Mumps

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

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