There are many conditions that I have learned about, yet never seen. Some conditions I was not wise enough to diagnose.  Others conditions patient rarely develop have because of vaccinations!  Unfortunately, despite vaccinations, there are still outbreaks of these important conditions.  We’ve discussed Measles and Pertussis previously. Now, let us look at Mumps!

Mumps: Basics

• Mumps virus is a Paramyxoviridae virus.
• Mumps is a vaccine preventable disease, although does still occur in outbreaks.
  • Large outbreaks recorded in UK (2004), USA (2006, 2009) and Netherlands (2009) [Dayan, 2008; Barskey, 2012; Sane, 2014]
    • Close to home (like recently in Charlotte).
  • Outbreaks have occurred primarily in college-aged adults and patients too old or too young to have been vaccinated.
  • The vaccine is not 100% effective and there are populations that are unvaccinated.
  • So, while the vaccine has helped substantially, you still may encounter a patient with mumps!

• Compared to measles and pertussis, mumps is generally more benign. [Hviid, 2008]
  • In pre-vaccine era, mumps was a major cause of aseptic meningitis. [Rotbart, 2000]

• Mumps shows a seasonality that shows peak in Winter and Spring.
• Mumps is a self-limited illness and resolves within a few weeks.

Mumps: Presentation

• Like many childhood viral illnesses… it often looks benign at first.
  • Prodrome
    • Fever, malaise, headache.
    • Some will have ear and/or jaw pain.
    • Unfortunately, can be contagious during this time. [Kutty, 2010]

• Other clinical findings:
  • Parotitis
    • Most prevalent finding!
    • Seen in 95% of symptomatic patients! [Hviid, 2008]
    • Occurs in first 2 days of illness.
    • Usually resolves within 1-2 weeks.
    • Angle of mandible is obscured.
    • Bilateral involvement is common.
    • Can involve other salivary glands (not just parotid).
  • Aseptic Meningitis
    • Most common extra-salivary gland clinical finding.
    • CSF Pleocytosis is common (50%), but clinical meningitis occurs in only up to 15% of cases. [Hviid, 2008]
    • Encephalitis is rare (0.1%).
    • Permanent sequelae is rare.
  • Gonadal Involvement
    • Oophoritis (~5%) or orchitis (~30%) can occur.
    • Occurs 4-14 days after parotitis, but cases known to occur as late as 6 weeks after.
    • Testicle swelling and tenderness is usually unilateral. Bilateral in 15-30% of cases with orchitis. [Hviid, 2008]
    • Oophoritis can mimic appendicitis.
  • Pancreatitis
    • Seen in 4-5% of cases.
    • Often has mild clinical course.
    • Add Mumps to your Ddx of pancreatitis in kids!

Mumps: Parotitis DDx

• Obviously, other conditions can cause parotid swelling… and are likely more common! [Hviid, 2008]
• When there is no Outbreak, consider these entities as being more probable.
• Other Viral Infections
  • EBV
  • Parainfluenza virus
  • Adenovirus
  • Influenza A
  • Coxsakievirus
  • Parvo B19
  • Human herpesvirus 6
  • Acute HIV infection
• Bacterial Infections
  • Staph
  • Atypical mycobacteria
• Drugs
  • Phenothiazines
  • Iodines
  • Thiouracil
• Miscellaneous
  • Salivary stones
  • Salivary tumors
  • Malnutrition
  • Diabetes
  • Sjigren’s Syndrome

Mumps: Diagnosis

• Clinical definition = Acute onset of unilateral/bilateral parotid swelling or other salivary glands lasting 2 or more days without other clear cause.
• Laboratory diagnosis is based on identifying the mumps virus.
  • Virus can be isolated from saliva, CSF, urine, or seminal fluid within the 1^st week of symptoms!
  • RT-PCR is usually preferred over viral culture.
• Serology (ex, IgM level) is not as helpful as RT-PCR and effected by timing of sample during illness and previous vaccination status.

Mumps: Treatment

• Symptomatic primarily
• Avoid salivary-stimulating foods (ex, acidic).
• Keep away from pregnant women in 1st trimester.
• Isolate with Standard and Droplet Precautions for 5 days after onset of parotitis. [Kutty, 2010]

References

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