Mumps (Parotitis)

Mumps , also known as epidemic parotitis , is an acute , contagious viral infection primarily affecting the salivary glands, most notably the parotid glands .

Mumps is an acute , systemic , communicable viral infection . Its most characteristic feature is the painful swelling of one or both parotid glands .

Mumps is caused by the mumps virus ( genus Rubulavirus , family Paramyxoviridae ). This enveloped, single-stranded RNA virus is transmitted through respiratory droplets produced during coughing, sneezing, or talking by an infected individual. The virus replicates in the respiratory tract before spreading to other sites in the body, including salivary glands.

The primary mode of transmission is through direct contact with respiratory droplets from an infected person. This can occur through:

• Droplet spread : Inhalation of aerosolized droplets expelled from an infected person.
• Direct contact : Touching surfaces contaminated with respiratory secretions, and then touching the mouth, nose, or eyes. (This is less common than droplet spread).

Incubation Period:

The incubation period for mumps is usually 16–18 days (range 12–25 days), representing the time between infection and the onset of symptoms.

• Prodromal Stage: Mild fever, malaise, and anorexia may precede other symptoms.
• Parotitis : Painful swelling of one or both parotid glands usually develops within 24 hours (though it can be delayed up to a week). Other salivary glands may also be affected. Swelling is accompanied by tenderness in the area between the earlobes and the mandibular angle. Patients often report earache, difficulty eating, and difficulty speaking. Glandular swelling increases for a few days and then gradually subsides, usually disappearing within a week.
• Orchitis : Most common in post-pubertal males, presenting as painful and tender enlargement of one or both testes. This can lead to testicular atrophy and potentially sterility.
• Oophoritis : In females, it causes lower abdominal pain (LAP).
• Mumps Pancreatitis : Causes abdominal pain, which can be difficult to diagnose.
• Mumps Encephalitis: Presents with high fever and marked changes in the level of consciousness.
• Parotitis: Painful swelling of one or both parotid glands (located below and in front of the ears). This is the hallmark feature of mumps. The swelling typically begins unilaterally but often becomes bilateral.
• Fever : Often high-grade (39-40°C or higher).
• Headache : A common and often severe symptom.
• Myalgia (muscle aches): Generalized muscle pain and stiffness.
• Malaise (general feeling of illness): Fatigue, weakness, and lack of energy.
• Anorexia (loss of appetite): Reduced or absent desire to eat.
• Nausea and vomiting : Occasional symptoms, particularly in children.
• Facial pain : This can be intense and localized to the affected salivary gland(s).
• Swelling of other salivary glands : Although less common, submandibular and sublingual glands can also be involved.
• Painful swallowing : Due to inflammation of the salivary glands and surrounding tissues.
• Dry mouth (xerostomia) : From reduced salivary gland function.

Diagnosis is primarily clinical, based on the characteristic swelling of the parotid glands and other symptoms. However, laboratory confirmation may be helpful, especially in atypical cases or suspected outbreaks. Tests include:

• Serological tests : Detecting specific IgM and IgG antibodies against the mumps virus. IgM indicates acute infection, while IgG suggests past infection or immunity.
• Viral culture : Less commonly used due to its lower sensitivity and longer turnaround time than serology.
• PCR (polymerase chain reaction) : Can detect the viral RNA in saliva or other specimens. This is a highly sensitive and specific method for

Aims :

• Relieve symptoms.
• Prevent complications.
• Prevent spread of infection.

Medical Management:

There’s no specific antiviral treatment for mumps . Management focuses on supportive care:

• Complete bed rest: Encourage rest to facilitate recovery.
• Fever control : Antipyretics (e.g., acetaminophen) as needed.
• Communication and feeding: Devise strategies to ensure effective communication and comfortable feeding, especially for those with difficulty swallowing.
• Steroids (if prescribed): Corticosteroids (e.g., hydrocortisone 100-200 mg initially, followed by prednisolone 10-15 mg twice daily for 5-7 days) may be used to reduce inflammation in severe cases, but this is at the doctor’s prescription..
• Anti-inflammatory medications : (In severe cases, corticosteroids are sometimes considered, but mainly if there’s severe complications)
• Supportive care: Focuses on adequate rest, hydration, and pain management.
• Hydration : Ensure adequate fluid intake to prevent dehydration. Offer fluids the patient can tolerate.
• Pain relief : Acetaminophen (paracetamol) can be used to manage fever and pain and cold compresses. Avoid NSAIDs (like ibuprofen or aspirin) as these may increase the risk of bleeding.
• Soft diet : Provide soft foods that are easy to swallow and minimize discomfort.
• Oral hygiene : Encourage frequent rinsing of the mouth with warm salt water to soothe inflammation.
• Vaccination : A live attenuated mumps vaccine ( part of the MMR vaccine) is highly effective in preventing mumps. It’s usually given subcutaneously in two doses, starting at 9 months or first contact, and at 18 months of age in Uganda.
• Hygiene : Avoid sharing eating and drinking utensils with infected individuals.
• Meningitis (inflammation of the meninges): The virus can spread to the brain, causing meningitis, with symptoms such as severe headache, stiff neck, fever, and altered mental status.
• Encephalitis (inflammation of the brain): A rare but serious complication characterized by inflammation of the brain tissue.Symptoms can include seizures, coma, and lasting neurological deficits.
• Orchitis (inflammation of the testicles): Common in post-pubertal males, causing testicular pain, swelling, and tenderness. While it can cause temporary discomfort and potentially impact fertility in severe cases, it usually resolves without long-term effects.
• Oophoritis (inflammation of the ovaries): Rare complication in females, causing similar symptoms to orchitis, though usually less severe.
• Deafness : Rare complication of mumps.
• Pancreatitis (inflammation of the pancreas): Can lead to severe abdominal pain, nausea, and vomiting.
• Myocarditis (inflammation of the heart muscle): Rare but potentially life-threatening complication.
• Nephritis (inflammation of the kidneys): Rare and typically mild.