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1 TITLE PAGE
2 TITLE
3 Acute parotitis: a possible precocious clinical manifestation of SARS-CoV-2
4 infection?
5
6 Pasquale Capaccio,1,2 MD; Lorenzo Pignataro,1,3 MD; Mario Corbellino,4 MD; Sabine
7 Popescu-Dutruit,5 MD; Sara Torretta,1,3 MD.
8
9 1Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’
10 Granda Ospedale Maggiore Policlinico; 2Department of Biomedical Surgical Dental Science,
11 University of Milan; 3Department of Clinical Sciences and Community Health, University of
12 Milan, Milan; 4 ASST-Fatebenefratelli-Sacco, Milan, Italy. 5General Practitioner, Verbier,
13 Switzerland.
14
15 Corresponding Author and address for reprints:
16 Sara Torretta, MD
17 Department of Clinical Sciences and Community Health,
18 Università degli Studi di Milano,
19 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico,
20 Via F. Sforza 35,
21 20122 Milano,
22 Italy
23 Tel.: +39 0250320245; Fax: +39 0250320248;
24 E-mail: [email protected]
25 Keywords: SARS-CoV-2; coronavirus; infection; parotitis; sialadenitis.
26 Funding: none 1
This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery.
27 Conflicts of interest/competing interests: nothing to declare
28 Ethics approval: not applicable
29
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This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery.
31 Sir,
32 Manifestations of coronavirus disease (COVID-19), resulting from primary infection by
33 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), include fever, cough,
34 dyspnoea, myalgia, headache, and diarrhea. Rhinorrhoea and sore throat are also
35 reported,1 as olfactory impairment.
36 Transmission occurs through mucosal inoculation of infected droplets or direct contact from
37 symptomatic or asymptomatic carriers.
38 Diagnosis is performed by reverse transcriptase Real-Time PCR (RT-PCR) of
39 nasopharyngeal or oropharyngeal swabs (NPS). However, SARS-CoV-2 can be found at
40 high viral loads in saliva specimens.2 Given the high diagnostic concordance between
41 nasopharyngeal and saliva specimens in detecting respiratory viruses, including
42 coronaviruses, and considering that coronaviruses can be found in saliva specimens but not
43 in nasopharyngeal aspirates,3 To4 tested SARS-CoV-2 in saliva samples from 12 patients:
44 all but one were positive with a decreasing viral load trend.
45 A SARS-CoV-2 tropism for the epithelial salivary ducts cells was described in rhesus
46 macaques.5 This suggests the possibility of SARS-CoV-2 salivary infection, although its
47 detection in saliva may be partially related to the contribution, in this mileu, of secretions
48 from the nasopharynx or the lower airways.4
49 We describe a SARS-CoV-2 positive patient whose first clinical manifestation was an acute,
50 non-suppurative parotitis.
51 In an Italian familiar cluster of infection (mother and 1 brother with asymptomatic COVID-
52 19, another brother with mild symptoms, all of them with a positive RT-PCR NPS) under
53 quarantine in Switzerland from March 9, a previously healthy 26-year old male developed a
54 left painful parotid swelling on the same day. Fever (max 38°C) and myalgia occurred (March
55 10-11). The patient slowly improved with complete recovery (March 13). Hyposmia and
56 ageusia were self-reported (March 16). 3
This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery.
57 Clinically, a discrete swelling of the left parotid gland without purulent discharge after parotid
58 massage was found. Blood assays revealed a mild increase in reactive C-protein (8.9 mg/L),
59 while the white blood cell count and formula were normal. Cytomegalovirus and
60 paramyxovirus antibodies were negative, except for IgG-paramyxovirus (300 kAU/L).
61 Ultrasonography showed an enlarged and diffuse hypoechoic parotid gland structure, with
62 increased vascularization at Color-Doppler; no salivary duct enlargement or stones were
63 identified. Traditional SARS-CoV-2 RT-PCR testing on NPS resulted negative, while a rapid
64 immunochromatographic test (PRIMA Lab SA, Balerna, Switzerland) was weakly positive
65 for SARS-CoV-2 IgG, and negative for IgM (April 1).
66 Although we could not document SARS-CoV-2 RNA in the saliva, we believe that acute,
67 non-suppurative parotitis should be considered a possible manifestation of the COVID-19
68 disease spectrum.
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This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery.
72 References
73 1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical
74 characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a
75 descriptive study. Lancet. 2020;395:507-513.
76 2. Wang WK, Chen SY, Liu IJ, Chen YC, Chen HL, Yang CF, et al. SARS Research Group
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78 associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis.
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80 3. To KKW, Lu L, Yip CCY, Poons RW, Fung AM, Chen A, et al. Additional molecular testing
81 of saliva specimens improves the detection of respiratory viruses. Emerg Microbes Infect.
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83 4. To KKW, Tsang OTY, Yip CCY, Chan KH, Wu TC, Chan JMC, et al. Consistent detection
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85 5. Liu L, Wei Q, Alvarez X, Wang H, Du Y, Jiang H, et al. Epithelial cells lining salivary gland
86 ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the
87 upper respiratory tracts of rhesus macaques. J Virol. 2011;85:4025-4030.
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