The Correlation Between Dacryoadenitis and Mumps in Childhood

8/3/2019 The Correlation Between Dacryoadenitis and Mumps in Childhood

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Correlation between Dacryoadenitis and

Mumps

BY :

Birri Ifkar

030.08.061

MEDICINE FACULTY

TRISAKTI UNIVERSITY

JAKARTA, NOVEMBER 2011

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ABSTRACT

Mumps is caused by an RNA virus classified in the Paramyxoviridae family.

Other causes of parotitis include infection with Cytomegalovirus,Parainfluenza virus

types 1 and 3,Influenza A virus.

Dacryoadenitis is an inflammatory enlargement of the lacrimal gland.

Dacryoadenitis may be separated into acute and chronic syndromes with infectious or

systemic etiology. And the etiology of dacryoadenitis especially in childhood because

of Paramyxovirus.

And the virus is spread from human reservoir by direct contact, airborne

droplets, fomites contaminated by saliva, and sexes equally.

Sometimes Paramyxovirus can attacks many glands when it have through

vascular system. In childhood can suffers mumps and dacryoadenitis as the

complications because the virus after infects to salivary glands through the blood

vessels, it can infects lacrimal gland also or when the virus enter to the body through

the conjunctiva it can makes inflammation and dacryoadenitis without have to enter

vascular system before.

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CHAPTER I

INTRODUCTION

Mumps is a disease of childhood, the highest incidence occurs in children

between 5 - 9 years of age. The disease is less contagious than other childhood

diseases such as measles and varicella. According to a recent epidemiological survey

in America, 10% of the population had mumps during each of the first 5 years of life,

74% had it by age 10, and 95% by 20 years of age. Mumps is caused by an RNA virus

classified in the Paramyxoviridae family. Other causes of parotitis include infection

with Cytomegalovirus,Parainfluenza virus types 1 and 3,Influenza A virus. 1



systemic etiology. And the etiology of dacryoadenitis especially in childhood because

ofParamyxovirus.

The writer choose this topic because of mumps is endemic in most

unvaccinated populations; the virus is spread from human reservoir by direct contact,

airborne droplets, fomites contaminated by saliva, and sexes equally. As we know,

people can prevent themself from bacteria or virus that has possibility to infect them.

So the only thing that we can do is knowing some informations about it and prevent

the complication that may be occur.

CHAPTER II

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II.1 The Anatomy of Lacrimal System

The lacrimal apparatus consists of accessory eye parts that are responsible for

production of tears and the formation of a tear film over the eyes. While the lacrimal

glands or tear glands are the factories that produce tears, tear ducts, lacrimal puncta,

the lacrimal sac and lacrimal duct all help drain tears away into the nose. Tears are not

just something produced by the body in response to emotion or grief, they are

necessary to protect the eyes and ensure their optimal function. Too little or excessive

tears can result in dry eyes or watering eyes respectively, both conditions posing

problems to the eyes.

Lacrimal Gland

The main lacrimal gland is an almond-shaped structure located in the

cavernous orbit along with the eyeball. Made up of orbital and palpebral parts, the

gland is placed above the outer angle of the eye. About 10 or 12 ducts or tubes emerge

from the gland and open into the angle formed by the upper eyelid with the eyeball,

an area called the upper fornix. A few ducts run a longer course to open under the

lower eyelid into the lower fornix. These ducts carry tears from the lacrimal gland to

be secreted onto the surface of the eyeball. In addition, there are accessory lacrimal

glands called the glands of Krause and glands of Wolfring. These are very tiny glands

distributed beneath the conjunctiva in and around the fornices. When sections are

studied under the microscope, the lacrimal gland appears very similar to salivary

glands. Both are made up of acini or groups of cells actively secreting substances.

The accessory lacrimal gland of Krause lies immediately adjacent to the fornix

of the upper eyelid The glands of Krause are accessory lacrimal glands having the

same structure as the main gland. They are placed deeply in the substantia propria of

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salivary glands which lie in the mucosa or submucosa, and open directly, or indirectly

through a number many short ducts.

