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MUMPS
XIE QIFENG
Dept. of Infectious Disease
Introduction
Mumps is an acute respiratory tract
infectious disease caused by mumps virus,
it occurs primarily in school-aged children
and adolescents.The most prominent
manifestation is nonsuppurative swelling
and tenderness of the salivary glands with
one or both parotid glands involved in
most cases.
Introduction
Meningitis, meningoencephalitis,
epididymo-orchitis, oophoritis and
pancreatitis are the common
extrasalivary gland manefestations of
mumps.
Etiology
• Mumps virus (Paramyxovirus parotitis)
belongs to Paramyxoviridae family. RNA
virus.
• 6 major proteins. nucleocapsid associated
(S antigen) for diagnosis. Hemagglutininneuraminidase(V antigen) for protection.
Etiology
• Sensitive to ether,ultraviolet and
high temperature
• Humans are the only natural host
Epidemiology
• Sources of infection:
Patients in early course of the disease, hosts
under covert infection.
The period of peak contagion before or at
the onset of parotitis.
• Route of transmission :
Via droplet nuclei or direct contact,fomites
• Epidemic features:
Endemic throughout the world.
The peak incidence in winter and
spring.
School-aged children at high risk.
Post-infection immunity is stable and
long-lasting.
Pathogenesis and Pathology
The virus usually infecting glandular
tissue such as parotid, orchis or oophoron.
The main pathologic findings are
nonsuppurative inflammatory reactions.
The meningoencephalitis may involve
the Fusion protein.
Clinical Manifestations
• Incubation period:
averages 16 to 18 days
with a range of 2 to 4 weeks.
• Prodromal symptoms include low- grade fever,
anorexia,malaise and headache.
• Parotid tenderness and ipsilateral earache
within 1 or 2 days after the illness onset,then
parotid is visibly enlarged and go to maximum
size over next 2 to 3 days accompanied severe
pain and normal or high temperature. One
parotid enlarges after the other. The orifice of
Stensen’s duct is edematous and erythematous.
Parotid returns to normal size within a week.
Patients with parotitis have difficulty with
pronunciation and mastication. Citrus fruits
and juices exacerbates the pain.
Other salivary glands involved include
submandibular adenitis and sublingual adenitis.
•
Clinical meningitis occurs in 15% of patients
with mumps. Its onset averages 4-5 days after
parotitis but may before, after or in the
absence of parotitis. Clinical features are
headache, vomiting, fever and nuchal rigidity.
CSF pleocytosis. Prognosis is benign.
•
The onset of orchitis is abrupt with high
temperature, chills , testicular pain and
swelling. Impaired fertility is rare.
• Oophoritis develops in 5% postpubertal
women with mumps. Impaired fertility is
rare.
• Pancreatitis is manifested by severe epigastric
pain and tenderness,fever,nausea,and vomiting.
Diagnosis
• In most instances, the diagnosis of mumps is
made on the basis of a exposure history and of
parotid swelling and tenderness accompanied
other symptoms.
• Laboratory confirmation is unnecessary in
typical cases, exception the absence or
recurrence of parotitis and extrasalivary glands
involved. Serologic tests,viral isolation.
Amylase and lipase.
Differential Diagnosis
• Suppurative parotitis
• Other viral parotitis: caused by parainfluenza
virus, coxsackievirus and influenza A virus.
---serologic tests or viral culture
• Parotid enlargement caused by other reasons
Prognosis
Benign and self-limited
Major death causes are severe mumps
encephalitis
Treatment
• Supportive and symptomatic treatment
• Anti-viral therapy: ribavirin and interferon
• Dexamethason for meningoencephalitis
• Diethylstilbestrol for orchitis
Prenvention
• Patients should be isolated.
• Attenuated mumps virus vaccine has been
available. More than 90% vaccine recipients
produced protective antibody.
Aseptic meningitis associated with
vaccine virus occurred in 0.025% recipients.
Mumps vaccine should not be
administered to pregnant women or persons
with immunodeficiencies.
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