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Key Features

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  • No prior mumps immunization or waning vaccine immunity

  • Parotid gland swelling

  • Aseptic meningitis with or without parotitis

  • Infected patients are infectious from 2 days prior to 5 days after the onset of parotitis

  • Incubation period is 14–21 days

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Clinical Findings

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  • Salivary gland disease

    • After a prodrome of fever, severe headache, aches and anorexia, tender swelling of parotid glands occurs (70–80% bilateral)

    • Ear is displaced upward and outward; the mandibular angle is obliterated

    • Parotid stimulation with sour foods may be quite painful

    • Orifice of the Stensen duct may be red and swollen; yellow secretions may be expressed, but pus is absent

    • Parotid swelling dissipates after 1 week

  • Meningoencephalitis

    • Manifested by severe headache, vomiting, and asymptomatic mononuclear pleocytosis

    • Although neck stiffness, nausea, and vomiting can occur, encephalitic symptoms are rare (1:4000 cases of mumps)

  • Pancreatitis

    • Epigastric abdominal pain may represent transient pancreatitis

    • Because salivary gland disease may elevate serum amylase, lipase and amylase isoenzymes are required for assessing pancreatic involvement

  • Orchitis, oophoritis

    • Associated with fever, local tenderness, and swelling

    • Second most common presentation of mumps (after parotitis)

    • Epididymitis is usually present

      • Most often unilateral

      • Resolves in 1–2 weeks

  • Other

    • Thyroiditis, mastitis (especially in adolescent females), arthritis, and presternal edema (occasionally with dysphagia or hoarseness) may be seen

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Diagnosis

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  • Peripheral blood leukocyte count is usually normal

  • Cerebrospinal fluid may contain a modest number of cells (eg, 250 cells/μL, predominantly lymphocytes), with mildly elevated protein and normal to slightly decreased glucose

  • Viral culture or polymerase chain reaction tests of saliva, throat, urine, or spinal fluid may be positive for at least 1 week after onset

  • Paired sera assayed by ELISA or a single positive IgM antibody test are used for diagnosis

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Treatment

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  • Supportive; provision of fluids, analgesics, and scrotal support for orchitis

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