Overview
Mumps is an acute respiratory infectious disease caused by the mumps virus mainly characterized by parotid gland enlargement, pain, and sometimes spread to other salivary glands such as submandibular gland, sublingual gland, and exocrine glands such as pancreas, etc. Mumps viral infection is caused by the mumps virus mainly by general treatment, medication, etc.
Definition
Mumps is an acute respiratory infectious disease caused by the mumps virus, and is a category C infectious disease in China.
Mumps virus belongs to the paramyxovirus, spherical, weak resistance to the outside world, easily killed, exposure to ultraviolet light can quickly die, heated to 55 ~ 60 ℃, after 20 minutes that is inactivated, but cold-resistant.
Morbidity
The prevalence of mumps is 21.88/100,000 persons.
The reported incidence of mumps in China was 479,518, 327,759, 187,500 and 182,833 cases from 2012 to 2015, with the number of incidence cases dropping from the 3rd to the 6th place among the 11 C infectious diseases.
Regional distribution: Widespread in the world.
Time distribution: The disease can develop in all seasons, with winter and spring being the most common months (February to May).
Population distribution: Anyone can develop the disease, and it is most common in children between the ages of 1 and 15 (more than 90%), especially children between the ages of 5 and 9. After the widespread use of vaccines, the age of onset has been pushed back to 15-30 years.
Causes
Causes
Mumps is caused by mumps virus infection, which is an infectious disease. There are three basic conditions that lead to epidemics.
Source of infection: People with mumps and people with latent infection (healthy but carrying the mumps virus) are sources of infection.
Transmission: mainly through droplets via the respiratory tract, but also through direct contact with virus-contaminated objects (e.g., saliva-contaminated eating utensils and toys).
Susceptible population: Unvaccinated and uninfected people are generally susceptible, most often affecting children between 1 and 15 years of age. It is prevalent in collective institutions such as kindergartens, primary and secondary schools, and often presents as a collective disease.
Symptoms
Incubation period
The incubation period ranges from 8 to 30 days, with an average of 18 days, and the incubation period is contagious.
Prodromal period
Most patients have no obvious prodromal symptoms.
A few patients may have fever, headache, muscle pain, weakness and fatigue, loss of appetite and other symptoms.
Acute phase
After the prodromal symptoms last for a few hours to 2 days, typical symptoms of parotid gland enlargement and pain appear, with varying degrees of severity.
Parotid enlargement
Parotid enlargement can be unilateral or bilateral, simultaneous or sequential.
Parotid enlargement is centered on the earlobe and develops pear-shaped in front, back and below, with shiny, burning skin at the enlarged area, elasticity and tenderness.
Parotid enlargement mostly peaks in 2 to 3 days and subsides after 4 to 5 days.
Localized pain: pain increases when opening the mouth, chewing or eating acidic food.
Enlargement of other glands: submaxillary gland or sublingual gland may be affected. In the case of submaxillary gland enlargement, there is obvious swelling and slight tenderness in the neck; in the case of sublingual gland enlargement, there is swelling of the tongue and neck, and difficulty in swallowing.
Systemic symptoms: there may be fever, headache, loss of appetite and other systemic symptoms. Fever is 38~40℃ and the duration varies (as short as 1~2 days, a few up to 2 weeks).
Recovery period
Parotid gland enlargement gradually subsides, and the whole course of the disease is 10~14 days.
Complications
Testiculitis
Testiculitis is the most common complication of mumps in adult males, and 20% to 30% of adult patients develop testicular inflammation.
Testiculitis usually occurs on the 4th to 5th day of mumps, manifested by the reappearance of fever, unilateral or bilateral testicular swelling and pain, which peaks in 3 to 4 days and then gradually recovers.
Meningoencephalitis
It is caused by the direct invasion of the virus into the central nervous system in the case of mumps.
Fever, headache, vomiting, drowsiness and cervical rigidity may occur, and a few patients may have coma and convulsions.
Ovaritis
Women with ovaritis may have mild symptoms, such as lumbar pain, lower abdominal tenderness and menstrual disorders.
Pancreatitis
Fever, nausea, vomiting, epigastric pain, abdominal distension, diarrhea or constipation may occur.
Hearing loss
Mumps is an important cause of unilateral sensorineural deafness in children, rarely occurring in both ears.
Seek medical attention
Department of Medicine
Infection
The presence of obvious swelling, pain, tenderness in the cheeks, pain in chewing or swallowing, accompanied by fever, malaise, headache, nausea, vomiting, etc. requires prompt medical attention.
Pediatrics
Children may also seek pediatric care if they experience any of the above symptoms.
