MUMPS Mumps is a self – limiting benign viral infection of the salivary glands with systemic manifestations and complications.

Epidemiology Mumps is endemic world over It spreads primarily in late winter and early spring Common in both sexes, 5 – 15 years but all are susceptible Infant are rarely involved due to presence of transplacentally acquired maternal mumps antibodies. Man is the only reservoir of infection.

Transmission Transmitted by direct contact, through fomites contaminated by the infective sliva, or airborne droplets. Period of infectivity lasts from 7 days prior to and 9 days after the appearance of the parotid or salivary glands swelling. Life long immunity

Pathogenesis Virus enters through the respiratory tract. Proliferation takes place in either the parotid gland or the superficial epithelium of the respiratory tract. This is followed by viremia, virus is localized in the salivary glands or central nervous system. The parotid gland is most often involved. Mumps virus has been isolated from human saliva, blood, urine, and cerebrospinal fluid (CSF) during the acute phase of the illness. The interstitial tissue shows edema and infiltration with lymphocytes.

Clinical features Salivary manifestations : - – Pain near the lobe of ear and difficulty in chewing within 24 hours of the onset. – Area behind the angle of jaw appears full and parotid swelling – Obliteration of the mandibular angle – Ear lobe may appear to be pushed upwards and outward – Submaxillary and sublingual glands may also be enlarged – Disease begins unilaterally but involves the other side also within 48 – 72 hours in 75 % of cases – Fever and tenderness settle in 1 – 6 days – Swelling disappears in 6 to 10 days.

Extrasalivary manifestations Aseptic meningitis ( 10 % ) : - within 1 weeks prior to and 3 weeks after the onset of parotitis. Complains of : severe headache, vomiting and neck stiffness Encephalitis less common than meningitis Deafness ( 8 th nerve damage ) Facial palsy Guillian barre syndrome

complications Orchitis and or epididymitis : - affected testis is swollen and tender Pancreatitis : - epigastric pain, tenderness, vomiting, and fever with chills Oophoritis Nephiritis : - excretion of virus in urine Mumps in pregnancy : -1 st trimester ( increased fetal mortality, LBW babies ) Others ( less common ) : - myocarditis, mastitis, arthritis, optic neuritis, thrombocytopenic purpura

Differential diagnosis Supurrative parotitis : pus can be extracted Recurrent parotitis : H /O allergy Calculus in Stensen`s duct causes intermittent swelling Lymphadenitis

Laboratory findings Infection can be confirmed by viral culture or serology Culture samples can be obtained by pharyngeal swab or from urine or cerebrospinal fluid during the febrile course of disease. Serology can be confirmed via enzyme immunoassay, complement fixation, or hemagglutination inhibition.

DIAGNOSIS Confirmatory Clinical Factors (1) a history of exposure to mumps 2 to 3 weeks before onset of illness, (2) clinical picture of parotitis or other glandular involvement, and (3) signs of aseptic meningitis.

Treatment conservative measures to provide symptomatic relief and adequate hydration and nutrition. Treatment of orchitis includes bedrest, scrotal support, analgesics, and ice packs. Patients with significant CNS involvement require hospitalization for observation and supportive care. There is currently no established role for antiviral drugs, corticosteroids, or passive immunotherapy in the treatment of mumps

Control of Mumps Vaccine Live-virus mumps vaccine is administered 0.5 cc ; commonly given in combination with MMR (measles, mumps, rubella) vaccine First dose is recommended at from 12 to 15 months of age Second dose is recommended at school entry (age 4 to 6 years) If no preschool dose is given, the second dose should be administered before age 12 MMR Vaccine Contraindications Pregnancy Febrile illness Planned pregnancy within 3 months Severe immunocompromised state Blood product or immune globulin within 3 to 6 months (dose dependent) MMR Vaccine Should Be Used with Caution in These Situations Seizure disorder Thrombocytopenia