Mumps: Causes, Symptoms, Complications and Treatment

Mumps
Kuldeep Vyas
Asst. Prof. Community Health Nursing

Definition
Kuldeep Vyas M.Sc. CHN 25-06-2020
2
Mumps is an acute viral infection of
childhood that typically involves swelling of
one or both parotid glands, although many
different organs can be infected.

Etiology
3
Mumps virus, the cause of mumps, is an
RNA virus of the genus Rubulavirus in
the Paramyxoviridae family , which also
includes the parainfluenza viruses. Only
one serotype is known

Epidemiology
4
 Mumps is endemic in most unvaccinated
populations
 The virus is spread from human reservoir by ;
* Direct contact
* Airborne droplets
* Fomites contaminated by saliva
* possibly by urine
 It is distributed worldwide
 Affects both sexes equally

Epidemiology (cont.)
5
 Before introduction of the vaccine in 1967:
* the peak incidence of the disease occurred
in children 5-9 yr of age
* 85% of infections occurred in children younger
than 15 yr of age.
 Now most cases occur in young adults,
producing outbreaks in colleges or in the
workplace.

6
 Outbreaks appear to be primarily related
to a lack of immunization, especially in an
underimmunized cohort of children born
from 1967-1977, rather than to waning to
immunity.
 Epidemics occur at all seasons but are
slightly more frequent in late winter and
spring.

7
In the United States, the reported
incidence of mumps declined after the
introduction of mumps vaccine in 1967
 the recommendation for its routine use in
1977.
 After expanded recommendations for a 2-
dose measles, mumps, and rubella (MMR)
vaccine schedule for measles control in
1989, mumps cases declined further

Reported cases of mumps infection per 100 000 population, 1978–2003.
(Data from Centers for
Disease Control and Prevention. Summary of notifiable diseases, United
States 2003. MMWR
2005;52: 54.)
8

9
 Virus has been isolated from saliva as long as 6
days before and up to 9 days after appearance
of salivary gland swelling.
 Transmission does not seem to occur more
than 24 hr before the appearance of the swelling
or later than 3 days after it has subsided.
 Virus has been isolated from urine from the 1st-
14th day after the onset of salivary gland
swelling.

Pathogenesis
10
 After entry into the last and initial
multiplication in the cells of the respiratory
tract, the virus is bloodborne to many
tissues, among which the salivary and
other glands are the most susceptible.

Clinical Manifestations
11
 The incubation period ranges from 14-24
days, with a peak at 17-18 days.
 Approximately 30-40% of infections are
subclinical
 In children, prodromal manifestations are rare
but may be manifest by:
* Fever
* Muscular pain (especially in the neck)
* Headache
* Malaise
typically precede the parotid swelling by 12 to
24 hours

Clinical Manifestations (cont.)
12
*Common complaints are:
Earache on the side of parotid involvement
Discomfort with eating or drinking acidic
food
* Parotid pain is most pronounced during the
first few days of swelling

13
The swollen parotid gland lifts the earlobe
upward and outward, and the angle of the
mandible is obscured
 the opening of the Stensen duct on the
buccal mucosa is edematous and
erythematous.
 Trismus (spasm of the masticatory
muscles) can occur.

Toddler with mumps parotitis
(Courtesy of A.
Margileth.)
14

15
 Other salivary glands such as the
submandibular and sublingual glands may
also be involved.
In 10-15% of patients only the
submandibular gland(s) may be swollen
 Presternal edema can be notable.
 Morbilliform rash has been reported in
association with mumps infection

16
Systemic symptoms, including fever,
usually resolve within 3 to 5 days
 the parotid swelling subsides within 7 to
10 days
 Adolescents and adults have more severe
disease than young children.

Diagnosis
17
 The diagnosis of mumps parotitis is usually
apparent from the clinical symptoms and physical
examination
 Routine laboratory tests are nonspecific; usually
leukopenia is present with relative lymphocytosis.
 An elevation in serum amylase levels is common;
the rise tends to parallel the parotid swelling and
then to return to normal within 2 wk

Diagnosis (cont.)
18
The microbiologic diagnosis is by serology
or virus culture
Enzyme immunoassay for mumps
immunoglobulin (Ig).
IgG and IgM antibodies are most commonly
used for diagnosis.
 IgM antibodies are detectable in the first
few days of illness and are considered
diagnostic

Diagnosis (cont.)
19
Mumps virus can be cultured from the
saliva, cerebrospinal fluid, blood, urine,
brain, and other infected tissues.
 Primary cultures of human or monkey
kidney cells are used for viral isolation
 The mumps skin test is unreliable for
diagnosis of mumps and for determination
of susceptibility to infection.

