Mumps

A moderate-highly contagious acute viral infection caused by Rubulavirus (of Paramyxoviridae family).

Background

  • Although a systemic infection, it usually mainly affects the parotid glands.
    • Spread is by direct contact with saliva droplets and the incubation period is around 17 days (most infectious 2 days prior to symptoms to around 9 days after)
  • It is now a notifiable disease and quite rare (only 918 notifications and 522 lab confirmed diagnoses in Scotland in 2012) after the introduction of the MMR vaccine
    • However, there have recently been some outbreaks, particularly in university students who have not received any or all of the vaccine (after the false link to autism in the 80s/90s)

Presentation

  • Non-specific symptoms of low-grade fever, headache, earache, malaise, myalgia, anorexia etc can occur 1-2 days before the onset of any glandular inflammation
  • Parotitis
    • Typically begins in one side then spreads bilaterally
    • Swollen, red, painful, hot over the angle of the jaw.
      • Can be severe enough to limit movement, eating, swallowing etc
    • Can last for 3-5 days before settling
    • It is usually just the parotid glands that are affected, but occasionally other salivary glands are affected and rarely- extra-oral glands (e.g. thyroid, pancreas) can become inflamed also
  • Fever is a common finding
  • Orchitis
    • Occurs in around 10% of patients with mumps and usually presents 4-7 days after the parotitis.
    • Usually unilateral but may affect the other side days later
    • Severe testicular pain and tenderness, and swelling, accompanied by fever, chills, headache.
  • Viral meningitis
    • Usually mild and self-limiting (over 7-10 days), occurring a couple of days after parotitis (however, many patients who develop mumps meningism do not have any parotitis)
    • Fever, headache, vomiting, neck stiffness and lethargy.

NB If the patient has been immunised, consider another cause of symptoms e.g. Epstein-barr virus or other viruses.

Management

  • Most cases just require supportive care (bed rest, high fluid intake etc)
  • Make sure to notify health protection (public health)

 

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