Mumps - Causes, Symptoms and Treatment
Also known as infectious or epidemic parotitis, mumps is an acute viral disease caused by a paramyxovirus. It is most prevalent in children older than age 5 but younger than age 9. Infants under age of 1 year, seldom get this disease because of passive immunity from maternal antibodies.
Causes of Mumps
The mumps paramyxovirus is found in the saliva of an infected person and is transmitted by droplets or by direct contact. The virus is present in the saliva 6 days before to 9 days after onset of parotid gland swelling; the 48-hour period immediately preceding onset of swelling is probably the time of highest communicability. The incubation period ranges from 14 to 25 days (the average is 18 days). One attack of mumps (even if unilateral) almost always confers lifelong immunity.
Signs and Symptoms of Mumps
The clinical features of mumps vary widely. An estimated 30% of susceptible people have subclinical illness.
Mumps usually begins with prodromal symptoms that last for 24 hours and include myalgia, anorexia, malaise, headache, and low-grade fever. These symptoms are followed by an earache that's aggravated by chewing, parotid gland tenderness and swelling, a temperature of 101 to 104 F (38.3° to 40° C), and pain when chewing or when drinking sour or acidic liquids. Simultaneously with the swelling of the parotid gland, or several days later, one or more of the other salivary glands may become swollen.
Complications can include epididymoorchitis and mumps meningitis. Epididymo-orchitis, which Occurs in approximately 25% of postpubertal males who contract mumps, produces abrupt onset of testicular swelling and tenderness, scrotal erythema, lower abdominal pain, nausea, vomiting, fever, and chills. Swelling and tenderness may last for several weeks; epididymitis may precede or accompany orchitis. In 50% of men with mumps-induced orchitis, the testicles show some atrophy, but sterility is extremely rare.
Mumps meningitis complicates mumps in 10% of patients and affects males three to five times more often than females. Symptoms include fever, meningeal irritation (nuchal rigidity, headache, and irritability), vomiting, drowsiness, and a lymphocyte count in cerebrospinal fluid ranging from 500 to 2,000/ul. Recovery is usually complete. Less common effects are pancreatitis, deafness, arthritis, myocarditis, encephalitis, pericarditis, oophoritis, and nephritis.
Diagnosis for Mumps
In mumps, a diagnosis is usually made after the characteristic signs and symptoms develop, especially parotid gland enlargement with a history of exposure to mumps. Serologic antibody testing can verify the diagnosis when parotid or other salivary gland enlargement is absent. lf comparison between a blood sample obtained during the acute phase of illness and another sample obtained 3 weeks later shows a fourfold rise in antibody titer, the patient most likely had mumps. Differential diagnoses include other infectious viruses (such as those caused by parainfluenza virus type 3, coxsackieviruses, and influenza A virus), sarcoidosis, and Sjogren's syndrome.
Treatment for Mumps
Effective treatment includes analgesics for pain, antipyretics for fever, and adequate fluid intake to prevent dehydration from fever and anorexia. lf the patient can't swallow, I.V. fluid replacement may be necessary.
Special Considerations and Prevention Tips for Mumps
Emphasize the importance of routine immunization with live attenuated mumps virus (paramyxovirus) and for susceptible patients (especially males) who are approaching or are past puberty. In the U.S. the mumps vaccine is usually given as part of the MMR at age! 5 months, and then again later in childhood; it is over 95% effective in preventing mumps disease. Also, immunization within 24 hours of exposure may prevent or attenuate the actual disease. Immunity against mumps lasts at least 12 years.
1. Stress the need for bed rest during the febrile period.
2. Give analgesics, and apply warm or cool compresses to the neck to relieve pain.
3. Give antipyretics and tepid sponge baths for fever.
4. To prevent dehydration, encourage the patient to drink fluids; to minimize pain and anorexia, advise him to avoid spicy, irritating foods and those that require a lot of chewing.
5. During the acute phase, observe the patient closely for signs of central nervous system involvement, such as an altered level of consciousness and nuchal rigidity.
6. Respiratory isolation is advocated for mumps. Precautions should be taken by all personnel in contact with the patient.
7. Report all cases of mumps to local public health authorities.
8. The patient should be excluded from school or the workplace for 9 days from the onset of mumps.
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