Differentials
Parainfluenza
SIGNS / SYMPTOMS
Usually causes an acute respiratory infection with fever, coryza, pharyngitis, and cough. Pneumonia can also develop. Less likely than mumps to cause parotitis.
INVESTIGATIONS
Serology testing or viral culture is diagnostic.
Coxsackievirus
SIGNS / SYMPTOMS
Often causes hand-foot-and-mouth disease as well as herpangina (illness with ulcerative lesions on the posterior oropharyngeal structures). Haemorrhagic conjunctivitis can occur. More severe complications include myocarditis, pericarditis, and encephalitis. Less likely than mumps to cause parotitis on an epidemic scale.
INVESTIGATIONS
Serology testing or viral culture is diagnostic.
Acute HIV infection
SIGNS / SYMPTOMS
Can cause an acute illness with fever, malaise, lymphadenopathy, and maculopapular rash.
INVESTIGATIONS
Positive HIV serum testing.
EBV
SIGNS / SYMPTOMS
Causes infectious mononucleosis, characterised by fever, sore throat, lymphadenopathy, and atypical lymphocytosis. EBV is also associated with several human tumours, including Burkitt's lymphoma, Hodgkin's disease, and B-cell lymphoma.
INVESTIGATIONS
Positive heterophile antibodies.
Influenza A
SIGNS / SYMPTOMS
Abrupt onset of headache, fever, chills, myalgias, and malaise with accompanying respiratory tract signs. Influenza has seasonal fluctuation, occurring in the winter months most commonly.
INVESTIGATIONS
Viral isolation from throat swabs, nasopharyngeal washes, or sputum.
Acute suppurative parotitis
SIGNS / SYMPTOMS
Acute bacterial infection of the parotid gland, most commonly caused by Staphylococcus aureus.
INVESTIGATIONS
Ultrasound demonstrates findings consistent with abscess. S aureus from culture of aspirate from duct orifice.
Sjogren's syndrome
SIGNS / SYMPTOMS
Chronic inflammation of the salivary glands. Also causes excessive dryness in the eyes, mouth, nose, vagina, and skin.
INVESTIGATIONS
Positive rheumatological blood studies, including ANA, Sjogren's syndrome (SS)-A, SS-B antibodies, RF.
Parotid duct obstruction
SIGNS / SYMPTOMS
Obstruction of the flow of saliva out of the parotid gland, causing pain and inflammation. Can be from a variety of causes, such as stones and tumours.
INVESTIGATIONS
X-rays for stones may be helpful.
Coronavirus disease 2019 (COVID-19)
SIGNS / SYMPTOMS
Residence in/travel to a country/area or territory with local transmission, or close contact with a confirmed or probable case of COVID-19, in the 14 days prior to symptom onset.
INVESTIGATIONS
Real-time reverse transcription polymerase chain reaction (RT-PCR): positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA.
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