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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.
Fever
  • You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands.[kidshealth.org]
  • Symptoms include fever, headache, muscle aches, tiredness, and loss of appetite, followed by swelling of the salivary glands.[adolescentvaccination.org]
  • Take over-the-counter pain relievers, such as acetaminophen and ibuprofen , to bring down your fever. Soothe swollen glands by applying ice packs . Drink plenty of fluids to avoid dehydration due to fever.[healthline.com]
  • 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.[symptoma.com]
Malaise
  • Patients often present with nonspecific viral symptoms of fever, myalgias, and malaise. More specific features include facial swelling (parotitis) in 95% and/or testicular pain (orchitis).[radiopaedia.org]
  • Anyone experiencing symptoms — such as fever, headache, swollen salivary glands and malaise — should isolate themselves and call their doctor, the health department said. Mumps is a contagious, viral infection.[pantagraph.com]
  • Initial symptoms are typically non-specific, such as headache, malaise and fever, followed within a day by the characteristic swelling of the parotid (salivary) glands.[who.int]
  • Other symptoms may include low-grade fever, malaise, and headache, but approximately one third of infected persons do not have clinically apparent illness so cases often go undetected.[denver.cbslocal.com]
  • 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.[symptoma.com]
Chills
  • Symptoms include swelling in the jaw, fever, chills, body aches and loss of appetite. Anaheim Ducks defenseman Francois Beauchemin had a fever for five days and lost 10 pounds. But as of Sunday, Crosby had none of those symptoms.[usatoday.com]
  • This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected.[kidshealth.org]
  • Initial symptoms include chills, headache , loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms.[medical-dictionary.thefreedictionary.com]
Vomiting
  • Salient clinical indicators of CNS involvement include headache, fever, nausea, vomiting, and nuchal rigidity.[reference.medscape.com]
  • This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected.[kidshealth.org]
  • Other symptoms may include Fever lasting 3 to 5 days Headache Nausea Occasional vomiting Weakness A decrease in appetite Swelling and pain in the joints (and in boys, of the testes) A child with mumps will become contagious beginning a day or two before[healthychildren.org]
  • When to Call a Doctor for Mumps Call the doctor and go to your hospital's emergency department if your child develops these conditions: Dehydrated and unable to keep any fluids down Continuing vomiting Lethargic (weak and listless) Pain or a stiff neck[emedicinehealth.com]
Nausea
  • Salient clinical indicators of CNS involvement include headache, fever, nausea, vomiting, and nuchal rigidity.[reference.medscape.com]
  • This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected.[kidshealth.org]
  • Other symptoms may include Fever lasting 3 to 5 days Headache Nausea Occasional vomiting Weakness A decrease in appetite Swelling and pain in the joints (and in boys, of the testes) A child with mumps will become contagious beginning a day or two before[healthychildren.org]
  • It presents with upper abdominal pain, nausea and vomiting.[symptoma.com]
Parotid Swelling
  • Ordinarily, the parotid glands are not palpable; but in patients with mumps, parotid swelling increases rapidly over several days.[reference.medscape.com]
  • (credit: CBS) While infectious, the person socialized with a group of three friends who all subsequently developed unilateral parotid swelling and tenderness in late January.[denver.cbslocal.com]
  • Usually one testicle becomes swollen and painful about 7-10 days after the parotids swell.[kidshealth.org]
Jaw Pain
  • Symptoms include fatigue, fever, swollen salivary glands, rash, and jaw pain and can last a few weeks. Once exposed, it can take between 12 to 25 days for symptoms to appear.[abc17news.com]
  • In addition to swollen glands in the neck, symptoms of mumps include fever, headache, earache, jaw pain, fatigue, and loss of appetite. People who previously had mumps are considered immune from a second infection.[bostonglobe.com]
Angioedema
  • Mucoepidermoid carcinoma Sclerosing polycystic adenosis Sialadenitis Parotitis Chronic sclerosing sialadenitis Sialectasis Sialocele Sialodochitis Sialosis Sialolithiasis Sjögren's syndrome Orofacial soft tissues – Soft tissues around the mouth Actinomycosis Angioedema[en.wikipedia.org]
Arthritis
  • Rare complications include arthritis, meningitis , encephalitis , pancreatitis , deafness, and inflammation of the heart.[emedicinehealth.com]
  • Mumps during pregnancy has not been associated with congenital malformations. [16] Other reported complications include chronic arthritis, arthralgias, and nephritis. [ 15 ] Causes Mumps is typically caused by a single-stranded RNA virus belonging to[emedicine.medscape.com]
  • Rarely, mumps may also cause encephalitis, myocarditis, mastitis, thryoidits, nephritis, arthritis, and thrombocytopenic purpura, as well as spontaneous abortions (miscarriage) in pregnant women, who are infected.[nvic.org]
  • […] encephalitis Sensorineural hearing loss/deafness [ 8 ] Transverse myelitis Polyneuritis Guillain-Barré syndrome Cerebellar ataxia (with encephalitis) Keratouveitis Thyroiditis Myocarditis Mastitis Pneumonia Pancreatitis Nephritis Orchitis Oophoritis Arthritis[reference.medscape.com]
Facial Swelling
  • More specific features include facial swelling (parotitis) in 95% and/or testicular pain (orchitis). Serum IgM antibody testing can be used to confirm a case of mumps, if necessary. Mumps is a single-stranded RNA paramyxovirus 2 .[radiopaedia.org]
  • The most noticeable symptom of mumps is facial swelling, or “chipmunk cheeks,” caused by the swollen salivary glands. This swelling can be very painful, and is sometimes the only symptom.[familydoctor.org]
  • Tests and diagnosis of mumps Normally, mumps can be diagnosed by its symptoms alone, especially by examining the facial swelling.[medicalnewstoday.com]
Testicular Pain
  • More specific features include facial swelling (parotitis) in 95% and/or testicular pain (orchitis). Serum IgM antibody testing can be used to confirm a case of mumps, if necessary. Mumps is a single-stranded RNA paramyxovirus 2 .[radiopaedia.org]
  • In males who have gone through puberty, two or three of every 10 will experience testicular pain and swelling. Not everyone will have the typical symptoms; many infected people will just have respiratory symptoms without any swollen glands.[adultvaccination.org]
  • Other symptoms may include testicular pain (in males), abdominal pain , seizures , stiff neck, and difficulty swallowing . Orchitis (inflammation of one or both testicles) is the most feared complication of mumps.[emedicinehealth.com]
  • After 3-7 days, testicular pain and swelling ease, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis.[kidshealth.org]

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.

References

Article

  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.

Symptoms

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