Mumps: Clinical Features, Complications, and Diagnosis
Mumps is an acute viral infection primarily affecting children and adolescents, characterized by swelling and tenderness of the salivary glands. The virus, a member of the Paramyxoviridae family, exhibits irregular spherically shaped virions. Epidemiologically, mumps is endemic worldwide, with periodic epidemics affecting mainly young individuals. The pathogenesis involves transmission via droplet spread or direct contact, leading to glandular and neural tissue involvement. Clinical features include a prodromal stage followed by parotid swelling and potential involvement of other glands. Complications can range from CNS manifestations to epididymo-orchitis. Diagnosis is typically clinical, with laboratory confirmation for atypical cases or epidemiological purposes.
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MUMPS: is an acute generalized viral infection of children and adolescents, causing swelling and tenderness of the salivary glands, and rarely epididymoorchitis.More severe manifestations are commoner in older patients. THE VIRUS: 1-Amember of the Paramyxoviridae VIRUS;IRREGULAR,SPHERICALLY DIAMETER 200 NM);the nucleocapsid is enclosed by a three layer envelope. 2- The nucleocapsid contains the S(soluble) antigen, to which antibodies may be detected early in infection. 3-Glycoproteins on the surface have HA,NA,and cell fusion activity, and include the V (viral) antigen detected in late infection by complement fixation. family,ssRNA (AVERAGE SHAPED VIRION
EPIDEMIOLOGY: 1-ENDEMIC THROUGHOUT THE WORLD, epidemics took place every 2-5 years, with 90% of cases occurring in those younger than 15 years. 2-Passive immunity makes infection uncommon in children under 1 year. PATHOGENESIS: 1-TRANSMITTED By DROPLETS SPREAD OR DIRECT CONTACT. Most infectious just before parotitis. 2-During incubation, the virus proliferate in the upper respiratory tract, with consequent viremia and localization to glandular and neural tissue. 3-Parotid glands show interstitial edema and serofibrinous exudate with mononuclear cells infilteration.Cases of orchitis are similar with the addition of interstitial haemorrhage,polymorphnuclear infiliteration,and araes of local infarction due to vascular compromised
CLINICAL FEATURES: 1-Incubation is 2-4 weeks. A 24 hours non specific prodrome of fever, headache and anorexia is followed by earache and ipsilateral parotid tenderness. The gland SWELLS OVER 2-3 DAYS AND IS ASSOCIATED WITH SEVERE PAIN. Swelling can lift the ear lobe up and outwards. The other side follows within a couple of days in 75%of cases. Patients experiences difficulty in pronunciation and mastication. Once swelling has peaked, recovery is rapid-within a week. Complications of parotitis are rare (e.g.sialectasis).Other glands may be involved. 2-CNS involvement: the commonest extra glandular manifestation in children.Meneingitis is seen in less than 10% of those with parotitis, although less than 50% of cases of mumps meningitis show no evidence of glandular disease. Onset is 4-7 days after glandular symptoms bur can occur I week before or 2 weeks later. Male more than female. Symptoms resolve 3-10 days later, and recovery is complete with no sequelae.
NEUROLOGICAL: COMPLICATIONS:meningitis,encephalitis,GBS,permenant deafness, transient deafness,ataxia,facial palsy, transverse myelitis. 3-presternal pitting edema and tongue swelling thought to be due to lymphatic obstruction by swollen regional glands(6%). . 4-Epididymo-orchitis-the commonest extra glandular manifestations in adults, seen in 20-30% of post pubertal males with mumps(one in six cases is bilateral).Rare before puberty. It may be the only manifestation of mumps. ABRUPT ONSET OF fever and warm, swollen(up to four times normal),tender testicles with erythema of the overlying skin. Fever resolves at 5 days following gonadal symptoms. Some degree of atrophy may be seen in 50% once recovered. Infertility is rare. 5- Others:oopheritis,polyarthritis,pancreatitis,myocarditis,nephritis, thyroiditis,mastitis,and hepatitis.
DIAGNOSIS: is usually clinical. Laboratory confirmation is required for epidemiological purposes or when disease is atypical. 1-serum amylase is elevated in parotitis or pancreatitis(isoenzyme analysis is required to differentiate the source). 2-seroloyg-serum IgM antibody testing should be performed as soon as disease is suspected. It remains positive for less than 4 weeks but may be negative in 50% of the previously immunized with acute infection. A convalescent sample 2-3 weeks after the first, demonstrating a 4-fold or greater increase in IgG titre is diagnostic. 3- VIRAL culture: present in saliva from 2 days before symptom onset to 5 days after. May be present in CSF up to 6 days after onset. 4-PCR-based tests . TREATMENT: are available 1-symptoms control: antipyretics and fluids if persistent vomiting. 2-No benefit of steroid has been demonstrated. 3-Anecdotal evidence that IFN-alpha speed resolution of orchitis. PREVENTION: vaccination is more the 95% effective, and take places at 12 months and preschool as part of MMR.