In humans, the mayor salivary glands are comprised of the paried parotids, and

the submandibular, and sublingual glands.3

Parotid Gland

The paired parotid glands are the largest of the salivary glands. Each has an

average weight of about 25 grams, and is an irregular, lobulated, yellowish mass,

lying largely below the external acoustic meatus between the mandible

sternocleidomastoid. The gland also projects forward on the surface of the masseter,

where a small, usually detached part lies between the upper above zygomatic arch,

and the parotid duct which lies below, the pars accessoria.

The parotid consists almost entirely of serous glandular tissue. Several

structures traverse the gland in part, or in whole, and even branch within it. The

external carotid artery enters the posteromedial surface, separating dividing into the

maxillary artery, superficial temporal artery and the posterior auricular artery. The

retromandibular vein, formed by the union of the maxillary and superficial temporal

veins is superficial to the external carotid artery. The most superficial is the facial

nerve, entering high on the posteromedial surface and passing forward and down

behind the mandibular ramus in two main divisions, from which it's terminal branches

diverge to leave by the anteriomedial surface passing medial to it is anterior margin.

Submandibular Gland

The paired submandibular glands are irregular in shape and about the size of

walnuts 10 grams. Each consists of a large superficial duct, and a smaller deep part,

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continuous with each other around the posterior border of the mylohyoid. Although

predominately serous, they are seromucous glands.

Sublingual Gland

The sublingual gland is the smallest of the major salivary glands, about half

the size of the submandibular gland, weighing only about 2 g, measuring about 2.5

cm, and shaped like a flattened almond.

CHAPTER III

III.1 DACRYOADENITIS



systemic etiology. . And the etiology of dacryoadenitis especially in childhood

because of paramyxovirus.

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In United States Dacryoadenitis is uncommon, therefore, data about its

prevalence are sparse. One in 10.000 ophthalmic patients has dacryoadenitis

according to one report. Inflammatory enlargement of the lacrimal gland is much

more common than lacrimal gland tumors. And no data about mortality and morbidity

of dacryoadenitis. Acute dacryoadenitis tends to be a self-limiting condition.4

Acute dacryoadenitis is most commonly due to viral or bacterial infection.

Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.

Chronic dacryoadenitis is usually due to noninfectious inflammatory disorders.

Examples include sarcoidosis, thyroid eye disease, and orbital pseudotumor.

The palpebral lobe of the lacrimal gland is often involved and is easily seen by

everything the upper lid. It is noted to be prolapsed and enlarged. The palpebral lobe

tends to be firm and tender on palpation through the lid.

Other associated ophthalmic physical signs of acute dacryoadenitis include the

following chemosis (conjunctival swelling), conjunctival injection, mucopurulent

discharge, erythema of eyelids, lymphadenopathy (submandibular), swelling of the

lateral third of the upper lid, and proptosis.

Systemic physical signs of acute dacryoadenitis include the following parotid gland

enlargement, fever and malaise, upper respiratory infection.

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Sign and Tests

Dacryoadenitis can be diagnosed by examination of the eyes and lids. Special

tests such as a CT Scan may be required to search for the cause. Sometimes biopsy

will be needed to be sure that a tumor of the lacrimal gland is not present.

The result that we can find in people with acute dacryoadenitis from CT Scan

test are the affected lacrimal gland shows diffuse enlargement, oblong shape, and

marked enhancement with contrast. Whereas in chronic dacryoadenitis will show

similar findings when compared to acute dacryoadenitis, except that chronic lesions

show no marked enhancement with contrast. In addition, the lacrimal gland changes

may be bilateral in contrast to acute dacryoadenitis.

Lacrimal gland biopsy results vary depending upon the etiology. Biopsy is not

indicated in acute dacryoadenitis.