DIFFERENTIAL DIAGNOSIS
20
The differential diagnosis of parotitis is broad and includes:
 bacterial (suppurative) parotitis
 parotid duct stone
 drug reactions
 recurrent parotitis of childhood
 Other viruses, such as influenza, coxsackievirus A,
echovirus, and parainfluenza viruses 1 and 3, can cause
parotitis and are usually responsible for “recurrent
mumps”
 parotid tumor
 Sjögren syndrome

21
viru
s.
(Courtesy of J.H.
Brien.)

Treatment
22
There is no specific antiviral therapy;
treatment is entirely supportive.
 Antipyretics (acetaminophen or ibuprofen)
are indicated for fever.
Bed rest should be guided by the patient's
needs, but no evidence indicates that it
prevents complications. The diet should be
adjusted to the patient's ability to chew.

Treatment(cont.)
23
 Orchitis should be treated with local
support and bed rest.
Mumps arthritis may respond to a 2-wk
course of a nonsteroidal anti-inflammatory
agent or corticosteroids.
Salicylates do not appear to be effective

Complications
24
 MENINGOENCEPHALOMYELITIS
1.The most frequent complication in childhood
2.Clinical manifestations occur in more than
10% of patients
3.The incidence of mumps meningoencephalitis
is approximately 250/ 100,000 cases
4. The mortality rate is about 2%

Complications
25
 MENINGOENCEPHALOMYELITIS (cont.)
5. may be either:
I. Primary infection of neurons:
parotitis frequently appears at the same
time or following the onset of encephalitis
II. Postinfectious encephalitis with
demyelination :
encephalitis follows parotitis by an
average of10 days.

Complications
26
 MENINGOENCEPHALOMYELITIS (cont.)
*Mumps meningoencephalitis is clinically
indistinguishable from meningoencephalitis of
other origins
* Moderate stiffness of the neck is seen, but the
remaining findings on neurologic examination are
usually normal
*The cerebrospinal fluid may show a lymphocytic
pleocytosis of less than 500 cells/ mm3, although
occasionally the count may exceed 2,000 cells/mm3.

Complications (cont.)
27
 ORCHITIS AND EPIDIDYMITIS
1. These complications rarely occur in
prepubescent boys but are common (14-35%) in
adolescents and adults.
2. The testis is most often infected with or without
epididymitis; epididymitis may also occur alone.
3. Bilateral orchitis occurs in approximately 30% of
patients. Rarely, there is a hydrocele.
4.The orchitis usually follows parotitis within 8 days.
Orchitis may also occur without evidence of
salivary gland infection. .

Complications
28
 ORCHITIS AND EPIDIDYMITIS (cont.)
5.The onset is usually abrupt, with a rise in
temperature, chills, headache, nausea, and
lower abdominal pain;
6. The affected testis becomes tender and
swollen, and the adjacent skin is edematous
and red.
7.The average duration of illness is 4 days.
8. Approximately 30-40% of affected testes atrophy,
leaving a cosmetic imbalance.
9. Infertility is rare even with bilateral orchitis.

29
OOPHORITIS
Pelvic pain and tenderness are noted in
about 7% of postpubertal female patients.
There is no evidence of impairment of
fertility.

30
PANCREATITIS
* Mild or subclinical pancreatic involvement is common, but
severe pancreatitis is rare.
* It may be unassociated with salivary gland manifestations
and may be misdiagnosed as gastroenteritis.
* Epigastric pain and tenderness, which are
suggestive, may be accompanied by
fever, chills, vomiting, and prostration.
* An elevated serum amylase value is characteristically
present in patients with mumps, with or without clinical
manifestations of pancreatitis

31
 MYOCARDITIS
*Serious cardiac manifestations are extremely
rare
* mild infection of the myocardium may be more
common than is recognized.
* Electrocardiographic tracings revealed changes, mostly
depression of the ST segment, in 13% of adults in one
series.
* Such involvement may explain the precordial pain,
bradycardia, and fatigue sometimes noted among
adolescents and adults with mumps.

