Mumps or Parotitis

Mumps is a viral infection that primarily affects saliva-producing (salivary; parotid) glands that are located below ears. Mumps also called Parotitis. The hallmark symptom of mumps infection is swelling of the salivary glands.

Mumps viral infection affects the salivary glands; this is infection easily preventable by a vaccine. Mumps disease affects the parotid glands; salivary glands located below and in front of the ears.

Mumps is a viral infection and contagious disease, causes painful swelling of the salivary glands. The disease spreads through infected saliva of individual.

Mumps is a contagious disease caused by a mumps virus. This infection typically begins with fever, muscle aches, headache, tiredness, and loss of appetite and then in most people swelling of salivary glands (parotid gland; located in front and below the ear) causes the puffy cheeks, swollen jaw and tender. Mumps infection can cause swelling in one or both of salivary glands.

The primary sign of mumps infection is swollen salivary glands that cause the cheeks to puff out and tender.

Mumps is the most common virus, affecting either the parotid (more common) or the submandibular gland.

Epidemiological Triad

Agent- Mumps causative agent is mumpsvirus, paramyxovirus (RNA virus),  member of the Rubulavirus family.

Host – Mumps occur in children between 5 -15 years of age. It occurs in severe form in adults than in children.

Environmental factors – Peak incidence of mumps occurs in winter and spring. It occurs with overcrowding

Mode of Transmission

Mumps infection mainly spread by inhalation or oral contact with respiratory droplets or secretions such as coughing, sneezing, or talking of mumps virus infective person. It transmitted through direct contact with saliva or respiratory droplets from the mouth, nose, or throat.  

1. Droplet nuclei

2. Direct contact with an infected person

4. Spread from person to person through infected saliva

5. Contract mumps by breathing in saliva droplets; sneezed or coughed from an infected person.

6. Contract mumps y sharing utensils or cups with individual, who has mumps.

7. Sharing items that contaminated with saliva on them, such as water bottles or cups.

8. Fomites contaminated by saliva

9. Also carried in the urine

Incubation Period

The incubation period of mumps is usually 16-18 days, with a range of 12 to 25 days

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 Pathophysiology of Mumps

1. Respiratory transmission of virus

2. The primary site of infection, viral replication of the epithelium of the upper respiratory or the GI tract or eye.

3. The virus rapidly spreads to the local lymphoid tissue, replication in nasopharynx and regional lymph nodes, a primary viraemia occurs.

4. Viremia 12-25 days after exposure with spread to tissue

5. Mutliple tissue infected during viremia and virus spreads to different sites and gland in the body.  

6. Virus lodged into salivary gland; parotid gland

7. Inflammation and Swelling of parotid gland; parotitis

8. Lymphocyte infiltration

9. Swelling, pain,and tenderness of parotid gland

Clinical Manifestation

Mumps is best known for causes the puffy cheeks and tender, swollen jaw that result of swollen salivary glands under the ears on one or both sides, often called parotitis.

1. Pain and swelling in one or both the parotid glands located near ear.

2. Pain in the swollen salivary glands on one or both sides of your face

3. Ear-ache on the affected side prior to onset of swelling

4.  Pain and stiffness on opening the mouth

5. High fever of 103°F

6. Head-ache

7. Pain while chewing or swallowing

8. Muscle aches

9. Weakness and fatigue

10. Loss of appetite

Swollen salivary glands and a fever may also indicate –

1. Blocked salivary gland due to parotid duct obstruction

2. Different viral infection

Causes of Parotitis

Mumps diseases caused by a mumps virus that spreads easily from person to person through infected saliva. If the person isn’t  immune, can contract mumps by sneezed or coughed  or breathing in saliva droplets from an infected person and also contract mumps from sharing utensils or cups with who has mumps infective.

Laboratory Diagnosis

Laboratory diagnosis for mumps is antibody testing, viral cultures, or RT-PCR (Reverse transcription polymerase chain reaction)

Prevention and Control

 Mumps infection is preventable with vaccination.  The best way to prevent mumps is to be vaccinated against the mumps disease. This vaccination usually given as a combined measles-mumps-rubella (MMR). Most people have developed immunity to mumps once fully vaccinated.

Mumps vaccines are typically administered in early childhood, but if need also be given in adolescence and adulthood. This vaccination protects against three diseases – measles, mumps, and rubella.

1. Vaccine – Live attenuated vaccine recommended for children over one year of age. Mumps vaccine available in a combination form of vaccine measles, mumps and rubella (MMR).

Vaccine                             Dose               Route                       Age

Live attenuated Vaccine  0.5ml             IM              12 and 15 months

Two doses of the MMR vaccine are recommended for child before a enters school. MMR Vaccines should be given when the child –

1. Between the ages of 12 and 15 months

2. Between the ages of 4 and 6 years

CDC recommendation that children get two doses of MMR vaccine. startwith the first dose of vaccine at 12 and 15 months of age, and the second dose of vaccine at 4  and 6 years of age.

Vaccinated with MMR is the best way to prevent mumps and mumps associated complications. This vaccine is available in the combination measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella (MMRV) vaccines.

Note – It should not be given to pregnant and immunosuppressive patients.

Treatment of Mumps

Mumps has no specific antiviral treatments. Treatment of mumps is aimed at alleviating symptoms and preventing further complications.

Non-medicinal ways to manage the disease include –

1. Using ice or heat packs on the neck and scrotum

2. Consuming more fluids

3. Eating soft food

4. Gargling with warm salt water

Anti-fever medications

An antipyretic drugs used during the febrile period, excluding aspirin when given to children, may cause Reye syndrome; swelling in the liver and brain.

Analgesics

Analgesicsalso be provided to control pain from mumps inflammatory conditions.

Mumps Postexposure Prophylaxis

MMR(Measles-mumps-rubella) vaccine is not recommended for mumps postexposure prophylaxis (PEP). If persons already infected with mumps, MMR vaccine has not been shown to prevent illness and not be used as post-exposure prophylaxis.

Complications of Mumps

1. Orchitis (testicles to swell) – causes one or both testicles to swell in males.

2 Ovaritis – swelling of the ovaries (oophoritis), which can cause; lower abdominal pain

3. Pancreatitis – inflammation in pancreas cause pain in the upper abdomen, nausea and vomiting.

4. Meningoencephalitis – inflammation of the meninges and the brain itself, cerebral tissue.

5. Myocarditis – inflammation of the heart muscle (myocardium)

6. Nerve deafness – hearing loss

7. Polyarthritis – inflammation of one or more joints

8. Hydrocephalus –  accumulation of CSF occurs within the brain

9. Encephalitis – mumps can  lead to inflammation of the brain (encephalitis).

10. Miscarriage – Contracting mumps while you’re pregnant, especially early in pregnancy, may lead to miscarriage.

11. Nephritis – inflammation of the kidneys because of  presence of the virus in urine.

12. Recurrent sialadenitis – frequent inflammation of the salivary glands.