Gregory Sonnen MD
Nancy Henry MD, PhD
Essentials of Diagnosis
General Considerations
Mumps, historically known as epidemic parotitis, was one of the most common early childhood infections before the routine use of mumps vaccination starting in 1968. Reported cases of mumps have dropped 98% when compared with the prevaccine era. It is spread primarily during the late winter and early spring. Before the vaccination era, mumps epidemics occurred in 3- to 4-year cycles.
Mumps virus is a 150-nm paramyxovirus. It is composed of single-stranded RNA contained in a helical nucleocapsid. The viral envelope contains hemolysin, hemagglutinin, and neuraminidase.
Mumps virus is spread via respiratory secretions, with humans being the only natural reservoir. The latent phase of the virus is from 12 to 25 days. The host is communicable from 2 days before to 9 days after the onset of parotid swelling. Mumps is often inappropriately thought to be “less communicable” than other pediatric viruses. This concept is probably owing to the high incidence (20–40%) of subclinical infections.
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BOX 35-1 Mumps Clinical Syndromes |
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Clinical Findings
Orchitis is an uncommon complication of mumps in adults and adolescents, with the highest rate found in the 15- to 29-year age group.
It is rare in children. Orchitis is suspected when the patient has a high fever at the end of the first week of illness. This is soon accompanied by swelling, tenderness, and severe pain in the testis. Roughly 75% of mumps orchitis is unilateral. Rarely, testicular atrophy follows orchitis. Sterility is rare and is seen in cases of bilateral orchitis. Orchitis usually lasts 4–6 days.
Mumps infection during the first trimester of pregnancy confers an increased risk of spontaneous abortion but no increased risk of fetal malformation. Other uncommon complications include meningoencephalitis, deafness, arthritis, pancreatitis, thyroiditis, mastitis, and oophoritis.
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BOX 35-2 Treatment of Mumps |
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BOX 35-3 Control of Mumps |
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Diagnosis
Diagnosis is based on physical findings and culture or serology. History of a mumps contact can be difficult to find owing to the significant number of subclinical cases. Cerebrospinal fluid will demonstrate a lymphocytic pleocytosis if meningitis is present.
Treatment
Therapy is aimed primarily at analgesia (Box 35-2). Opioids are often needed for the pain of orchitis, which can be quite severe. Local application of cool compresses may also help relieve some of the orchitis pain. Intravenous hydration may be needed for some patients. Lumbar puncture may be therapeutic for patients with severe headache. Mumps immune globulin has little clinical value. It is no longer available in the United States.
Prevention & Control
Virus is shed 1 day before onset of symptoms and continues to shed for 9 days after the onset of parotitis. Droplet isolation should be maintained on hospitalized patients during this period. Children should be excluded from school and daycare during this period.
The live virus vaccine is usually given in combination with the MMR vaccine (measles, mumps, and rubella). The first vaccine should be given between 12 and 15 months of age. The second dose is usually given between ages 4 and 6 years. If the second dose is missed, it should be given before age 12 years. Various contraindications exist for the vaccine (Box 35-3).
REFERENCES
American Academy of Pediatrics, Committee on Infectious Diseases: Mumps. In Peter G (editor): 1997 Red Book: Report of the Committee on Infectious Diseases, 24th ed. American Academy of Pediatrics, 1997.
Brunell PA: Mumps. In Feigin RD, Cherry JD (editors): Textbook of Pediatric Infectious Diseases, 3rd ed. Saunders, 1992.