Mumps

Mumps (epidemic parotitis) is an acute, systemic viral disease caused by the mumps virus, a member of the family Paramyxoviridae. It is characterized by the swelling of the salivary glands, typically the parotid glands.


Presentation

Mumps is characterized by the following features.

Prodromal phase: Initially, there is a prodromal phase in which the patient suffers from malaise and low-grade fever.

Parotitis: After the prodromal feature, the classical, tender enlargement of the parotid gland starts developing. In around 75% of the cases, the enlargement is bilateral. Usually, there is swelling of only one gland in the initial stage and the second gland enlarges after one to three days. Sometimes, the second gland may enlarge after the recovery of the first gland.

Complications: The common complications of mumps include orchitis, oophoritis, meningitis and pancreatitis. If meningitis or orchitis develop as complications of mumps, high grade fever may also be seen [4].

  • Orchitis: Orchitis is a known complication of mumps [5]. It occurs in around 25 to 40% of the postpubertal men suffering from mumps. Bilateral orchitis is present in 33% of the cases. Orchitis typically develops 7 to 10 days after the onset of parotitis. Rarely, the patient may become sterile.
  • Oophoritis: Inflammation of the ovaries is a common complication of mumps and is suggested by lower abdominal pain and enlargement of the ovaries.
  • Meningitis: Meningitis is also a frequent complication of mumps infection [6]. It develops in around 30% of the patients suffering from mumps. It presents with headache, neck stiffness, fever and lethargy.
  • Pancreatitis: Mumps is responsible for up to 5% of the cases of pancreatitis; however it is not yet clear whether or not it is actually caused by mumps virus. It presents with upper abdominal pain, nausea and vomiting.
  • Other rare complications of mumps include neuritis of the vestibulocochlear nerve (causing transient hearing loss and labrynthitis), encephalitis, Guillain-Barre syndrome, thyroiditis, hepatitis, myocarditis, nephritis and thrombocytopenia.

Workup

Mumps is easily diagnosed on clinical grounds. However, the following investigations are helpful in confirming the diagnosis.

  • Blood tests demonstrate a relative lymphocytosis is seen in case of mumps infection.
  • Serum amylase is commonly elevated with or without pancreatitis because of salivary gland involvement [7].
  • Examination of the cerebrospinal fluid (CSF) shows lymphocytic pleocytosis along with normal to low glucose in case of meningitis [8] [9].
  • Mumps is confirmed by isolation of the virus from the saliva or cerebrospinal fluid; or by the demonstration of a fourfold rise in complement fixing antibodies.

Treatment

The treatment of mumps is supportive and symptomatic. Mumps does not require any specific antiviral therapy as the illness is self-limiting.

Isolation: The patient suffering from mumps should be isolated until the swelling of the parotid gland(s) subsides.

Bed rest: During the febrile period of the disease, the patient should be advised to have bed rest.

Painkillers: Non-steroidal anti-inflammatory drugs (NSAIDs) such as paracetamol and ibuprofen are used to treat the pain of parotitis. Application of warm or cold compresses topically over the parotid gland may soothe the pain.

The complications of mumps are treated as follows.

Orchitis: In case of orchitis, the scrotum should be suspended with support and ice bags should be applied to keep their temperature from rising to dangerously high levels. Analgesics are given for pain. Injection of 1% procaine solution in the spermatic cord at the external inguinal ring also reduces pain. Injection of hydrocortisone followed by oral prednisolone is also helpful in reducing the pain and inflammation [10].

Meningitis: In case of meningitis, cerebral edema is treated by the use of mannitol and steroids. If the patient is experiencing fits, antiseizure medication may also be given.

Pancreatitis: The treatment of pancreatitis is symptomatic.

