About Mumps

Mumps is a disease caused by a virus that usually spreads through saliva and can infect many parts of the body, especially the parotid salivary glands. These glands, which produce saliva for the mouth, are found toward the back of each cheek, in the area between the ear and jaw. In cases of mumps, these glands typically swell and become painful. Mumps was common until the mumps vaccine was licensed in 1967. Signs and Symptoms Cases of mumps may start with a fever of up to 103 Fahrenheit (39.4 Celsius), as well as a headache and loss of appetite. The well-known hallmark of mumps is swelling and pain in the parotid glands, making the child look like a hamster with food in its cheeks. The glands usually become increasingly swollen and painful over a period of 1 to 3 days. The pain gets worse when the child swallows, talks, chews, or drinks acidic juices (like orange juice). Both the left and right parotid glands may be affected, with one side swelling a few days before the other, or only one side may swell. In rare cases, mumps will attack other groups of salivary glands instead of the parotids. If this happens, swelling may be noticed under the tongue, under the jaw, or all the way down to the front of the chest. Mumps can lead to inflammation and swelling of the brain and other organs, although this is not common. Symptoms appear in the first week after the parotid glands begin to swell and may include: high fever, stiff neck, headache, nausea and vomiting, drowsiness, convulsions, and other signs of brain involvement Mumps in adolescent and adult males may also result in the development of orchitis, an inflammation of the testicles. Usually one testicle becomes swollen and painful about 7 to 10 days after the parotids swell. This is accompanied by a high fever, shaking chills, headache, nausea, vomiting, and abdominal pain that can sometimes be mistaken for appendicitis if the right testicle is affected. After 3 to 7 days, testicular pain and swelling subside, usually at about the same time that the fever passes. In some cases, both testicles are involved. Even with involvement of both testicles, sterility is only a rare complication of orchitis. Additionally, mumps may affect the pancreas or, in females, the ovaries, causing pain and tenderness in parts of the abdomen. Contagiousness/transmissions The mumps virus is contagious and spreads in tiny drops of fluid from the mouth and nose of someone who is infected. It can be passed to others through sneezing, coughing, or even laughing. The virus can also spread to other people through direct contact, such as picking up tissues or using drinking glasses that have been used by the infected person. People who have mumps are most contagious from 2 days before symptoms begin to 6 days after they end. The virus can also spread from people who are infected but have no symptoms. Incubation The incubation period for mumps can be 12 to 25 days, but the average is 16 to 18 days. Duration Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time. Treatment If you think that your child has mumps, call your doctor, who can confirm the diagnosis and work with you to monitor your child and watch for complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks. Because mumps is caused by a virus, it cannot be treated with antibiotics. At home, monitor and keep track of your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by the doctor,aspirin should not be used in children with viral illnesses because its use in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death. You can also soothe the swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid

serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated. When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles. A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school. When to Call the Doctor Call the doctor if you suspect that your child has mumps. If your child has been diagnosed with mumps, keep track of his or her temperature and call the doctor if goes above 101 Fahrenheit (38.3 Celsius). Because mumps can also involve the brain and its membranes, call the doctor immediately if your child has any of the following: stiff neck, convulsions (seizures), extreme drowsiness, severe headache, or changes of consciousness. Watch for abdominal pain that can mean involvement of the pancreas in either sex or involvement of the ovaries in girls. In boys, watch for high fever with pain and swelling of the testicles. Prevention Mumps can be prevented by vaccination. The vaccine can be given alone or as part of the measles-mumps-rubella (MMR) immunization, which is usually given to children at 12 to 15 months of age. A second dose of MMR is generally given at 4 to 6 years of age, but should be given no later than 11 to 12 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor will have the most current information. Duration Children usually recover from mumps in about 10 to 12 days. It takes about 1 week for the swelling to disappear in each parotid gland, but both glands don't usually swell at the same time. Professional Treatment If you think that your child has mumps, call your child's doctor, who can confirm the diagnosis and work with you to monitor your child's progress and watch for any complications. The doctor can also notify the health authorities who keep track of childhood immunization programs and mumps outbreaks. Because mumps is caused by a virus, it cannot be treated with antibiotics. Home Treatment Monitor and record your child's temperature. You can use nonaspirin fever medications such as acetaminophen or ibuprofen to bring down a fever. These medicines will also help relieve pain in the swollen parotid glands. Unless instructed by your child's doctor, aspirin should not be used in children with viral illnesses because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death. You can also soothe your child's swollen parotid glands with either warm or cold packs. Serve a soft, bland diet that does not require a lot of chewing and encourage your child to drink plenty of fluids. Avoid serving tart or acidic fruit juices (like orange juice, grapefruit juice, or lemonade) that make parotid pain worse. Water, decaffeinated soft drinks, and tea are better tolerated. When mumps involves the testicles, the doctor may prescribe stronger medications for pain and swelling and provide instructions on how to apply warm or cool packs to soothe the area and how to provide extra support for the testicles. A child with mumps doesn't need to stay in bed, but may play quietly. Ask your doctor about the best time for your child to return to school. Nursing Care Tips for a Person Suffering from Mumps Mumps is medically classified as a contagious disease in which a virus causes salivary gland enlargement. The illness usually occurs during childhood. Recovery takes place in a few days, but complications frequently develop, most commonly in patients older than twelve years. Doctors say that the symptoms - chilliness, headache, lack of appetite, and moderate fever begin two to four weeks after contact, and usually appear a few hours before the salivary glands become painful. According to medical experts, the parotid gland, situated just in front of the ear, is usually primarily affected. Any of the salivary glands may be involved. Pain in the involved glands is induced by external pressure on the gland, by swallowing, or by taking sour substances into the mouth. The swelling usually lasts from three to six days. Medical records show that the most common serious complication is an involvement of the sex

glands, either testes (orchitis) or ovaries. In about one-fourth of the cases among older boys and men, at least one of the testes is affected. The affected testis is swollen and painful. In some cases, the organ later atrophies, being rendered sexually sterile. Unless both testes are thus involved, experts say that a man is still capable of fatherhood. Even when one or both testes atrophy, the male sex hormones are produced in normal fashion. Comparable involvement of the ovaries in women is less common, experts add. According to doctors, there is no specific treatment, but a child with mumps should be kept at home until a week after all swelling of his salivary glands has disappeared. He should be kept away from other children or from adults who have not had the disease. Patients over twelve should remain in bed until their fever has disappeared. Recommended nursing care is as follows: 1) The patient, especially if over twelve years of age, should be protected against chilling. 2) Swollen salivary glands may be less painful if a hot-water bottle or an ice bag is placed over them for a few minutes each hour. The choice of heat or cold depends on which makes a patient more comfortable. 3) The patient should receive light food, easily swallowed. 4) The patient is made more comfortable by rinsing the mouth every two or three hours with a warm salt solution (one level teaspoonful of salt to a pint or 450 c.c. of water). 5) In cases in which the testes become involved, the patient should be kept at absolute bed rest and the scrotum supported by a large tuft of cotton or by an adhesive tape bridge placed between the thighs to support the weight of the swollen scrotum. Periodic application of an ice bag to the scrotum may provide some relief. 6) If the pancreas becomes involved, it is usually advisable to feed the patient by vein, not by mouth. 7) If complications develop, a physician should be in charge of the case. 8) A mumps vaccine is available for immunization. About 10 percent of all cases of mumps develop some degree of encephalitis with severe headache, drowsiness, and vomiting. Usually this complication clears up spontaneously. Another occasional complication is pancreatitis, with severe nausea, vomiting, and abdominal pain. Even with this development, spontaneous recovery usually ensues within a week. Pathophysiology Spread is by respiratory droplets, direct contact, or contaminated fomites. [1] The incubation period is usually 14 to 18 days, and peak contagion occurs 1 to 2 days before the onset of symptoms. Viral shedding has been isolated in saliva as early as 7 days before and until 9 days after clinical symptoms. Vaccination status does not seem to impact the duration of viral shedding. [2] The primary site of viral replication is the epithelium of the upper respiratory tract, and, rarely, the infection can remain localised to the respiratory tract. Usually, the virus spreads quickly to the local lymphoid tissue and viraemia often ensues, enabling the virus to travel to distant parts of the body. [1] Infected mononuclear cells are also a means of spread of the virus. [2] Mumps virus has an affinity for glandular epithelium; virus replication often occurs in the parotid gland ductal epithelium, causing interstitial oedema, local inflammation, and painful swelling of the gland. [2] Generally, life-long immunity occurs after a mumps infection. However, 1% to 2% of cases are thought to be re-infections. I. Epidemiology A. Peak Age 10-19 years B. Incidence 1. U.S. Cases in 1968: 152,000 cases 2. U.S. Cases in 2000: 338 cases II. Pathophysiology Caused by a paramyxovirus A. Transmission 1. Infected Salivary secretions or urine B. Infectious: 1. Start: 6 days before Parotitis 2. Ends: 2 weeks after symptom onset C. Incubation: 12-25 days (typically 16-18 days)