32
ARTHRITIS
*Migratory polyarthralgia and even arthritis are
occasionally seen in adults with mumps but are
rare in children.
*The knees, ankles, shoulders, and wrists are
most commonly affected.
*The symptoms last from a few days to 3 mo,
with a median duration of 2 wk

33
THYROIDITIS
* It is uncommon in children
* A diffuse, tender swelling of the thyroid
may occur about 1 wk after the onset of
parotitis
* Antithyroid antibodies subsequently
develop

34
DEAFNESS
* Unilateral, rarely bilateral, nerve
deafness may occur
* the incidence is low (1/15,000 cases)
* mumps was historically a leading cause
of unilateral nerve deafness.
* The hearing loss may be transient
or permanent.

35
OCULAR COMPLICATIONS
* Dacryoadenitis may occur with painful
swelling, usually bilateral, of the lacrimal
glands.
* Optic neuritis (papillitis) may occur
*Symptoms vary from loss of vision to mild
blurring, with recovery in 10-20 days.

Prognosis
36
The prognosis of mumps in childhood is
excellent.
 Infection usually confers permanent
immunity
 Reinfections have been documented

Prevention
37
Mumps vaccine is derived from the Jeryl
Lynn strain of mumps virus,
The vaccine induces antibody in 96% of
seronegative recipients and has 97%
protective efficacy.
The initial mumps immunization, usually
as measles- mumps-rubella (MMR)
vaccine, is recommended at 12- 15 mo
of age.
 A second immunization, also as MMR, is
recommended routinely at 4-6 yr of age
but may be administered at any time
during childhood provided at least 4 wk
have elapsed since the first dose.

Prevention (cont.)
38
 Women should avoid becoming pregnant for 30
days after monovalent mumps vaccination (3
mo if vaccination was performed with rubella
vaccine).
 Other contraindications to vaccination include:
*allergy to a vaccine component
(anaphylaxis to neomycin)
* moderate or severe acute illnesses with or
without
fever
*immunodeficiency (primary
immunodeficiencies, cancer and cancer
therapy, long-term high-dose corticosteroid
therapy, severely immunocompromised,
including those with HIV infection)

Prevention (cont.)
39
Children who have not previously received
the second dose should be immunized by
11-12 yr of age.
 Rarely, parotitis and low-grade fever can
develop 10-14 days after vaccination.
Vaccinees do not shed virus.
 Maternal antibody is protective in the
infant in the first 6 mo of life.

Summary
40
 Mumps is an acute viral infection involves swelling of
one or both parotid glands
 Mumps is an RNA virus of the genus Rubulavirus in the
Paramyxoviridae family
 spread from human reservoir by ; direct contact.
airborne droplets. fomites contaminated by saliva and
possibly by urine
 Transmission does not seem to occur more than 24 hr
before the
appearance of the swelling or later than 3 days after it
has subsided
 The incubation period ranges from 14-24 days, with a
peak at 17-18 days.
 Approximately 30-40% of infections are subclinical
 Common complaints are: earache ,discomfort with
eating or drinking acidic food parotid pain is most

Summary
41
 the opening of the Stensen duct on the buccal mucosa is
edematous
and erythematous.
 submandibular and sublingual glands may also be
involved.
 the parotid swelling subsides within 7 to 10 days
 The diagnosis of mumps parotitis is usually apparent
from the clinical symptoms and physical examination
 There is no specific antiviral therapy; treatment is entirely
supportive.
 Complications include:
MENINGOENCEPHALOMYELITIS, ORCHITIS AND
EPIDIDYMITIS, OOPHORITIS , PANCREATITIS ,
MYOCARDITIS, ARTHRITIS , THYROIDITIS,
DEAFNESS and OCULAR COMPLICATIONS
 The prognosis of mumps in childhood is excellent.
 Infection usually confers permanent immunity

Mumps: Causes, Symptoms, Complications and Treatment

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