lymphadenitis was shown in all of them. It was suggested that intraparotid lymphadenitis due to COVID-19 could be the cause of the presentation of parotitis [17]. A 32-yearold man with COVID-19 was reported by Taha Ismail and Mohamed Naser who had unilateral parotitis. ...
Ramsay-hunt-syndrome associated with unilateral parotitis following COVID-19 vaccine: a case report
Article
Full-text available
  • Apr 2025
  • Eur Arch Oto Rhino Laryngol
Background Varicella-zoster-virus (VZV) reactivation is a recognized complication following COVID-19 vaccination; however, Ramsay-hunt-syndrome (RHS) rarely has been reported. Case presentation This case presents a 36-year-old immunocompetent man with features of RHS three weeks following the second dose of the BBIBP-CorV (Sinopharm) vaccine. Interestingly, he developed acute unilateral parotitis on his left side and the ultrasonography showed a 55*44*18 mm parotid gland with decreased parenchymal echogenicity. He was treated with valacyclovir, and after seven days he was discharged. Also, his parotitis was resolved by day 29 following the presentation of the first symptoms with no further complications. Conclusion The possibility of VZV reactivation after COVID-19 vaccination is an important point and it should be noted that this reactivation might present in unusual clinical scenarios.
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... [8] Although the direct spread of SARS CoV-2 into the parotid tissue is theoretically possible due to the presence of angiotensin-converting enzyme 2 (the virus receptor) in the parotid tissue, the exact mechanism of parotid enlargement is still not understood. [12] In one of the case reports, based on the MRIs of parotid gland, it was suggested that there is the presence of adenitis, which might impair the gland functioning and block the main gland duct (Stenon's duct), leading to saliva retention and parotid tissue inflammation. [13] The ultrasound studies of our patients reveal a similar picture with enlargement of intraparotid lymph nodes as well as parotid gland. ...
Abstract Case Series
Article
Full-text available
  • Dec 2024
View
... In the study conducted by Fisher et al (43), the patient exhibited clinical manifestations indicative of concurrent acute bacterial suppurative parotitis and viral parotitis. Another study documented three instances of parotitis associated with COVID-19, and patients presented with unilateral ear pain and retromandibular edema, and magnetic resonance imaging revealed the presence of intracarotid lymphadenitis (44). ...
Prevalence and association of oral manifestations with disease severity in patients diagnosed with COVID‑19: A cross‑sectional study
Article
Full-text available
  • Apr 2024
Systemic disorders may exhibit early signs when conducting an oral examination. Since the onset of the COVID‑19 pandemic, several studies have been published detailing the direct impact of the virus on the oral cavity. The present study aimed to determine whether indeed there are any significant disparities in oropharyngeal manifestations between individuals infected with severe acute respiratory syndrome coronavirus 2 and a control group, and whether the virus has the ability to invade and reproduce inside oral keratinocytes and fibroblasts, resulting in the development of oral ulcerations and superficial lesions. The present study provides an overview of the symptoms that occur at an early stage of the illness, and the most commonly affected regions of the oral cavity, including the tongue, lips, palate and oropharynx are examined. In the present retrospective study, 52 patients infected with COVID‑19 were recruited between April, 2021 and October, 2022. In addition, 52 individuals who tested negative for the virus were recruited as the control group. The study was conducted through a thorough examination and questionnaire provided to all participants. The results revealed that among the cohort of patients from the COVID‑19 group examined (n=52), a proportion (mean, 16.15) displayed oral manifestations. Specifically, 75% of the patients in the COVID‑19 group described oral cavity pain, and 69% of these patients had changes in teeth color or dental caries. In summary, in relation to the control group, the prevalence of oropharyngeal symptoms was generally lower compared to the COVID‑19 group, apart from oral cavity pain (30.8%), tonsillitis (17.3%), bleeding (34.6%), teeth color changes (36.5%), recurrence (15.4%) and abscesses (7.7%). Thus, on the whole, the patients without COVID‑19 had fewer oral manifestations.
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... One of our patients had parotitis (Case 6). This was shown by Lechien et al. who described parotitis caused by SARS-CoV-2 in three patients (34). The pathophysiological mechanism can be explained by the significantly higher number of ACE2 receptors on the salivary glands (including the minor salivary glands) compared to the lungs (35). ...
