subject: Mumps clinical features and management [print this page] Mumps clinical features and management Mumps clinical features and management
Mumps is a systemic paramyxovirus infection which commonlycauses inflammation of the salivary glands. It istransmitted by droplets from the mouth. Infection in childhoodis common but infectivity is low, and many peoplereach adulthood without becoming affected.
Clinical featuresThe incubation period is about 18 days. Mumps is a mild disease in childhood and about one-thirdof children infected have no symptoms. In its mildest formthere is fever with discomfort and swelling in the parotidglands, which lasts a week or less. In more severe formsthere is considerable malaise, the glands are painful andthere may be trismus. Other salivary glands are ofteninflamed and glands are sometimes involved sequentially.
Swollen parotid glands can be distinguished from lymphadenopathybecause the angle of the mandible is obliteratedby the former. The mouth is dry and there may beredness around the orifices of the parotid ducts, but thereis no purulent discharge.About 20% of adult males develop orchitis in the courseof mumps, but oophoritis is rare. Usually orchitis starts afew days after the onset of parotitis, but it may be earlierand may occur in the absence of parotitis. The swolleninflamed testicle is exquisitely tender and remains so for3-4 days before gradually recovering.
Orchitis is accompaniedby fever and malaise, and the latter often persistsfor some weeks.Orchitis is bilateral in 15-30% of cases, but even in thesepatients sterility is extremely rare. Although some shrinkageof involved testicles may be detected shortly after theillness, this does not imply complete loss of function and itis important to reassure patients on this point.Mumps virus is highly neurotropic and involvementof the CNS is the most common complication of thisinfection. There are two distinct entities, meningitis andencephalitis
.Lymphocytic meningitis occurs in about 5% of patientswith mumps parotitis, but this figure underestimates itsprevalence as it also occurs in the absence of parotitis.There is some seasonal variation in the clinical manifestations,meningitis with parotitis being more common inspring, whereas meningitis alone is seen more in summer.The time of onset of meningitis varies, but it usuallybecomes apparent a few days after parotitis. The CSFshows a lymphocytic pleocytosis and virus can be isolatedfrom it. The course is invariably benign.Encephalitis is rare. It either occurs during parotitis as aresult of direct viral invasion of the brain, or its onset is7-10 days after that of parotitis, when it represents apostinfectious encephalitis. Most patients recover completely,but there is a mortality of 1-2%.Pancreatitis is rarely severe but may account for some ofthe abdominal symptoms in mumps. Some degree ofabdominal pain is not infrequent and may be accompaniedby vomiting. In severe cases there is marked abdominaltenderness and the serum amylase and lipase levels areelevated.DiagnosisA clinical diagnosis usually presents little difficulty, but ifnecessary the virus can be isolated from saliva and throatwashings, or from CSF in cases of meningitis. Complementfixingantibody detection can be used to make a retrospectivediagnosis.ManagementThere is no specific treatment, but oral hygiene is importantboth for comfort and to prevent secondary infection.Orchitis requires testicular support and adequate analgesia.There is little evidence that corticosteroid treatment isbeneficial in orchitis.
Prevention Vaccination with a live attenuated vaccine was adopted aspart of the routine programme in the UK from 1988. It is given in combination with measles and rubella in the second year of life.
