MUMPS Guided by: Dr. Alpesh Patel Dr. Uday Patel

Prepared by: Foram Kamani Shefali Kantaria Parth Karavadia

(EPIDEMIC PARATITIS)

INTRODUCTION Mumps is an acute contagious viral

infection (family Paramyxovirus, genus Rubulavirus) characterized by unilateral or bilateral swelling of salivary gland, usually the parotid.

Submaxillary and sublingual glands are involved, but without parotid involvement also.

It may involved nerve meninges, pancreas and gonads.

It is usually disease of childhood, mumps may also affect adults and in such cases there is a greater tendency for complication to develop.

Incubation Period: 2 to 3 weeks Patient are contagious from 1 day

before the clinical appearance of infection to 14 days after its clinical resolution.

CLINICAL FEATURES This disease is preceded by the onset of

headache, chills, moderate fever, vomiting and pain below the ear.

Salivary g land involvement produces pain upon the mastication.

Bilateral parotid involvement occurs in about 70% of cases.

Parotid enlargement and swelling reaches its maximum in about 3 days.

The involvement of submandibular and parotid gland may be seen.

EPIDEMIOLOGY

The incubation period varies from 14-18 days with the extreme of one to four weeks.

It is transmitted by the respiratory route.

It can be isolated from the saliva of the infected patient either 7 days before the onset of parotitis or 9 days after its onset.

Most cases were unrecognized because of the absence of the parotid swelling.

As the disease is contagious before onset of parotitis, isolation of patient is not possible to prevent the infection.

Once infected, patients develop a lifelong immunity against the disease but recurrence is also reported.

NONSPECIFIC MUMPS There are characterized by

enlargement of one or more salivary glands that are not related etiologically to epidemic parotitis, or true mumps.

This may produce difficulty in diagnosis and differential separation from true mumps of viral origin.

These include: chronic nonspecific sialadenitis, nutritional mumps acute postoperative parotitis chemical mumps miscellaneous

CHRONIC NONSPECIFIC SIALADENITIS

It is insidious inflammatory disease of major salivary glands.

It is most common in adults,particularly in males.

It is caused by occurrence of salivary duct calculi with subsequent pyogenic bacterial infection.

Acute postoperative parotitis

It is retrograde infection of parotid gland by microorganisms ascending the parotid duct.

The patient suffering from dehydration ,suppression of salivary secretion, vomiting and mouth breathing.

It is seen in adults, middle age or older.

NUTRITIONAL MUMPS It is a chronic, asymptomatic,

bilateral enlargement of parotid and submandibular gland.

It is most common in young and middle aged adults.

CHEMICAL MUMPS It is a bilateral swelling of salivary glands

occassionaly accompanies the administration of either inorganic or organic iodine, and this has frequently been referred to as ‘iodine mumps’

Salivary glands increase five times their normal size within 17 days after the initiation of drug administration.

The glandular enlargement is due to true hypertrophy of acinar cells.

HISTOLOGY OF MUMPS Swollen parotid glands include

diffuse intersitial edema and an inflammatory infiltrate composed of histocytes, lymphocytes, and plasma cell.

This infilterate may compress the acini and ducts, and the exudate may also spill into the epithelial layer.

Other organ may be affected the salivary gland are swollen or not.

PATHOGENESIS Once transmitted through droplet

nuclei or saliva or fomites, it starts replicating in the respiratory epithelium.

It spreads to local lymph nodes and subsequently develop viremia.

The affected area shows perivascular and interstitial mononuclear cell infiltrates with edema.

Necrosis of acinar and epithelial ducts cells are seen in salivary glands and in the germinal epithelium of seminiferous tubules.

DIFFERENTIAL DIAGNOSIS It should be differentiated from

other parotid swelling caused by influenza, parainfluenza.1 and 3, coxsackie, HIV, and cytomegalovirus, Sjogren`s syndrome, pleomorphic adenoma, etc

DIAGNOSIS The diagnosis of mumps can be made

easily from the clinical presentation when the infection is occurring in an epidemic fashion.

Virus can be isolated from saliva and throat swabs two days before or seven days after the onset of parotitis and from CSF.

It can also be confirmed by the complement fixation test hemagglutination inhibition or ELISA.

Serum amylase is elevated in both parotitis and pancreatitis.

COMPLICATIONS Other organs of the body may be

affected as a complication of the disease. These include the testes, ovaries,

pancreas, mammary gland, and occasionally the prostate, epididymis and heart.

When mumps involved the adult male, orchitis is a great danger and ensues in approximately 20% of case.

This is usually unilateral, but occasionally complete sterility results.

The involvement of the pancreas producing an acute pancreatitis often causes an elevation in serum lipase.

Meningoencephalitis, deafness, and mastoiditis are also complication.

Rare complication like nerve deafness, facial paralysis cerebral ataxia, and encephalitis have also been reported.

When occurs in the trimester of pregnancy it results in abortion.

PROGNOSIS An overall prognosis is good in

uncomplication cases. Death occurs due to CNS or cardiac

involvement.

TREATMENT Treatment is conservative , maintaining

hydration and alimentation . Treatment of mumps is palliative in

nature . Frequently nonaspirin analgesics and

antipyretics are administered. In an attempt to minimized orchitis,

bed rest is recommened for males until the fever breaks.

Avoidance of sour foods and drinks helps to decrease the salivary gland discomfort.

As with measles and rubella, the best results come from prior vaccination, thereby preventing the infection.

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