Mumps is an acute infection caused by an RNA-containing virus of the genus Paramyxovirus, mainly affecting salivary glands and nerve cells. The causative agent of mumps is transmitted by airborne droplets, sometimes by contact through objects infected with the patient’s saliva. The clinic of mumps begins with fever and intoxication symptoms, against this background, swelling and soreness in the parotid region increases. A fairly typical clinic allows you to diagnose mumps without additional examination. Treatment is mostly symptomatic.
B26 Epidemic mumps
Mumps is an acute infectious disease that occurs with damage to the parotid salivary glands and nervous tissue. The natural susceptibility of people to infection is quite high, post-infectious immunity is persistent, long-lasting. Young children rarely suffer, due to the low probability of contact with patients and the presence of maternal antibodies. Currently, the predominant incidence is observed in the age group from 5 to 15 years, men are more likely to get sick. The incidence is widespread and all-season, with a slight increase in the number of cases of infection in the autumn-winter period.
The virus that causes mumps – an RNA-containing paramyxovirus – usually affects people, but there have been cases of infection of dogs from their owners. It is not resistant in the external environment, it easily dies during drying, temperature rise, under the influence of ultraviolet irradiation. At a low ambient temperature, it can maintain its viability for up to a year. The reservoir and source of the causative agent of mumps is a sick person. The virus is excreted in saliva and urine, is found in blood and liquor, breast milk.
Virus isolation begins 1-2 days before the first clinical manifestations and lasts about a week. 25-50% of cases of the disease occur in an erased or asymptomatic form, but patients actively secrete the virus. The causative agent of mumps is transmitted by an aerosol mechanism by airborne droplets. In rare cases (due to the instability of the virus), transmission through personal household items contaminated with saliva of a sick person is possible. There are cases of vertical transmission of the virus from mother to child in the prenatal period, childbirth, lactation.
The incubation period of mumps varies from a few days to a month, on average it is 18-20 days. In rare cases, children may have prodromal signs: headache, mild chills, myalgia and arthralgia, discomfort in the parotid glands, dry mouth. Most often, the disease begins acutely with a rapidly developing fever, chills. Fever usually persists for up to a week. Symptoms of intoxication are noted: headache, general weakness, insomnia.
A specific symptom of mumps is inflammation of the parotid salivary glands, often the submandibular and sublingual glands are also captured. Inflammation of the salivary glands is manifested by swelling in the area of their projection, the glands are dough-like, painful to the touch (mainly in the central part). Pronounced swelling of the gland can significantly deform the oval of the face, giving it a pear-shaped shape and lifting the earlobe. The skin above the inflamed gland remains of normal color, stretched, hardly forms folds, glistens. As a rule, the disease affects both parotid glands with an interval of 1-2 days, in some cases the inflammation remains one-sided.
In the parotid region, there is a feeling of bursting, pain (especially at night), there may be noise and pain in the ears (as a result of squeezing the Eustachian tube), hearing may decrease. A positive symptom of Filatov (pronounced soreness when pressing behind the earlobe), which is specific in the diagnosis of mumps. Sometimes pronounced tenderness of the glands prevents chewing, in severe cases, a trism of the masticatory muscles may develop. There is reduced salivation. Pain in the glands persists for up to 3-4 days, sometimes radiates into the ear or neck, later gradually passes, swelling regresses. Enlargement of the lymph nodes is not typical for mumps.
Adults tolerate mumps more heavily, they often show prodromal signs, intoxication is higher, catarrhal phenomena may occur. Noticeably more often the process affects the submandibular and sublingual salivary glands, sometimes localized only in them. The submandibular gland, swelling, takes the form of a swelling elongated along the course of the lower jaw, testy to the touch and painful. Sometimes the swelling spreads to the neck. Inflammation of the hyoid gland is characterized by the appearance of swelling under the chin, pain and hyperemia of the mucous membrane in the mouth under the tongue, soreness when it protrudes. Swelling of the salivary glands persists in adults often for 2 weeks or more.
Usually, the acute period of mumps is easy, but later complications such as serous meningitis (sometimes meningoencephalitis), orchitis, epididymitis, oophoritis and acute pancreatitis may be detected. There is an opinion that these diseases are a sign of a more severe course of mumps, since the virus tends to affect nervous and glandular tissues.
Diagnosis of mumps is made on the basis of a rather specific clinical picture, laboratory tests practically do not provide diagnostically significant information. In doubtful clinical cases, serological tests can be used: ELISA, RSC, RTGA.
In the first days of the disease, the method of separate determination of antibodies to V and S-antigens of the virus can be used. An additional diagnostic criterion is the degree of activity of amylase and diastase enzymes in blood and urine.
Uncomplicated mumps is treated at home, hospitalization is indicated only in cases of severe complications, or for quarantine purposes. With the development of complications of mumps, consultation with an andrologist, gynecologist, otolaryngologist and a surdologist is indicated. During the fever period, bed rest is recommended, regardless of how you feel, it is advisable to eat liquid and semi-liquid food for the first few days, drink water or tea more often. It is necessary to carefully monitor oral hygiene, rinse with boiled water or a weak soda solution, and thoroughly brush your teeth. Dry warming compresses are applied to the area of inflamed glands, physiotherapy techniques (UHF, UVI, diathermy) can be used.
Detoxification therapy is carried out according to indications, with severe intoxication, it is possible to prescribe small doses of glucocorticoids (steroid therapy is prescribed only for inpatient treatment). In the early stages of the disease, the therapeutic effect can be given by the introduction of human interferon or its synthetic analogues. If the mumps is complicated by orchitis, the use of suspensions is included in the therapy, cold is placed on the testicles for the first 3-4 days, and then they are warmed. Early administration of glucocorticosteroids has been shown.
Prognosis and prevention
The prognosis for uncomplicated mumps is favorable, recovery occurs within one to two weeks (sometimes a little longer). With the development of bilateral orchitis, there is a possibility of loss of fertile function. After suffering complications associated with damage to the nervous system, paresis and paralysis of muscle groups, hearing loss up to deafness may remain.
Specific prevention is carried out by inoculation with a live vaccine planned at the age of 1 year, then revaccination is performed at 6 years. For specific prevention, a live vaccine is used. Preventive vaccinations are carried out as planned for children aged 12 months who have not had mumps, followed by revaccination at 6 years of age with trivaccine (measles, rubella, mumps). Vaccination contributes to a significant reduction in the incidence of mumps and reduces the risk of complications. According to epidemiological indications, older people are vaccinated.
General prevention consists in isolating patients until complete clinical recovery (but not less than 9 days), disinfection is carried out in the hearth. Quarantine measures to separate children’s groups in case of detection of mumps are prescribed for 21 days, previously unvaccinated children who had contact with the patient are subject to vaccination.