Preparation
How to get to the doctor: registration, preparation of documents, common problems
Tips for seeking medical treatment
Avoid contact with people around you, wear a mask and gloves, and avoid public transportation.
For patients with high fever, physical cooling can be done first, such as applying cold compresses to the forehead and wiping hands, feet and armpits with warm water.
Medical Preparation Checklist
Symptom Checklist
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there fever? What is the highest degree?
Is there swelling and burning in the parotid area?
Is there pain in the parotid area that increases when opening the mouth or chewing?
(Male) Is there testicular pain?
What makes the symptoms worse or less severe?
When did the symptoms appear?
Medical History Checklist
Has there been any contact with a person with mumps?
Have you been immunized against mumps?
Checklist
Test results from the last 6 months, which can be brought to the doctor’s office
Laboratory tests: routine blood, blood amylase, urine amylase
Medication list
Medication in the last 3 months, bring along the box or package if available
Antipyretic and analgesic drugs: ibuprofen, acetaminophen
Antivirals: interferon, ribavirin
Diagnosis
Diagnosis is based on
Medical history
Previous exposure to patients with mumps.
Recent travel to mumps-endemic areas.
Clinical manifestations
Typical presentation is unilateral or bilateral enlargement and pain in the parotid and other salivary glands, which is exacerbated by opening the mouth, chewing or eating acidic foods.
Fever, headache, muscle pain, weakness and fatigue, and loss of appetite may be present.
Laboratory Tests
Routine blood tests
It can be done to find out the changes in blood cell counts, which can help to differentiate it from diseases such as septic mumps.
In mumps, the white blood cell count is mostly normal or slightly increased, and the lymphocyte count is relatively increased.
Septic mumps has an elevated white blood cell count and an elevated neutrophil count and ratio.
Fasting is not required before the test.
Serum and Urine Amylase
To find out the changes in amylase in the body and used as an aid to diagnosis.
Serum amylase is mildly to moderately elevated in 90% of patients, as is urinary amylase. The degree of amylase elevation is directly proportional to the degree of parotid gland enlargement.
Before urine specimen collection, the urethral opening and surrounding parts should be cleaned and clean mid-stream urine should be retained.
Cerebrospinal fluid examination
If a brain infection is suspected, cerebrospinal fluid composition can be analyzed for meningoencephalitis and virus isolation can also be performed.
Elevated cerebrospinal fluid protein and a mildly elevated white blood cell count may indicate viral meningoencephalitis.
Cerebrospinal fluid is usually extracted by lumbar puncture under anesthesia with the patient lying on his/her side.
Immunologic examination
Detection of mumps virus-specific IgM antibodies suggests recent mumps virus infection, but is usually detected after the second week of illness.
Fasting is not required before the test.
Virus isolation
Isolation of mumps virus from saliva, blood, cerebrospinal fluid, and urine specimens early in the course of the disease can confirm the diagnosis.
Virus isolation is complicated and has not been widely used in clinical practice.
Diagnostic criteria
Suspected diagnosis
The diagnosis is suspected if any of the following criteria are met
Unilateral or bilateral parotid or other salivary glands are enlarged and painful, and the pain is aggravated when opening the mouth, chewing or eating acidic food.
Epidemiologic history with any of meningoencephalitis, orchitis, or pancreatitis.
Epidemiologic history with fever, headache, muscle pain, weakness and fatigue, and loss of appetite.
Clinical diagnosis
Unilateral or bilateral parotid and other salivary glands are enlarged, painful, and the pain is increased when opening the mouth, chewing, or eating acidic foods, and any of the following are present
With fever, headache, muscle pain, weakness and fatigue, and loss of appetite.
Accompanied by meningoencephalitis.
Accompanied by orchitis.
Accompanied by pancreatitis.
Epidemiologic history of fever, headache, muscle aches, weakness and fatigue, and loss of appetite with any of the following.
A normal or slightly increased white blood cell count.
There is elevated serum or urinary amylase proportional to the degree of parotid gland enlargement.
There are cerebrospinal fluid changes of viral meningoencephalitis.
Confirmed diagnosis
The diagnosis has been suspected or clinically diagnosed, and any of the following points are met
No live attenuated mumps vaccine has been administered within 1 month, but mumps virus-specific IgM antibodies have been detected in the serum.
A 4-fold or more elevated mumps virus IgG antibody titer ratio (including positive antibody transitions) in serum during the recovery phase versus the acute phase (2 to 4 weeks interval).
Mumps virus is isolated in saliva, urine, cerebrospinal fluid, and other body fluids.