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III. Symptoms Subclinical presentation in 20% of cases A. Prodrome 1. Fever 2. Malaise 3. Headache 4. Anorexia 5. Myalgia B. Sudden onset pain in cheeks lasting >2 days 1. Unilateral or bilateral 2. Provoked by chewing or swallowing 3. Worse with sour foods IV. Signs Sialadenitis 1. Parotitis occurs in 30-40% of patients 2. Tender swelling of all Salivary Glands 3. Skin over Parotid Gland not warm or red a. Contrast with Bacterial Sialadenitis 4. Tenderness at mandibular angle 5. Parotid duct opening appears red in Buccal mucosa A. Orchitis (20-35% of postpubertal males) 1. Occurs 7-10 days after Parotitis 2. Testicular Atrophy (50%) 3. Sterility if bilateral involvement V. Complications Pancreatitis (usually uncomplicated) A. Central Nervous System Involvement 1. Asymptomatic Cerebrospinal Fluid Leukocytosis (50%) 2. Less common causes . Encephalitis (1 case per 400 to 6000 Mumps cases) i. Mortality: 1-2% death rate from Encephalitis a. Paralytic Polio-like syndrome b. Transverse myelitis c. Cerebellar ataxia B. Miscellaneous 1. Subacute Thyroiditis 2. Dacryoadenitis 3. Optic Neuritis 4. Iritis 5. Conjunctivitis 6. Myocarditis 7. Hepatitis 8. ThrombocytopeniaPurpura 9. Interstitial Pneumonia 10. Migratory Polyarthritis VI. Labs Complete Blood Count 1. Parotitis: Relative Lymphocytosis 2. Orchitis: Marked Leukocytosis A. Serum Amylase increased B. Cerebrospinal Fluid 1. White Blood Cells: 1000-2000 with Neutrophils Diagnosis: Culture, IgG, and IgM should all be done . Culture 1. Obtain sample within first 5 days of Parotitis 2. Blood, Throat, CSF, Urine

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3. Immunofluorescence positive in 2-3 days A. Serology 1. Mumps IgM . Positive after day 3 of swelling a. Titers peak by one week 2. Mumps IgG Obtain acute baseline Mumps IgG as soon as possible a. Check Mumps IgG again 3-5 weeks after onset b. Titer increases 4 fold VIII. Management . Orchitis Symptomatic relief 1. Prednisone 60 mg qd tapered over 7-10 days Prevention . MMR Vaccine after age 1 year X. Prognosis . Mortality: Up to 50 deaths per 1 million Mumps cases GENERAL CONCEPTS: The Paramyxoviruses are an important cause of respiratory disease in children. Illnesses include croup, bronchiolitis and pneumonitis. This group of viruses share similar features; they possess a double layered envelope with spikes, have a helical symmetry and contain a negative stranded RNA genome. An RNA-dependent RNA polymerase (RDRP) is contained within the virus particle. Paramyxoviruses replicate in the cytoplasm and are released by budding. Virus-specific antigens include those associated with the envelope and those contained within the nucleocapsid. The host range for the Paramyxoviruses includes humans and monkeys. These viruses produce multinucleated giant cells (syncytia) by production of a cell fusing factor, and then cause host cell lysis.

