Mumps (Epidemic Parotitis)
Mumps (or Epidemic Parotitis) is an acute viral disease spread by droplet infection. It affects mainly children of school age and young adults. The alternative name of mumps is infectious parotitis. The disease is characterised by pain & swelling commonly bilateral than unilateral of the parotid salivary gland. The infectivity rate is not high and there is serological evidence that 30-40% of infections are clinically in- apparent. Infection is more common during late winter and spring.
Mumps was a common childhood disease worldwide before the development of vaccination and the introduction of vaccine. It is still a significant threat to health in the undeveloped word. Mumps outbreaks still occur in developed countries sporadic-cally. Since mumps is viral disease hence it is self-limiting with no specific treatment apart from controlling the pain with analgesics.
Incubation Period :
• The average incubation period is about 18 days which ranges from 14 to 28 days. A quarantine period is not necessary.
• Contacts should be watched for the first sign of disease from the 12th to the 28th day after exposure.
• The disease is communicable from 6 days before to 9 days after facial swelling is apparent.
Causes of Mumps :
• Mumps is a contagious disease caused by mumps virus which belongs to the family Paramyxoviridae.
• Humans are the only known natural host for mumps virus.
• The virus is spread through direct contact or by airborne droplets from the upper respiratory tract.
Clinical Features :
Mumps usually starts with non specific symptoms like:
• Muscle pain (Myalgia)
• Malaise (Physical discomfort)
• Low grade fever
• Pain near the angle of the jaw is soon follows by tender swelling of one or both parotid glands.
• Within 24 hours the characteristic uni or bilateral swelling of the parotid glands occurs.
• Parotitis or swollen painful parotid glands alone is often the first feature of mumps. It occurs in 60-70% of infections and 95% of patients have this symptom.
• The swollen parotid gland subsides in a few days and may be succeeded by swelling of a previously unaffected gland.
• Within 1-4 days, other salivary glands are affected in about 10% of the cases.
• Fever and glandular swelling subside in about one week.
• The illness resolves completely unless complications occur.
• Symptoms are often not severe in children.
• Painful swelling of the parotid salivary gland is the most typical presentation of mumps.
• Orchitis (painful testicular swelling) occur at puberty or in early manhood and usually on one side only, but if it is bilateral, sterility may be a sequel.
• Rash occur in few cases.
• Anorexia is often a rare symptom.
• Obscure abdominal pain may be due to pancreatitis or oophoritis (inflammati-on of one or both ovaries).
• Acute lymphocytic meningitis is another mode of presentation.
• Encephalitis is rare. If such conditions are due to mumps, they are accompanied by a lymphocytosis.
• Other symptoms of mumps are dry mouth, sore face and or ears and rarely loss of voice in more serious cases.
• About 30% cases of mumps are asymptomatic, and spread the virus (disease) without knowing it.
Diagnosis of Mumps :
• Most of the cases of mumps can be diagnosed on clinical grounds alone and no confirmatory laboratory test is required.
• A physical examination confirms the presence of the swollen parotid glands.
• The diagnosis can be confirmed in doubtful cases by the demonstration of specific antibodies, or the virus may be cultured from the saliva, or in meningitis from the cerebro spinal fluid.
Differential diagnosis of Mumps :
1. Suppurative Parotitis: is distinguished by circumstances of onset in an old, frail, ill, febrile or dehydrated patient in whom oral hygiene is poor, and confirmed by obtaining pus from the parotid duct.
2. Calculus obstruction: This is the rare phenomenon.
3. Sarcoidosis: may cause enlarged parotid glands and is usually accompanied by other signs especially uveitis
Complications of Mumps :
• Involvement of other organ systems.
• Orchitis or epidedymitis in about 30% of cases of mumps, out of which 50% develop testicular atrophy and rarely sterility.
• Abortion in about 25% of cases in the first trimester of pregnancy.
• Meningitis in mild form in about 10% of cases.
• Pancreatitis with pain in abdomen and vomiting in about 4% of cases.
• Oophoritis i.e. inflammation of ovaries in about 5% of female cases.
• Encephalitis though very rare. When it occurs is fatal in 1% of cases.
Prevention of Mumps :
1. The mumps can be prevented by personal hygiene and isolation.
2. Active Immunisation by MMR (Measles Mumps Rubella) vaccine.
Treatment of Mumps :
• The disease is self limiting and there is no specific treatment.
• Only symptomatic treatment is required.
• Oral hygiene is very important when mouth is too dry due to lack of salivation.
• Difficulty in opening the mouth may necessitate feeding through a straw.
• Apart from the relief of symptoms as they appear, no other treatment is necessary.
• Orchitis can be relieved by the administration of prednisolone for few days without apparent danger of dissemination of infection.
• Apply heat or ice packs near the angle of jaw area.
• Paracetamol is given may help in relieving pain.
• ASPIRIN is not prescribed to children in viral disease because it may leads to Reye syndrome.
• Encourage soft foods, extra fluids and hot saline gargles to relieve symptoms.
• Isolation of mumps patients is necessary until the gland last affected has subsided.
Prognosis of disease :
• Prognosis of mumps is good, if other organs are not involved.
• Life long immunity developed once disease occurs.