Differential diagnosis
Suppurative parotitis
Similarities: Both can have symptoms of parotid enlargement.
Differences: In suppurative parotitis, the parotid enlargement is mostly unilateral, with obvious localized redness, swelling, heat and pain, and pus may flow out when the parotid gland is squeezed. Laboratory tests show an elevated white blood cell count and effective antibiotic treatment.
Mumps caused by other viruses
Similarities: Parotid enlargement may be present.
Differences: Parainfluenza viruses 1 and 3, influenza A virus, coxsackie A virus, herpes simplex virus, etc. can cause mumps and require pathogenetic testing to differentiate.
Cervical and pre-auricular lymphadenitis
Similarities: Both may have similar symptoms of tissue enlargement near the ear.
Differences: Lymphadenitis of the neck and preauricular lymph nodes does not center on the earlobe, but is confined to the neck or preauricular area, and is hard and clearly marginated. Inflammatory conditions such as pharyngitis and ear sores may be present. Laboratory tests may show an elevated white blood cell count and neutrophil count to differentiate the two.
Dry syndrome
Similarities: Both may have symptoms such as unilateral or bilateral parotid gland enlargement.
Differences: Dry syndrome is a systemic disease that occurs most often between the ages of 40 and 60. It can also have symptoms such as dry eyes, dry mouth, and dry nose, which can be differentiated by laboratory tests.
Other causes of parotid gland enlargement
Allergic parotitis, parotid duct obstruction can cause parotid gland enlargement, but usually recurrent, sudden swelling and quickly subside, laboratory tests can be distinguished.
Treatment
General treatment
Mumps requires isolation and bed rest until the parotid swelling subsides completely.
Diet should be light, easy to digest, soft food is preferred, avoid acid, hard, spicy and other stimulating food, so as not to aggravate the pain due to saliva secretion and chewing.
Keep your mouth clean and hygienic, and rinse your mouth with saline after eating.
Drink more water as appropriate.
People with concurrent pancreatitis should be fasted and given intravenous nutrition.
When the fever is high, intermittent cold compresses can be applied to reduce the temperature.
Medication
Analgesic drugs
Applicable to headache, parotid gland swelling and pain obvious people.
It can reduce local pain and lower the temperature.
Commonly used drugs include ibuprofen and acetaminophen.
Antiviral drugs
Early application can relieve symptoms and reduce complications.
Commonly used drugs are interferon (intramuscular injection), ribavirin (intravenous drip).
Glucocorticoid
Glucocorticosteroids are suitable for those with severe symptoms, especially those with complications such as orchitis and meningoencephalitis.
Short-term application can relieve symptoms and shorten the course of the disease.
Commonly used drugs are dexamethasone (intravenous drip).
Traditional Chinese Medicine (TCM)
Chinese medicine believes that mumps can be treated both internally and externally.
Internal treatment: Chai Hu Ge Gen Tang and Pu Ji Disinfecting Drink with additions and subtractions, in order to remove wind and clear heat, detoxify and eliminate swelling.
External treatment: apply fresh cactus slices or Qingdai San externally to reduce the swelling and pain of the parotid gland.
Prognosis
Cure
Mumps can heal on its own.
The prognosis of mumps is mostly benign, with long-lasting or even lifelong immunity after a single infection, and re-infection is rare.
Dangers
Parotid gland enlargement and pain may affect normal work, study and life.
It is contagious and may infect others, and in severe cases, it can cause small-scale epidemics.
It can cause complications such as orchitis, meningoencephalitis, ovaritis and pancreatitis.
Daily
Daily Management
Dietary management
Diet should be light and easily digestible, try to eat liquid or soft food, and avoid chewing as much as possible.
Eat more vegetables, fruits and other foods rich in vitamins and minerals.
Avoid spicy, oily and too hard food.
Drink more water as appropriate.
Oral management
Keep your mouth clean and brush your teeth carefully in the morning and evening.
Rinse your mouth with saline after eating.
Work and rest management
Take rest, have a regular routine and avoid working hard or staying up late.
Prevention
Active vaccination
Measles, mumps and rubella (MMR) vaccine has been incorporated into the national immunization program, and children should be vaccinated according to the schedule.
Adults can be additionally immunized with live attenuated mumps vaccine after the effect of the vaccine has diminished. Pregnant women, immunocompromised people and people who are allergic to egg white should not be vaccinated with this vaccine.
Personal protection
Pay attention to indoor ventilation and keep the air circulating.
Exercise, eat a healthy diet and drink plenty of water.
During mumps epidemics, avoid close contact with mumps patients, minimize activities in crowded places, wash your hands frequently, and wear a mask when you go out.