Diagnosis
Inflammation of the parotid gland. Bilateral should make you think of mumps or toxic/drug.
Epidemiologic Risks
Salivary stones as an outpatient, intubation as an inpatient.
Microbiology
Outpatient: Streptococci (all) and S. aureus (the most common).
In the US most parotitis is NOT mumps:
"Of 101 specimens, 38 were positive for a single virus: Epstein-Barr virus (23), human herpes virus (HHV)-6B (10), human parainfluenza virus (HPIV)-2 (3), HPIV-3 (1), and human bocavirus (1). Mumps virus, enteroviruses (including human parechovirus), HHV-6A, HPIV-1, and adenoviruses were not detected (PubMed)." Influenza A can also be a cause.
Two studies suggest influenza as a cause (PubMed)(PubMed).
Inpatient: S. aureus and gram-negative rods such as Pseudomonas.
Empiric Therapy
Outpatient cephalexin OR dicloxacillin or even amoxicillin/clavulanate.
Inpatient: third-generation cephalosporins +/- vancomycin.
Pearls
Call ENT to help drain, especially if she is a sourpuss; lemons can make the saliva flow and help drain the pus.
Curious Cases
Relevant links to my Medscape blog
Last Update: 12/13/18.