Mumps

The mumps virus is a member of the paramyxovirus group and only one serotype is known. Before the introduction of the vaccine, mumps parotitis was a common pediatric illness. Children presented with a low grade temperature and parotid swelling, often bilaterally. The submaxillary and sublingual glands may also be infected in 10-15% of the cases.

Epidemiology

  1. Although the vaccine was introduced in 1968, it was not universally recommended until 1977. 
  2. Cases are related to lack of immunization rather than a failure of the vaccine.
  3. Spread is by respiratory droplets
  4. Transmission may be occur about 24 hours prior to parotid swelling and 3 days after swelling is gone.
  5. There is transplacental antibody protection that lasts 6-8 months
  6. Incubation period is 14-24 days with a peak at 17 days.

Clinical Manifestations

  1. There is a prodrome of fever, headache, sore neck, and malaise followed by parotid swelling that may be rapid at first and peaks at 3 days. The swelling is preauricular and extends downward to obscure the angle of the jaw and reaches the mastoid. The ear is pushed upwards and out. The temperature elevation is moderate and rarely >40 C. 
  2. The swelling lasts about 3-7 days
  3. The gland is tender and eating spicy or sour foods will increase the pain
  4. There may be swelling around Stenson's duct on the buccal mucosa.

Complications

  1. Aseptic meningitis. May be seen clinically in 10% of cases and monos can be found in the CSF in 65% of individuals with mumps.  May be associated with low CSF glucose and may think that you are dealling with a bacterial meningitis.
  2. Orchitis- usually in adolescent boys with the acute onset of testicular swelling associated with high temperature and pain. Treatment is local support and analgesics. Atrophy of the teste in 30% and 13% infertility rate. 
  3. Pancreatitis, myocarditis, nephritis, thyroiditis, unilateral hearing loss, eye involvement
  4. Mumps in pregnant women has been associated with an increased rate of spontaneous abortion but not with an increase in congenital malformations.
  5. Complications may occur without parotitis.

Diagnosis

  1. Clinical diagnosis but may be confirmed by getting IgM antibodies or antibody titers 2 weeks after the acute infection.
  2. May culture virus from oral secretions, urine, blood, and CSF.

Differential Diagnosis

  1. Other viruses -parainfluenza, influenza, HIV
  2. Suppurative parotitis- Staph. aureus 
  3. Calculi of the duct
  4. Recurrent parotid swelling of unknown etiology
  5. Malignancies of the parotid
  6. Preauricular lymphadenitis

Treatment

  1. Symptomatic

Immunization

  1. Live vaccine usually given with the measles and rubella (MMR). 
  2. Two dose given at 12-15 months and 4-6 years
  3. Rarely symptoms following the vaccine although cases of parotid swelling 7-10 days after immunization have been reported.
  4. There is antibody production in greater than 90% and the vaccine is 97% protective

Control

  1. The patients are contagious for 9 days after the onset of parotid swelling.
  2. The use of vaccine after munps exposure in not effective in preventing the disease

References

  1. Gold, Eli. Almost Extinct Disease: Measles, Mumps, Rubella, and Pertussis. Pediatrics in Review April 1996
  2. 2000 Redbook
  3. Davidkin I. Etiology of Mumps like Illness.  J. Infect. Dis 2005;191:719-23
  4. Dayan G et al. Recent Resurgence of Mumps in the United States.  NEJM April 10, 2008
  5. Baszis,K. et al.  Recurrent Parotitis as a Presentation of Primary Pediatric Sjorgen Syndrome.  Pediatrics January 2012

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