COVID-19 and oral lesions: 2020–2024 outpatient case series and literature review
Article
Full-text available
  • Mar 2024
Data on oral lesions of coronavirus disease (COVID-19) are conflicting, and there are few evidence-based data on oral lesions directly caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this case series and literature review is to determine the prevalence of oral lesions associated with COVID-19 in outpatients and identify oral manifestations that are likely associated with COVID-19. We present 15 patients that came for their first specialist examination to the Oral Medicine Outpatient Clinic, Dental Clinic, Split, Croatia between November 2020 and January 2024. Their medical and dental history was taken following CARE guidelines. The prevalence of oral lesions associated with SARS-CoV-2 was 1.42% during the 4-year follow-up period. The most common oral lesions were nonspecific erosions, stomatitis, salivary flow disorders (xerostomia, oligosialia), salivary gland diseases (sialadenitis, chronic sialadenitis), candidiasis, pigmentation, aphthae, burning mouth syndrome, and geographic and fissured tongue. The mean latency period was 25.1 days. The site most commonly affected was the tongue (61.5%). Oral lesions associated with COVID-19 occurred in middle-aged patients, with an equal distribution by sex. They presented in a mild form and did not correlate with the severity of the clinical picture of COVID-19.
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... MRI was done for three cases and intraparotid lymphadenitis was shown in all of them. It was suggested that intraparotid lymphadenitis due to COVID-19 could be the cause of the presentation of parotitis (25). A 32year-old man with COVID-19 was reported by Taha Ismail and Mohamed Naser who had unilateral parotitis. ...
Ramsay-Hunt-Syndrome Associated with Unilateral Parotitis Following COVID-19 Vaccine
Preprint
Full-text available
  • Dec 2023
Varicella-zoster-virus (VZV) reactivation is a recognized complication following COVID-19 vaccination; however, Ramsey-hunt-syndrome (RHS) rarely has been reported. This case presents a 36-year-old immunocompetent man with features of RHS three weeks following the second dose of the BBIBP-CorV (Sinopharm) vaccine. Interestingly, he developed acute unilateral parotitis on his left side and the ultrasonography showed a 55*44*18 mm parotid gland with decreased parenchymal echogenicity. He was treated with valacyclovir, and after seven days he was discharged. Also, his parotitis was resolved by day 29 following the presentation of the first symptoms with no further complications. The possibility of VZV reactivation after COVID-19 vaccination is an important point and it should be noted that this reactivation might present in unusual clinical scenarios.
View
... Some studies tried to explain the development of oral manifestations by two mechanisms: directly related to the specificity of COVID-19 virus and its effect on nasal and oral mucosal cells [9] , or indirectly as a result of COVID-19associated stress, immunosuppression or related to drugs treatment [4,5,10] . ...
A Suspected Denture Stomatitis Induced By COVID 19 Virus
Article
Full-text available
  • Aug 2021
Patients infected with coronavirus disease 2019 (COVID-19) could develop serious life-threatening conditions. The typical symptoms of this disease include dry cough, fever, myalgia and headache. Possible mucocutaneous involvements associated with COVID-19 should be considered especially for denture wearer patients. This article reports a Covid-19 positive patient who has denture stomatitis and oral reddish lesions appeared and developed during the infection period, this could identify unknown manifestations of COVID-19.
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Oral manifestations and prognosis of COVID-19 positive population in Suining City in the post-epidemic era
Preprint
  • Aug 2023
Objectives: To investigate the oral symptoms of COVID-19 ’s “positive” group in Suining City after the comprehensive liberalization of epidemic prevention and control measures in China. To explore the related influencing factors of symptom differences and provide reference for the treatment of patients in the post-epidemic era. Methods: An online survey based on a random sample of 25 questions. Results: 1768 valid questionnaires were collected. The data showed that 363 people had oral problems after an infection with novel coronavirus. The oral problems after SARS‐CoV‐2 infection mainly focused on gingiva swelling or bleeding (38.57%), toothache (37.74%), bad breath (27.55%), oral ulcer (30.30%), abnormal taste (24.24%) and some infected people had a variety of oral symptoms. A small number of infected people also have other oral problems. The incidence of oral symptoms was significantly correlated with sex, age, educational level, place of residence, smoking, basic diseases, long-term saline gargle and vaccination of COVID-19 vaccine. In addition, the age, place of residence, smoking history, basic diseases, and vaccination also showed significant differences in prognosis. Conclusions: In the post-epidemic era, the most common oral problems are gingiva swelling or bleeding, toothache, bad breath, oral ulcer, and abnormal taste. And maintaining good living habits is the basis for promoting disease recovery and oral health.
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Clinical and Epidemiological Characteristics of 1,420 European Patients with mild‐to‐moderate Coronavirus Disease 2019
Article
Full-text available
  • Apr 2020
Background The clinical presentation of European patients with mild‐to‐moderate Covid‐19 infection is still unknown. Objective To study the clinical presentation of Covid‐19 in Europe. Methods Patients with positive diagnosis of Covid‐19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analyzing the relationship between outcomes. Results 1,420 patients completed the study (962 females, 30.7% of health care workers). The mean age of patients was 39.17±12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by on 45.4%. The mean duration of Covid‐19 symptoms of mild‐to‐moderate cured patients was 11.5±5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose, and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild‐to‐moderate Covid19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. Conclusion The clinical presentation of mild‐to‐moderate Covid‐19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild‐to‐moderate Covid‐19 that needs to be recognized as such by the WHO. Abstract
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Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States
Article
Full-text available
  • Mar 2018
  • CLIN INFECT DIS
Background: During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods: NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results: Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions: Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.
