Mumps Disease

BASICS

DESCRIPTION

Acute generalized paramyxovirus infection usually presenting with unilateral or bilateral parotitis. Epidemics late winter and spring with transmission by respiratory secretions. Incubation is approximately 14 to 24 days.

System(s) affected: Reproductive, Hemic/Lymphatic/Immunologic, Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA:
- 0.29/100,000 (725 per year)
- 0.0064/100,000
- 90% of adults are seropositive even without history
Predominant age: 85% occur before age 15 years, but more severe in adults
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Parotid pain and swelling in one or both glands
Rare prodrome of fever, neck muscle ache, malaise
Initial parotid swelling just behind jaw
Swelling peaks in 1–3 days, lasts 3–7 days
Obscures angle of mandible
Elevates earlobe
Redness at opening of Stensen's duct
Sour foods cause pain in the parotid gland region
Moderate fever, usually not above 104°F (40.0°C). High fever is frequently associated with complications.
Meningeal signs in 15%, encephalitis in 0.5%
Rarely arthritis, orchitis, thyroiditis, mastitis, pancreatitis
Rare maculopapular erythematous rash
Up to 50% of cases may be asymptomatic
Swelling in the sternal area, rare, but pathognomonic of mumps

CAUSES

Mumps paramyxovirus
Other viruses, such as Coxsackie (rare)

RISK FACTORS

Urban epidemics, non-vaccinated population
Usual communicable period is 24 hours before to 72 hours after onset of parotitis
Incubation period usually 18 days

DIAGNOSIS

LABORATORY

Viral isolation from throat washings, urine, blood, or spinal fluid
Serum amylase elevated
Rise in paired antibodies: Anti-"S" antibodies peak early and may be seen at the time of presentation
Cerebrospinal fluid (CSF) - leukocytosis
Leukopenia

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Periductal edema and lymphocytic infiltration

SPECIAL TESTS

Rarely necessary, an easier salivary test for IgM is pending

IMAGING

Useful to differentiate mumps orchitis from testicular torsion

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient, if no complications
High fever and testicular pain - may hospitalize for steroids or interferon

GENERAL MEASURES

Supportive and symptomatic care
For patients with orchitis, ice packs to scrotum can help relieve pain
Scrotal support with adhesive bridge while recumbent and/or athletic supporter while ambulatory
Use IV fluids if severe nausea or vomiting accompanies pancreatitis

SURGICAL MEASURES

N/A

ACTIVITY

Mumps orchitis - bedrest and local supportive clothing, such as wearing 2 pairs of briefs, or adhesive-tape bridge

DIET

Liquids if cannot chew

PATIENT EDUCATION

Must be out of school until no longer contagious – about 9 days after onset of pain
Orchitis is common in older children but rarely results in sterility
Immunization of family may protect against later exposures but not the present one

FOLLOW UP

PREVENTION/AVOIDANCE

2 doses of live mumps vaccine recommended for active immunization: at 15 months and at entry to middle school (postexposure vaccination does not protect from recent exposure)
Isolate hospitalized patients until 9 days past onset

POSSIBLE COMPLICATIONS

May precede, accompany, or follow salivary gland involvement and may occur (rarely) without primary involvement of the parotid gland
Meningitis or encephalitis may present 10 days after first symptoms of illness. Aseptic meningitis is typically mild, but meningo-encephalitis may lead to seizures, paralysis, hydrocephalus, or, in 2% of cases, death
Cerebrospinal fluid (CSF) pleocytosis, usually lymphocytes, found in 65% of cases with parotitis
Orchitis common (30%) in postpubertal boys; starts within 8 days after parotitis; fever, swollen testis of 4-day duration; fertility impaired in 13% but absolute sterility is rare
Oophoritis in 7% of postpubertal females, no decreased fertility
Pancreatitis, usually mild
Nephritis, thyroiditis, or arthralgias are rare
Myocarditis – usually mild, but may depress ST segment; may be linked to endocardial fibroelastosis
Deafness – 1/15,000 unilateral nerve deafness; may not be permanent
Inflammation about the eye (rare)
Dacryoadenitis, optic neuritis

EXPECTED COURSE AND PROGNOSIS

Complete recovery is usual, immunity is permanent
Sensorineural hearing loss in 4% of adults - transient
Rare recurrence after 2 weeks may be recurrent non-epidemic parotitis

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric:

In adolescents - orchitis more common
Most cases of acute epidemic mumps occur in children aged 5 to 15. Unusual in children less than 2 years. Most infants less than 1 year are immune
Less likely to develop complications

Geriatric: Most are immune
Others: Most complications occur in post-pubertal group

PREGNANCY

No proven complications of vaccine, but theoretically should not vaccinate in pregnancy
Disease may increase rate of spontaneous abortion in first trimester

OTHER NOTES

A portion of people infected with mumps virus have no parotid swelling and a clinically inapparent infection

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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