MUMPS

DEFINITION

Mumps is an acute, systemic, communicable viral infection whose most distinctive feature is
swelling of one or both parotid glands.
Involvement of other salivary glands, the meninges, the pancreas, and the gonads is also
common

ETIOLOGIC AGENT

Mumps virus,
a paramyxovirus RNA virus 100 to 600 nm.

EPIDEMIOLOGY

The incidence of mumps is highest in the winter and spring,

With epidemics every 2 to 5 years.
, mumps is principally a disease of childhood, although today more than 50% of cases occur in
young adults.

The incubation period of mumps generally ranges from 14 to 18 days, with extremes of 7
and 23 days

One attack of mumps usually confers lifelong immunity.

Long-term immunity is also associated with immunization.

PATHOGENESIS

Mumps virus is transmitted by droplet nuclei, saliva, and fomites.

Replication of the virus in the epithelium of the upper respiratory tract leads to viremia, which is
followed by infection of glandular tissues and/or the central nervous system (CNS)

CLINICAL MANIFESTATIONS

The prodrome of mumps consists of fever, malaise, myalgia, and anorexia.

Most commonly involved gland PAROTID

Parotitis usually occur within the next 24 h but may be delayed for as long as a week;
It is generally bilateral, although the onset on the two sides may not be synchronous and
at times only one side is affected

Swelling of the parotid is accompanied by tenderness and obliteration of the space

between the ear lobe and the angle of the mandible
The patient frequently reports an earache and finds it difficult to eat, swallow, or talk.
Glandular swelling increases for a few days and then gradually subsides, disappearing
within a week.
The orifice of Stensen's duct is commonly red and swollen.

The submaxillary and sublingual glands are involved less often than the parotid and are
almost never involved alone

COMPLICATIONS
 Orchitis is the most common manifestation of mumps among postpubertal males,
developing in about 20% of cases
The testis is painful and tender and is enlarged to several times its normal size;
accompanying fever is common.

Testicular atrophy develops in half of the affected men.

Since orchitis is bilateral in fewer than 15% of cases, sterility after mumps is rare.
Oophoritis in womenfar less common than orchitis in menmay cause lower abdominal pain
but does not lead to sterility

 Aseptic meningitis,
 Mumps meningitis ----is almost invariably self-limited
 Mumps pancreatitis
 Other unusual complications of mumps include myocarditis, mastitis, thyroiditis,
nephritis, arthritis, and thrombocytopenic purpura
DIFFERENTIAL DIAGNOSIS

The diagnosis of mumps is made easily in patients with acute bilateral parotitis and a history of
recent exposure.
The myriad causes of bilateral parotid swelling other than mumps virus include infection with
other viruses, such as
parainfluenza virus type 3,
coxsackieviruses,
and influenza A virus;
metabolic diseases, such as diabetes mellitus and uremia;
and drugs, such as phenylbutazone and .
. Other conditions associated with chronic parotid swelling include sarcoidosis, Sjogren's
syndrome, and infection with HIV.
Suppurative parotitis, usually caused by Staphylococcus aureus, is most often unilateral.

TREATMENT

Therapy for parotitis and other manifestations of mumps is symptomatic

The administration of analgesics and the application of warm or cold compresses to the
parotid area may be helpful.
. Testicular pain may be minimized by the local application of cold compresses and
gentle support for the scrotum
PREVENTION

Live attenuated mumps vaccine

The subcutaneously administered vaccine may be given to children older than 1 year
Mumps vaccine is usually administered as part of the measles-mumps-rubella (MMR)
vaccine at the age of 12 to 15 months and again at 4 to 12 years of age

MEASLES (RUBEOLA)

DEFINITION

Measles (rubeola) is a highly contagious, acute, exanthematous respiratory disease with a

characteristic clinical picture and pathognomonic enanthem.

ETIOLOGIC AGENT

Measles virus is a member of the genus Morbillivirus and the family Paramyxoviridae
100 to 250 nm RNA

EPIDEMIOLOGY

Measles has a worldwide distribution;

Humans are the only natural hosts,
Measles epidemics occurred every 2 to 5 years in the winter and spring

Measles virus is transmitted by respiratory secretions,

. Patients are contagious from 1 or 2 days before the onset of symptoms until 4 days after the
appearance of the rash.
Infectivity peaks during the prodromal phase.
The mean intervals from infection to onset of symptoms and to appearance of rash are 10 and 14
days, respectively

PATHOGENESIS AND PATHOLOGY

Measles virus invades the respiratory epithelium and spreads via the bloodstream to the
reticuloendothelial system, from which it infects all types of white blood cells, thereby establishing
infection of the skin, respiratory tract, and other organs.

CLINICAL MANIFESTATIONS

Measles begins with a 2- to 4-day respiratory prodrome of malaise, cough, coryza, conjunctivitis
with lacrimation, nasal discharge, and increasing fever with temperatures as high as 40.6C
105F
Koplik's spots appear as 1- to 2-mm blue-white spots on a bright red background
Koplik's spots are typically located on the buccal mucosa alongside the second molars
and may be extensive; they are not associated with any other infectious disease.
The spots wane after the onset of rash and soon disappear

 The characteristic erythematous, nonpruritic, maculopapular rash of measles begins

at the hairline and behind the ears, spreads down the trunk and limbs to include the
palms and soles, and often becomes confluent.
At this time, the patient is at the most severe point of the illness.
By the fourth day, the rash begins to fade in the order in which it appeared.
Brownish discoloration of the skin and desquamation may occur later.
Fever usually resolves by the fourth or fifth day after the onset of rash;
Lymphadenopathy, diarrhea, vomiting, and splenomegaly are common features.
The entire illness usually lasts about 10 days.
The disease tends to be more severe in adults

COMPLICATIONS

The complications of measles can conveniently be divided into three groups, according to the
site involved:
the respiratory tract,
the central nervous system (CNS), and
the gastrointestinal tract

Respiratory tract involvement, manifested as laryngitis, croup, or bronchitis, occurs in the majority
of cases of uncomplicated measles.
In young children, otitis media is the most common complication.
Pneumonia is a frequent reason for hospitalization, especially of adults. The pneumonia is of
viral origin in the majority of cases, but secondary bacterial infection (most commonly caused by
streptococci, pneumococci, or staphylococci) also takes place with some frequency

 measles encephalitis;

.
 Gastrointestinal complications of measles include gastroenteritis, hepatitis, appendicitis,
ileocolitis, and mesenteric adenitis

 Measles can exacerbate preexisting tuberculosis,

LABORATORY FINDINGS

Lymphopenia and neutropenia are common in measles

DIFFERENTIAL DIAGNOSIS

The differential diagnosis of measles includes Kawasaki's syndrome, scarlet fever,

infectious mononucleosis, toxoplasmosis, drug eruption, and Mycoplasma pneumoniae
infection
PREVENTION

measles vaccine has been available as the combination vaccine measles-mumps-rubella

(MMR); MMR vaccine should be administered to children between the ages of 12 and 15
months
TREATMENT

Therapy for measles is largely supportive and symptom-based.

Patients with otitis media and pneumonia should be given standard antibiotics.
Patients with encephalitis need supportive care, including observation for increased intracranial
pressure.
Controlled trials suggest clinical benefit from high doses of vitamin A in severe or potentially
severe measles, especially in children under the age of 2 years..

Ribavirin is effective against measles virus in vitro and may be considered for use in
immunocompromised individuals.