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HIV-associated cysts of the parotid glands - A study with histomorphology and magnetic resonance imaging addressed to formal pathogenesis
Article
  • Jan 1996
Background: Multiple and bilateral parotid Lymphoepithelial cysts (LEC) are encountered in 3-6% of HIV-infected patients. The formal pathogenesis of LEC is controversial. They are thought to develop from embryological salivary gland inclusions in intraparotid lymphnodes. Methods: Seventeen operative parotid specimens from HIV-infected patients were examined histologically and immunohistologically. Findings of magnetic resonance imaging (MRI) were correlated with the histological results. Results: A continuous spectrum of a lymphoepithelial salivary gland lesion is found, developing initially from a lymphoid infiltration of salivary lobules to lymphoepithelial duct lesions with cystic dilatation up to large ductal cysts (diameter up to 3.5 cm) with high-grade parenchymal atrophy. The ductal and cystic lesions demonstrate an intense basal cell hyperplasia without participation of myoepithelial cells. The MRI findings indicate involvement of the entire tissue of both parotid glands. Conclusions: The prefered hypothesis of a development of HIV-associated Lymphoepithelial cysts from preexisting salivary lymphnode inclusions cannot be verified. Our results demonstrate a continuous development of the cysts from a Sjogren-like cystic lymphoepithelial lesion of parotid glands. The enormous cystic dilatation of the duct lesions presumably is a consequence of ductal obstruction through basal cell hyperplasia of striated ducts and intense intraglandular lymphofollicular hyperplasia.
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HIV-assoziierte Zysten der Ohrspeicheldrüsen*
Article
  • Dec 1996
Multiple and bilateral parotid Lymphoepithelial cysts (LEC) are encountered in 3-6% of HIV-infected patients. The formal pathogenesis of LEC is controversial. They are thought to develop from embryological salivary gland inclusions in intraparotid lymphnodes. Seventeen operative parotid specimens from HIV-infected patients were examined histologically and immunohistologically. Findings of magnetic resonance imaging (MRI) were correlated with the histological results. A continuous spectrum of a lymphoepithelial salivary gland lesion is found, developing initially from a lymphoid infiltration of salivary lobules to lymphoepithelial duct lesions with cystic dilatation up to large ductal cysts (diameter up to 3.5 cm) with highgrade parenchymal atrophy. The ductal and cystic lesions demonstrate an intense basal cell hyperplasia without participation of myoepithelial cells. The MRI findings indicate involvement of the entire tissue of both parotid glands. The preferred hypothesis of a development of HIV-associated Lymphoepithelial cysts from preexisting salivary lymphnode inclusions cannot be verified. Our results demonstrate a continuous development of the cysts from a Sjögren-like cystic lymphoepithelial lesion of parotid glands. The enormous cystic dilatation of the duct lesions presumably is a consequence of ductal obstruction through basal cell hyperplasia of striated ducts and intense intraglandular lymphofollicular hyperplasia.
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Mumps
Article
  • Apr 2008
  • LANCET
Mumps is a common childhood infection caused by the mumps virus. The hallmark of infection is swelling of the parotid gland. Aseptic meningitis and encephalitis are common complications of mumps together with orchitis and oophoritis, which can arise in adult men and women, respectively; other complications include deafness and pancreatitis. Clinical diagnosis can be based on the classic parotid swelling; however, this feature is not present in all cases of mumps and can also occur in various other disorders. Laboratory diagnosis is based on isolation of virus, detection of viral nucleic acid, or serological confirmation (generally presence of IgM mumps antibodies). Mumps is vaccine-preventable, and one dose of mumps vaccine is about 80% effective against the disease. Routine vaccination has proven highly effective in reducing the incidence of mumps, and is presently used by most developed countries; however, there have been outbreaks of disease in vaccinated populations. In 2005, a large epidemic peaked in the UK, and in 2006 the American midwest had several outbreaks. In both countries, the largest proportion of cases was in young adults. In the UK, susceptible cohorts too old to have been vaccinated and too young to have been exposed to natural infections were the primary cause of the mumps epidemic. In the USA, effectiveness and uptake in combination appear not to have been sufficient to obtain herd immunity for mumps in populations such as college students.
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COVID-19 Task Force of YO-IFOS
  • 420
  • J R Lechien
  • C M Chiesa-Estomba
  • S Place
  • Y Van Laethem
  • P Cabaraux
  • Q Mat
Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al.; COVID-19 Task Force of YO-IFOS. Clinical and epidemiological characteristics of 1,420
European patients with mild-to-moderate coronavirus disease 2019
  • Apr 2020
  • J INTERN MED
European patients with mild-to-moderate coronavirus disease 2019. J Intern Med. 2020 Apr 30 [Epub ahead of print]. https://doi.org/10.1111/joim.13089