EPIDEMIC PAROTITIS

(Mumps)
Prof.Dr. Haluk okura

Case-1: 4/12 years old

Fever 3 days; preauricular swelling.

Swelling is red and hot.
Pus at the orifice of Stensen duct.
WBC: 24.000/mm3, left shift, ESR: 50
mm/hr.

Your diagnosis ?

Case-2: 5 years old

Contact of a child with mumps (5 days

ago).
Preauricular swelling (3x4 cm), and mild
fever (2 days)
Swelling: Red, hot and tender.
WBC: 18.000/mm3; left shift, ESR: 40/hr.

Your diagnosis ?

Case-3: 4 years old

Your diagnosis ?

Brother has mumps before 3 weeks.

Fever, vomiting and headache
Stiffness of the neck, remaining findings are
normal
WBC: 8.400/mm3, 60% lymphocytes.
CSF: cleary appearence, protein: 60 mg/dl, pandy (+),
blood glycose: 110 mg, CSF glycose:75 mg, cells: 120
lymphocytes.
Amylase level is HIGH

Mumps

is an acute, generalized
viral disease in which painful
enlargement of the salivary
glands, chiefly the parotids, is the
usual presenting sign.

Etiology

Paramyxovirus
Only one serotype is known.
Cytopathic effect
Virus has a predilection for glandular and
nervous tissue.

Isolation of the virus

Brain
Saliva
CSF
Blood
Urine

Infectivity

Lost of the infectivity as a result of heating

at 55o to 60o C for 20 minutes and after
exposure to formalin or to UV light.
Infectivity is maintained for years at
temperatures of -20o to -70o C.

Epidemiology

Human reservoir only

Spread by direct contact, airborne droplets,
fomites contaminated by saliva, and possibly by
urine.
It is distributed worldwide and affects both sexes
equally.
Epidemics are slightly more frequent in late
winter and spring.
30-40% of infections are subclinical.

Virus has been isolated from saliva as

long as 6 days before and up to 9 days
after appearance of salivary gland
swelling.
Transmission: 24 hr before appearence of
swelling - 3 days after it has subsided

Lifelong immunity usually follows

clinical or subclinical infections,
although second infections have been
documented.
Transplasental antibodies are
effective in protecting infants during
their first 6-8 mo.

Pathogenesis
Initial multiplication in the cells of the
respiratory tract
The virus is blood-borne to many
tissues.
The salivary and other glands are
most susceptile

Clinical manifestations:

Incubation period: 14-21 days (mean:

17-18 days)

Prodromal period: Rare in children.

Malaise, fever, muscular pain,
headache. (24 hr ).

 Swelling

of the parotid glands

Moderate

fever (1-6 days)

Swelling of parotid ( or submandibularsubmental ) glands

Bilateral, 25% unilateral.

Painful, tender.
Never red and hot !
More readily appreciated
by sight than palpation.
Swollen tissues push the
ear upward and outward.
Duration: 3-7 days.
The angle of the
mandible is no visible.

Swelling

Bilateral swelling

Unilateral swelling

Redness and swelling at the

opening of the Stensen (or
Wharton) duct

Pus

Redness and edema

Complications (Manifestations ?)

Meningoencephalitis
Myocarditis
Orchitis, epididymitis
Thyroiditis
Oophoritis
Mastitis
Pancreatitis
Nephritis

Deafness
Arthritis
Ocular
complications
Thrombocytopenic
purpura
Diabetes mellitus (?)
Mumps
embryopathy

Meningoencephalitis (ME):

Systemic disease 10% of all cases

60% of mumps patients have cells in CSF
ME usually follows the parotitis by 3 to 10 days.
The illness is characterized by fever, headache,
vomiting, change in sensorium, and meningial
irritation signs.
CSF: Viral meningitis
Patients usually recover completely.

ME may be preinfectious,
postinfectious, or even occur in
the absence of salivary gland
involvement

Pancreatitis

Sudden onset of severe epigastric pain

tenderness,
Fever,
Chills,
Extreme weakness,
Prostration, nausea and vomiting.
High levels of amylase!
The symptoms gradually subside over a period
of 3 to 7 days.
Usually full recovering

Orchitis - epididymitis

Second most common manifestation of mumps

in adulthood.
It usually follows parotitis, but it may precede it
or occur as an isolated manifestation
Unilateral involvement 20%-30% in mumps
after puberty.
Bilateral orchitis 2%

Orchitis

Fever, chills, headache, nausea,

vomiting and lower abdominal pain.
Testis begins to swell rapidly and
becomes very tender and painful.
Bilateral atrophy(rare): Sterility

Deafness

Rare but irreversible complication.

Usually unilateral, rarely bilateral.
Sudden onset of vertigo, tinnitus, ataxia,
and vomiting followed by permanent
deafness.

Mumps embryopathy
The risk is 5% in the first 3
mounths of pregnancy.
Cardiac, ocular and
neurological symptoms
occur.

Diagnosis

History of exsposure to mumps 2 to 3 weeks before

onset of illness.
Typical clinical signs of parotitis or aseptic
meningitis.
High levels of amylase.
Isolation of causative agent
Serological tests: CF, HI, ELISA, virus neutralization
Antibodies are detectable in blood in the 2. week.
A fourfold or greater rise in antibody titer (Useful for
the diagnosis of mumps ME without parotitis.)

Differential diagnosis
PAROTITIS:
Cervical adenitis
Suppurative parotitis
Recurrent parotitis
Calculus
Coxsackie virus infection
Parainfluenza 3 virus infection
Mixt tumors, hemangiomas, lymphangiomas
Uveoparotid fever

Differential diagnosis
MENINGOENCEPHALITIS
Coxsackievirus
ECHO virus
Tuberculous meningitis
Bacterial meningitis
Other intracranial pathologies.

Treatment
Symptomatic
Acetaminophen
Avoidence of sour foods
Parenteral fluid therapy (persistent
vomiting)

Prophylaxis
Standard immune globulin is
ineffective.
Mumps immune globulin ?
Mumps virus vaccine:
97% protective
MMR: 1yr old

Case-1: 4/12 years old

Fever 3 days; preauricular swelling.

Swelling is red and hot.
Pus at the orifice of Stensen duct.
WBC: 24.000/mm3, left shift, ESR: 50
mm/hr.

Your diagnosis ?

Case-2: 5 years old

Contact of a child with mumps (5 days

ago).
Preauricular swelling (3x4 cm), and mild
fever (2 days)
Swelling: Red, hot and tender.
WBC: 18.000/mm3; left shift, ESR: 40/hr.

Your diagnosis ?

Case-3: 4 years old

Your diagnosis ?

Brother has mumps before 3 weeks.

Fever, vomiting and headache
Stiffness of the neck, remaining findings are
normal
WBC: 8.400/mm3, %60 lymphocyte.

Meningoencephalitis

CSF: cleary appearence, Protein: 60 mg/dl, Pandy (+),

Blood glucose: 110 mg, CSF glucose:75 mg, cells: 120
lymphocytes.
Amylase level is HIGH

Summary

Fever and bilaterally parotid swelling

Swelling isnt red and hot.
Redness and swelling at the orifice of the Stensen
duct.
40% subclinical infection
Most frequent complication: Meningoencephalitis.
Sequeles: DM, deafness, sterility, embryopathy.
Rare in the first 6 mo. of life.
Prevantion with vaccine.