Mumps

After a 12- to 24-day incubation period, most people develop headache, anorexia, malaise, and a low- to moderate-grade fever. The salivary glands become involved 12 to 24 hours later, with fever up to 39.5 to 40° C. Fever persists for 24 to 72 hours. Glandular swelling peaks on about the 2nd day and lasts 5 to 7 days. Involved glands are extremely tender during the febrile period.

Parotitis is usually bilateral but may be unilateral, especially at the onset. Pain while chewing or swallowing, especially while swallowing acidic liquids such as vinegar or citrus juice, is its earliest symptom. It later causes swelling beyond the parotid in front of and below the ear. Occasionally, the submandibular and sublingual glands also swell and, more rarely, are the only glands affected. Submandibular gland involvement causes neck swelling beneath the jaw, and suprasternal edema may develop, perhaps because of lymphatic obstruction by enlarged salivary glands. When sublingual glands are involved, the tongue may swell. The oral duct openings of the affected glands are edematous and slightly inflamed. The skin over the glands may become tense and shiny.

Mumps is suspected in patients with evidence of salivary gland inflammation and typical systemic symptoms, particularly if there is parotitis or a known mumps outbreak. Laboratory testing is not needed to make a diagnosis but is strongly recommended for public health purposes. Other conditions can cause similar glandular involvement ( see Table: Non-Mumps Causes of Parotid and Other Salivary Gland Enlargement Non-Mumps Causes of Parotid and Other Salivary Gland Enlargement ). Mumps is also suspected in patients with unexplained aseptic meningitis or encephalitis during mumps outbreaks. Lumbar puncture is necessary for patients with meningeal signs.

Laboratory diagnosis of mumps is necessary if disease is

Mumps testing is also recommended for all patients with parotitis lasting ≥ 2 days without an identified cause. RT-PCR is the preferred method of diagnosis; however, serologic testing of acute and convalescent sera by complement fixation or enzyme-linked immunosorbent assays (ELISA) and viral culture of the throat, CSF, and occasionally the urine can be done. In previously immunized populations, IgM testing may be falsely negative; therefore, RT-PCR assays should be done on samples of saliva or throat washings as early in the course of the disease as possible.

Other laboratory tests are generally unnecessary. In undifferentiated aseptic meningitis, an elevated serum amylase level can be a helpful clue in the diagnosis of mumps despite the absence of parotitis. White blood cell count is nonspecific; it may be normal but usually shows slight leukopenia and neutropenia. In meningitis, CSF glucose is usually normal but is occasionally between 20 and 40 mg/dL (1.1 and 2.2 mmol/L), as in bacterial meningitis. CSF protein is only mildly elevated.

Uncomplicated mumps usually resolves, although a relapse occurs rarely after about 2 weeks. Prognosis for patients with meningitis is usually good, although permanent sequelae, such as unilateral (or rarely bilateral) nerve deafness or facial paralysis, may result. Postinfectious encephalitis, acute cerebellar ataxia, transverse myelitis, and polyneuritis occur rarely.

Treatment of mumps and its complications is supportive. The patient is isolated until glandular swelling subsides. A soft diet reduces pain caused by chewing. Acidic substances (eg, citrus fruit juices) that cause discomfort should be avoided.

Repeated vomiting due to pancreatitis may necessitate IV hydration. For orchitis, bed rest and support of the scrotum in cotton on an adhesive-tape bridge between the thighs to minimize tension or use of ice packs often relieves pain. Corticosteroids have not been shown to hasten resolution of orchitis.

Vaccination with live mumps virus vaccine Measles, Mumps, and Rubella (MMR) Vaccine The measles, mumps, and rubella (MMR) vaccine effectively protects against all 3 infections. People who are given the MMR vaccine according to the US vaccination schedule are considered protected... read more (also see Table: Recommended Immunization Schedule for Ages 0–6 Years Recommended Immunization Schedule for Ages 0–6 Years and see Table: Recommended Immunization Schedule for Ages 7–18 Years Recommended Immunization Schedule for Ages 7–18 Years ) provides effective prevention and causes no significant local or systemic reactions. Two doses, given as a combined measles, mumps, and rubella vaccine, are recommended for children:

Adults born during or after 1957 should have 1 dose, unless they have had mumps diagnosed by a health care practitioner. Pregnant women and people with an impaired immune system should not be given such live-attenuated vaccines.

Postexposure vaccination does not protect against mumps from that exposure. Mumps immune globulin is no longer available, and serum immune globulin is not helpful. The Centers for Disease Control and Prevention recommend isolation of infected patients with standard and respiratory droplet precautions for 5 days after the onset of parotitis. Susceptible contacts should be vaccinated, and a 3rd dose is recommended for previously immunized people at increased risk of mumps during an outbreak, as determined by public health officials. Robust data are lacking, but a 3rd dose and additional measures may help control an outbreak ( 1 Prevention reference Mumps is an acute, contagious, systemic viral disease, usually causing painful enlargement of the salivary glands, most commonly the parotids. Complications may include orchitis, meningoencephalitis... read more ). Nonimmune asymptomatic health care practitioners should be excused from work from 12 days after the initial exposure through 25 days after the last exposure.

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.