Makindo Medical Notes

Related Subjects: |Herpes Varicella-Zoster (Shingles) Infection |Chickenpox Varicella Infection |Varicella Cerebral Vasculopathy |Herpes Viruses |Herpes Zoster Ophthalmicus (HZO) Shingles |MonkeyPox |Mumps |Measles |Rubella (German Measles) |Epstein-Barr Virus infection

Mumps is an acute viral infection primarily affecting the salivary glands, particularly the parotid glands. While generally self-limiting, mumps can lead to significant complications, especially in young individuals. Early recognition and appropriate management are essential to prevent adverse outcomes.

About

• Definition: Mumps is a viral infection caused by the mumps virus, a member of the Paramyxoviridae family.
• Epidemiology: Most commonly affects school-aged children and young adults. The incidence has significantly decreased in regions with widespread MMR (measles, mumps, rubella) vaccination.
• Transmission: Highly contagious, spread through respiratory droplets and direct contact with infected saliva.

In a young person presenting with orchitis (inflammation of the testes), it is crucial to consider testicular torsion in the differential diagnosis to prevent potential loss of the testicle.

Virology

• Pathogen: Mumps virus, an RNA paramyxovirus.
• Transmission: Spread primarily by aerosol droplets from infected individuals.
• Incubation Period: Typically 18-21 days.
• Population Affected: Most common in unvaccinated individuals, particularly school-aged children and young adults.

Clinical Features

• Systemic Symptoms: Fever, headache, malaise, and general body aches.
• Parotid Gland Swelling: Painful, swollen parotid glands are a hallmark of mumps, giving the disease its name.
• Orchitis: Occurs in approximately 25% of post-pubertal males, leading to scrotal pain and swelling. While rare, it can cause sterility.
• Extraparenchymal Manifestations: Myocarditis and hepatitis can occur as complications.

Clinical Signs

• Parotitis: Swelling and tenderness of the parotid glands, often unilateral initially but typically bilateral as the disease progresses.
• Orchitis: Testicular swelling, pain, and tenderness. May be accompanied by fever and malaise.
• Mucocutaneous Lesions: Rash may be present in some cases.

Complications

• Parotitis: Occurs in 75% of cases, leading to significant discomfort.
• Oophoritis: In females, seen in about 5% of cases post-puberty.
• Orchitis: Present in 25% of post-pubertal males, rarely causing fertility issues.
• Meningitis: Viral meningitis-like symptoms occur in approximately 50% of cases, more common in males.
• Encephalitis: Rare but severe, with a mortality rate of 1-2% and potential for permanent deafness.
• Sensorineural Deafness: Transient hearing loss may occur.
• Spontaneous Abortion: May occur in the first trimester in pregnant women.

Prevention

• Vaccination: The MMR vaccine, administered at 13 months of age, contains a live attenuated mumps vaccine and has markedly reduced the incidence of mumps.
• Hygiene Practices: Regular handwashing, avoiding close contact with infected individuals, and covering mouth and nose when coughing or sneezing.
• Isolation: Infected individuals should be isolated to prevent the spread of the virus.

Investigations

• Polymerase Chain Reaction (PCR): Analysis of buccal mucosa samples for viral DNA.
• Serological Testing: Detection of rising IgM antibodies against the mumps virus or a fourfold rise in acute and convalescent IgG antibodies.
• Ultrasound: In cases of orchitis, scrotal ultrasound may be performed to rule out testicular torsion.

Management

• Supportive Care: Includes analgesia for pain, adequate hydration, and rest.
• Antibiotics: Reserved for secondary bacterial infections if present.
• Steroids: No evidence supports the routine use of steroids in orchitis, although they may be used to reduce pain and discomfort in some cases (e.g., Prednisolone 40 mg orally once daily for 4 days).
• Vaccination: Mumps vaccination as part of the MMR vaccine is crucial in preventing outbreaks and complications. Widespread use of the vaccine has significantly reduced the epidemic pattern of the disease.
• Specialist Referral: In cases of severe complications such as encephalitis or orchitis, referral to appropriate specialists is recommended.

Conclusion

Mumps is a preventable viral infection that primarily affects children and young adults. While it is generally self-limiting, awareness of its complications, such as orchitis and encephalitis, is essential for timely diagnosis and management. Vaccination remains the most effective strategy for preventing mumps and its associated complications.

References

• Centers for Disease Control and Prevention (CDC). Mumps. Available at: https://www.cdc.gov/mumps/index.html
• World Health Organization (WHO). Mumps. Available at: https://www.who.int
• National Institutes of Health (NIH). Mumps. Available at: https://www.ncbi.nlm.nih.gov
• Mayo Clinic. Mumps. Available at: https://www.mayoclinic.org
• American Academy of Pediatrics (AAP). Mumps. Available at: https://www.aap.org