DISTINCTIVE PROPERTIES: Mumps: A common acute disease of children, the mumps virus produces inflammation of salivary glands leading to obvious enlargement. Some severe manifestations can result from infection but there is only one serotype. PATHOGENESIS: Mumps: Mumps is a systemic infection spread by viremia. The major targets include glandular and nervous tissue. The virus enters via the pharynx or conjunctiva, there is local multiplication followed by viremia. A secondary viremia disseminates the virus to salivary glands, testes, ovaries, pancreas and the brain. The incubation period is 18-21 days and disease is asymptomatic in about 35% of those infected. The most characteristic response is painful enlargement of the parotid glands. Severe cases may progress to include epididymoorchitis in prepubescent males, which can cause atrophy of the testes, but rarely sterility. Mumps can also produce a transient high frequency deafness. HOST DEFENSES: Mumps: Interferon limits viral spread while IgM and IgG are protective. Long lasting IgG affords life-long immunity. EPIDEMIOLOGY: Mumps: Also found worldwide, mumps is endemic with peaks of acute disease appearing from January through May. Epidemics occur every 2-7 years and humans are the only host. Transmission is via salivary secretions and disease is contagious just before and after the symptoms. It is less contagious than Parainfluenza so intimate contact is usually required. In unvaccinated populations, about 45% of people are infected by age 5 and about 95% by 15 years of age. About 35% of those infected are subclinical, however. DIAGNOSIS:

Mumps: Typical symptoms on clinical presentation make diagnosis relatively easy. CONTROL: Mumps: Immunize at 15 months (measles, mumps, rubella live vaccine). What are the Causes of Mumps - How is it Spread? Mumps is usually caused by a virus named paramyxovirus. Main attack of this virus is salivary glands. This virus is usually present in the infected person's saliva, nose and throat. So it can be easily spread by direct contact with saliva, like kissing of an infected person and a healthy person, or can also be spread through sharing objects contaminated with infected saliva (e.g. cups, utensils). This virus can also be spread when by breathing in droplets coming from infected persons cough or sneeze fall on a healthy person. The incubation period (from initial infection to symptoms) of disease is quite long ranging from 2 -3 weeks. Paramyxovirus is spreads easily from person to person through infected saliva. An infected person can become contagious even 48 hours before the actual symptoms of mumps begin to be seen. Anyone who is not immune from either previous mumps infection or from vaccination can get mumps. Before the vaccination was discovered for mumps in US, it was one of the most common diseases in small children. But now as vaccines are available against mumps so there are very less chances of falling sick due to mumps. Some rare people who get mumps, have very mild or no symptoms therefore there is not much danger. So, every child must be properly vaccine against mumps with the MMR (measles, mumps, rubella) vaccination.

Swollen parotid glands, a classic symptom of mumps

Incubation: 12-25 days, but normally 16-18 days Epidemiology Man is the only known natural host. Mumps is prevalent worldwide, but incidence has significantly decreased in developed nations due to MMR vaccination. Mumps is known as a childhood disease because it normally affects children under 10 years of age. The virus is transmitted by respiratory secretions and by saliva via aerosol form and/or fomites. Symptomatology and Outcome

Symptoms Include: fever, malaise, myalgia, anorexia and parotitis, or swelling of the parotid glands that causes the characteristic grimace appearance. Testicular inflammation, or orchitis, in males is another common symptom.
Complications may include: o Meningitis (15% of cases), which may include neck stiffness and o Deafness (rare) o Pancreatitis o Myocarditis o Joint pain and arthritis (most commonly in adult cases)

Prevention/ Management The Measles, Mumps and Rubella vaccine has been very successful in decreasing the prevalence of Mumps. The vaccine includes the three live-attenuated viruses. It is very effective (95% efficacy) and provides long term immunity. There is no effective treatment for mumps except for treating symptoms such as fever and malaise in children by using analgesics and fever reducers.

The virus Paramyxovirus causes mumps. It effects humans of all ages and races, but its most common in young children. Its spread by direct contact with an affected persons saliva or blood. The droplets from sneezing or coughing can also spread mumps. Once youve gotten mumps you have lifelong immunity