Prognosis

In the patients with uncomplicated disease, the prognosis is excellent. Patients who develop complications may have chronic morbidity but fatality is still extremely rare. Even if the patients develop meningitis or encephalitis, the prognosis remains favorable, although there may be sensorineural deafness. Even then, the hearing loss is rarely permanent. Similarly, total loss of fertility in patients with orchitis is extremely rare and no loss of fertility is seen in case of oophoritis.

Mumps infection is also linked to the development of type 1 diabetes mellitus [2] [3].

Etiology

Mumps is caused by a paramyxovirus. The virus spreads by respiratory droplets and its infection is facilitated by lack of immunization against mumps and compromised immunity in the patient [1].

Epidemiology

Mumps was a very common disease several decades ago but nowadays, with the advent of MMR vaccine, the prevalence has greatly reduced in the developed countries. The incidence is highly variable from country to country depending upon the efficiency of their immunization programs.

Most of the patients of mumps are children of school age. Males and females are equally affected. However, the complications of the central nervous system are up to 3 times more common in males.

Sex distribution
Age distribution

Pathophysiology

Once the virus enters the body via respiratory droplets, it disseminates through the bloodstream into the parotid glands and several other sites such as the nervous system, the testes, ovaries etc. There is active inflammation and cellular infiltration that causes enlargement and pain of the parotid glands.

Prevention

Mumps can be prevented by proper immunization in children. Currently, the vaccine of choice is MMR (that covers mumps, measles and rubella) [11]. It should be given at the age of 12 months and then followed up with a second dose after another 12 months. Avoidance of contact with any active case of mumps is also helpful in prevention.

Summary

Mumps is a common viral disease of children that produces tender inflammation and enlargement of the parotid gland(s). The causal agent is a paramyxovirus and infectivity occurs by respiratory droplets, saliva and urine. The disease is self-limiting and the treatment is symptomatic and supportive unless there are complications.

Patient Information

Mumps is a viral disease of children in which the parotid salivary glands become enlarged and painful. It is a highly contagious disease and spreads through respiratory droplets. The disease is usually not dangerous and the patient is treated only with painkillers unless there are complications. Mumps can be prevented by proper vaccination.

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References

  1. Vigneron P. [Mumps. Epidemiology, diagnosis, etiology, prevention]. La Revue du praticien. Dec 1 2000;50(19):2177-2181.
  2. Ratzmann KP. Does mumps infection play a role in the etiology and pathogenesis of insulin-dependent diabetes mellitus? Medecine interne. Oct-Dec 1986;24(4):245-252.
  3. Hyoty H, Leinikki P, Reunanen A, et al. Mumps infections in the etiology of type 1 (insulin-dependent) diabetes. Diabetes research. Nov 1988;9(3):111-116.
  4. Rodriguez-Vidigal F, Redondo L, Aguilar FJ, Vera A, Munoz-Sanz A. [Lymphocytic meningitis by mumps virus: epidemiologic, clinical, serologic and evolutive analysis of 28 cases]. Enfermedades infecciosas y microbiologia clinica. Apr 1999;17(4):176-179.
  5. Manson AL. Mumps orchitis. Urology. Oct 1990;36(4):355-358.
  6. Behar M. [Mumps meningitis]. La Semana medica. Apr 7 1960;116:435-443.
  7. Lagunilla Martinez FL. [Amylase in the blood and infantile mumps infections]. Acta pediatrica espanola. Dec 1962;20:737-750.
  8. Tashima CK. CSF pleocytosis after mumps. The New England journal of medicine. Jun 12 1969;280(24):1362.
  9. Wilfert CM. Low CSF sugar in mumps. The New England journal of medicine. Jul 10 1969;281(2):106.
  10. Martynkin AS, Timchenko VN, Ignat'eva Iu D. [Post-mumps orchitis: sequelae, treatment and prevention]. Pediatriia. 1987(6):95-98.
  11. Elliman D, Sengupta N, El Bashir H, Bedford H. Measles, mumps, and rubella: prevention. Clinical evidence. 2007;2007.

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