Treatment

The treatment of dacryoadenitis varies with onset and etiology.

o If the cause of dacryoadenitis is a viral condition (most common) such

as mumps, simple rest and warm compresses may be all that is needed

because that is self limiting disease. And we can treat with supportive

measures (oral nonsteroid/ anti-inflammatories).5

o Protozoan or fungal related - Treat the underlying infection

accordingly with specific antiamoebic or antifungal agents.

o Inflammatory (noninfectious) - Investigate for systemic etiology, and

treat accordingly.

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manifestations are rare but may be manifest by fever, muscular pain (especially in the

neck), headache, and malaise.

In salivary glands, the onset is usually characterized by pain and swelling in

one or both parotid glands. The parotid swells characteristically; it first fills the space

between the posterior border of the mandible and the mastoid and then extend in a

series of crescents downward and forward, being limited above by the zygoma.

Edema of the skin and soft tissues usually extend further and obscures the limit of the

glandular swelling, so that the swelling is more readily appreciated by sight than by

palpation. Swelling may proceed extremely rapidly, reaching a maximum within a

few hours, although it usually peaks in 1-3 days. The swollen tissue push the earlobe

upward and outward, and the angle of the mandible is no longer visible. Swelling

slowly subsides within 3-7 days but occasionally lasts longer.

One parotid gland usually swells a day or two before the other, but in

approximately one quarter of cases the disease remains unilateral. The swollen area is

tender and painful, pain being elicited especially by testing sour liquids such as lemon

juice or vinegar. The parotid swelling is usually accompanied by low-grade fever, but

this may be absent.

Although the parotid glands alone are effected in the majority of patients,

swelling of the submandibular glands occurs frequently and usually accompanies or

closely follows that of the parotid glands.

The diagnosis of mumps parotitis, is usually apparent from the clinical

symptoms and physical examination. When the clinical manifestations are limited to

less common lesions, the diagnosis is less clear but may be suspected during an

outbreak. 6

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Routine laboratory tests are nonspecific; usually leucopenia is present with

relative lymphocytosis. An elevation in serum amylase levels is common; the rise

tends to parallel the parotid swelling and then to return to normal within 2 weeks. The

microbiologic diagnosis is by serology or virus culture. Enzyme immunoassay for

mumps immunolglobin (Ig) G and IgM antibodies are most commonly used for

diagnosis. IgM antibodies are detectable in the first few days of illness and are

considered diagnostic. They may remain elevated for weeks to months. IgG

antibodies are directed primarly against the fusion protein, cross reactions with

parainfluenza viruses mau occur. Seroconversion, or a fourfold increase in IgG titer,

is diagnostic.

Mumps virus can be cultured from the saliva, cerebrospinal fluid, blood, urine,

brain, and other infected tissues. Primary cultures of human or monkey kidney cells

are used for viral isolation. The mumps skin test is unreliable for diagnostic of mumps

and for determination of susceptibility to infection. Virus isolation may be carried out

by allantoic inoculation of 6 day old embryonated eggs or by tissue culture methods.

Virus can be isolated from the CSF during the first 2 - 3 days after the onset of

disease, and is present in urine and saliva for 2 to 3 weeks.

For treatment, there is no specific antiviral therapy, treatment is entirely

supportive. Antipyretics (acetaminophen or ibuprofen) are indicated for fever. Bed

rest should be guided by the patients needs, but no evidence indicates that it prevents

complications. The diet should be adjusted to the patients ability to chew. 6

Viremia early in the infection probably accounts for the widespread

complications. There is no firm evidence that maternal infection is damaging to the

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fetus, a possible relationship to endocardial fibroelastosis has not been firmly

established. Mumps in early pregnancy does increase the chance of abortion.

The initial mumps immunization, usually as measles-mumps-rubella (MMR)

vaccine, is recommended at 12-15 month of age. A second immunization, also as

MMR, is recommended routinely at 4-6 year of age but may be administered at any

time during childhood provided at least 4 week have elapsed since the first dose.

