Acute parotitis as a presentation of COVID‐19?

Abstract

Dear Editor, In connection with our earlier correspondence on the epidemiologic significance of the coronavirus disease (COVID-19)-related oral manifestations, it has been evident that larger observational studies following rigorous reporting guidelines are inevitable for better understanding of the ongoing pandemic from oral disease perspective (Riad, Klugar, & Krsek, 2020). Hereby, we describe, according to the STROBE guidelines, a series of 15 confirmed COVID-19 cases with acute parotitis symptoms that were highly attributed to the direct infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Von Elm et al., 2007). The investigated patients sought emergency care at our hospital during the period from March 20 to June 20, 2020 (Table 1). Nine patients (60%) were females, while six patients (40%) were males. The mean age was 38.67 ± 21.07 (10–73) years. All patients complained of unilateral pain related to the angle of the mandible region. An 11-item numerical rating scale (NRS) was used to assess the pain severity, with “0” denoting “no pain” and “10” denoting “pain as bad as you can imagine” (Williamson & Hoggart, 2005). The mean pain score was 7.00 ± 1.81 (3–10) points. While ten patients (66.7%) had a non-suppurative swelling, five patients (33.3%) did not experience any swelling until the diagnosis day. The most common adjacent symptom was headache (46.7%), then earache (33.3%) and pharyngitis (20%), respectively. The duration of pain varied considerably among patients with a mean duration of 3 ± 1.65 (1–6) days. All patients were confirmed as being infected by SARS-COV-2 using polymerase chain reaction (PCR) for nasopharyngeal swabs on the same day of otolaryngological diagnosis. The mean value of the cycle threshold (Ct) was 29.07 ± 3.60 (21–33). While the vast majority of the patients (86.7%) did not require any further medical investigation, only two of them needed specialized consultation because they had other systemic comorbidities, for example, diabetes mellitus and immunodeficiency, that may impose them to higher risk as COVID-19 patients. Although the sample size is limited, the simple linear regression revealed that age is the only independent variable that can predict the Ct value (p = .017). Our results support the hypothesis suggested by Xu et al. (2020) on the potential impact of COVID-19 on salivary gland diseases, including the parotid gland (Xu et al., 2020). They are also in line with previous cases reported from Italy and France for middle- and old-age patients with parotitis-like symptoms that were attributed to direct infection of SARS-COV-2 (Capaccio, Pignataro, Corbellino, Popescu-Dutruit, & Torretta, 2020; Lechien et al., 2020). We did not conduct laboratory tests to exclude mumps due to the advanced age of our patients and the non-persistent nature of the pain experienced by most of them; however, it is recommended to exclude other infectious etiologies, for example, mumps, rubella, influenza if present. Although we did not conduct PCR testing for salivary samples, it has been frequently confirmed that SARS-COV-2 is predominantly present in saliva due to the high expression of angiotensin-converting enzyme II (ACE2) in lining epithelial cells of salivary glands (To et al., 2020). All the investigated patients agreed to use their clinical and laboratory results for academic purposes while concealing their identifying personal data. To conclude, acute parotitis symptoms can be directly attributed to SARS-COV-2 infection with a great emphasis on larger epidemiological studies to reveal the potential role of age and viral load in the pain intensity and severity experienced by the patients. The authors declare that there is no conflict of interest. Abanoub Riad: Writing-original draft. Islam Kassem: Methodology; writing–review and editing. Mai Badrah: Data curation. Miloslav Klugar: Supervision. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.13571.

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