Mumps

Original article by Tom Leach | Last updated on 27/5/2014
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Background

  • Mumps is a NOTIFIABLE DISEASE in the UK
  • Another viral respiratory tract infection. Caused by the mumps virus.
  • Most common in winter/spring
  • Spread by droplet infection
  • Not as infectious as measles
  • Viral replication occurs in epithelial cells of the respiratory tract, before the virus gets into the parotid glands, and then spreads to other tissues.
  • After previous infection, immunity is lifelong
  • A patient is infectious from about 2 days before clinical signs to up to 9 days afterwards. Many cases are also subclinical, and thus many asymptomatic patients are infectious.
  • Intrauterine infection can occur in pregnancy
 

Clinical features

The incubation period lasts between 15-24 days. In up to 30% of cases, there will be no clinical features of infection at all!
Painful swelling of the parotids (Parotitis)
  • Often unilateral initially, becoming bilateral in 70% of cases
  • May present as ear ache, or pain on eating and drinking
  • The parotid duct may appear swollen and red on examination

Fever – usually lasts 3-4 days
Malaise
Orchitis – can be present in boys. It is uncommon before puberty, and is usually unilateral. It can sometimes reduce sperm count, but infertility is extremely rare.

  • Symptoms are generally less severe in young children, and worse in older children and adults
The patient is infective for up to 7 days after the appearance of parotid swelling. Children should be kept off school for a minimum of 7 days after the appearance of swelling
 

Investigations

Raised plasma amylase – due to pancreatic involvement. May also be associated abdominal pain.
 

Complications

Hearing lossrelatively common, but usually self- limiting - typically presents several days after the clinical features have resolved
Meningitisa CSF picture compatible with meningitis is seen in about 50% of cases. However:
  • Only 10% of cases have meningeal symptoms.

Encephalitisseen in 1 in 5000
Orchitis – can cause infertility
Pancreatitis

 

Treatment

Again, specific treatment is rare, and usually just supportive. The disease is usually self limiting. Anti-virals may be useful in some cases of immunodeficiency.