CHAPTER IV

The correlation between dacryoadenititis and mumps in childhood



systemic etiology. Whereas mumps is endemic in most unvaccinated populations; the

virus is spread from human reservoir by direct contact, airborne droplets, fomites

contaminated by saliva, and sexes equally. Mumps in childhood and dacryoadenitis

have same causes. There are paramyxovirus that virus classified in Paramyxoviridae

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family. The children who suffers mumps also can have dacyoadenitis in the same

times.

Paramyxovirus

The paramyxovirus is non-segmented and contains a molecule of linear,

negative-sense, single-stranded RNA. Paramyxovirusvirions consist of an envelope, a

nucleocapsid, and a matrix protein. Virions are large and have a complex

construction. They are spherical to pleomorphic, and can range from 150-200 nm in

diameter and 1000-10000 nm long. The envelope has spike-like projections spaced

widely apart and evenly covering the surface. The surface projections are embedded

in a lipid bilayer.

Mumps virus causes a systemic generalized infection that is spread by viremia

with involvement of glandular and nervous tissues as target organs. The infecting

virus probably enters the body through the pharynx or the conjunctiva. Local

multiplication of the virus in epithelial cells at the portal of entry and a primary

viremia precede a secondary viremia, lasting 2 to 3 days. The incubation period

usually is 18 to 21 days, but may extend from 12 to 35 days. Recognizable symptoms

do not appear in 35 percent of infected individuals. The virus is carried to the main

target organs. Viral replication takes place in the ductal cells of the glands.

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Sometimes paramyxovirus can attacks many glands when it have through

vascular system. In childhood can suffers mumps and dacryoadenitis as the

complications because the virus after infects to salivary glands through the blood

vessels, it can infects lacrimal gland also or when the virus enter to the body through

the conjunctiva it can makes inflammation and dacryoadenitis without have to enter

vascular system before.

Generally, the stages of replication of virus consists of 5 stages.

1. Attachment or adsorption of virions to host cells.

2. Penetration or injection of virions or nucleic acid into host cells.

3. Synthesis of nucleic acids and viral proteins by host cells.

4. Installation / assembly membrane components from virus who have envelopes

and nucleic acid packaging into new virions.

5. The release of virions that have been "cooked" from the host cell by the host

cell.

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PARAMYXOVIRUS

CONJUNCTIVA RESPIRATORY

TRACT

LACRIMAL

GLAND

DACRYOADENI

TIS

VASCULAR

SYSTEM

MANY ORGANS:

PAROTID GLAND

MUMPS


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Paramyxovirus infects salivary glands especially parotid gland as usually and

lacrimal gland because both of these has similar structure in histology. Salivary

glands produce saliva, a watery mixture of enzymes and mucus. The enzymes and the

mucus are produced by two distinct cell types, called serous cell and mucous cell.

Release of saliva is facilitated by contraction of myoepithelial cells.

The parotid gland is a compound, acinar, serous gland. Unlike all other salivary

glands, the parotid includes no mucous cells. The acinar lumen so visible only when

the acinus is sliced neatly across the middle. In such a slice, the cells look like slices

of pie, with the lumen in the center. Individual acini are drained by small intercalated

ducts. These in turn drain into striated (or "secretory") ducts, whose cells are

specialized for concentrating the secretory product. Cells lining the striated duct

pump water and ions across the epithelium, from the duct lumen and into interstitial

fluid.7

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PAROTID GLAND (image A) LACRIMAL GLAND (image B)

The lacrimal gland consists of a lobules and is a tubulo-racemose gland with

short branched gland tubules somewhat similar to the parotid. The acini consist of two

layers of cells placed on a thin hyaline basement membrane and surrounding a central

lumen. The basal cells are myoepithelial in character while the acinar cells are

cylindrical, and secrete fluid into a series of ducts of increasing size until becoming

the excretory duct. In image B shows a higher magnfication of a human lacrimal

gland complete with acinar structures that contain lumens (1) and protein rich acinar

cells that secrete lysozyme, tear lipocalin, lactoferrin and IgA. The reddish granules

(2) are secretory vesicles replete with protein. Some lumens are filled with protein

that is being secreted. Lymphocytes and plasma cells are scattered in the

interstitium(3).8

For treatment if the cause of dacryoadenitis is a viral condition (most

common) such as mumps, simple rest and warm compresses may be all that is needed

because that isself limiting disease. And we can treat with supportive measures (oral

nonsteroid/ anti-inflammatories).5 There is no specific antiviral therapy for treatment

children who suffers dacryoadenitis and mumps, treatment is entirely supportive.

Antipyretics (acetaminophen or ibuprofen) are indicated for fever. Bed rest should be

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guided by the patients needs, but no evidence indicates that it prevents complications.

The diet should be adjusted to the patients ability to chew.6

CHAPTER V

CONCLUSION

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Mumps is an important childhood disease that was historically widespread. It

is an acute viral infection characterized by painful enlargement of the salivary glands.

Mumps virus, is an RNA virus of the genus Paramyxovirus in the family

Paramyxoviridae.

MoreoverParamyxovirus infects salivary glands especially parotid gland as

usually and lacrimal gland because both of these has similar structure in histology.

For treatment dacryoadenitis and mumps in childhood there is no specific antiviral

therapy, treatment is entirely supportive.

REFERENCES

1. Epidemiology of Mumps Infection. Availabale at

http://virology-online.com/viruses/MUMPS2.htm. Accessed on June 6th,

2011.20
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2. Nasolacrimal System Anatomy. Available at:

http://emedicine.medscape.com/article/835092-overview. Accesed on June

8th, 2011.

3. Anatomy of Salivary Glands. Available at:

http://www.glandessalivaires.com/anglais/anatomy.html. Accessed on June

6th, 2011.

4. Dacryoadenititis. Available at:

http://emedicine.medscape.com/article/1210342-overview#a0199. Accessed

on June 9th, 2011.

5. Dacryoadenitis. Available at:

http://www.healthcentral.com/ency/408/001625trt.html. Accessed on June 9th,

2011.

6. Behrman, Kliegman, Jenson. Nelson Textbook of Pediatrics. 17th Edition.

Elsevier; 2004. P 1035-1036.

7. Introduction to Glandular Tissue.Available at:

http://www.siumed.edu/~dking2/erg/glands.htm. Accessed on June 11th,

2011.

8. Anatomy of The Human Eye. Available at:

http://www.images.missionforvisionusa.org/anatomy/2006/02/lacrimal-gland-

human.html. Accessed on June 11th, 2011.

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http://emedicine.medscape.com/article/835092-overviewhttp://emedicine.medscape.com/article/835092-overviewhttp://www.glandessalivaires.com/anglais/anatomy.htmlhttp://www.glandessalivaires.com/anglais/anatomy.htmlhttp://emedicine.medscape.com/article/1210342-overview#a0199http://www.healthcentral.com/ency/408/001625trt.htmlhttp://www.siumed.edu/~dking2/erg/glands.htmhttp://www.images.missionforvisionusa.org/anatomy/2006/02/lacrimal-gland-human.htmlhttp://www.images.missionforvisionusa.org/anatomy/2006/02/lacrimal-gland-human.htmlhttp://emedicine.medscape.com/article/835092-overviewhttp://www.glandessalivaires.com/anglais/anatomy.htmlhttp://emedicine.medscape.com/article/1210342-overview#a0199http://www.healthcentral.com/ency/408/001625trt.htmlhttp://www.siumed.edu/~dking2/erg/glands.htmhttp://www.images.missionforvisionusa.org/anatomy/2006/02/lacrimal-gland-human.htmlhttp://www.images.missionforvisionusa.org/anatomy/2006/02/lacrimal-gland-human.html

The Correlation Between Dacryoadenitis and Mumps in Childhood

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