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| {{Mumps}}
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| {{CMG}}; {{AOEIC}} {{LG}}
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| ==Overview==
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| Laboratory testing for mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, antigen detection by PCR, and serologic testing for [[IgM|IgM antibody]] or a significant rise in [[IgG|IgG antibody]]. However, there are many important caveats to be aware of when interpreting the results.<ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 | accessdate = 30 October 2011 }}</ref>
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| ==Initial Lab Tests==
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| ====Complete blood count with differential:====
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| *[[White blood cell|Total WBC count]] may be normal to elevated
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| *[[Lymphocytosis|Relative lymphocytosis]] may be observed
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| ====Serum studies:====
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| *Elevated of [[serum amylase]] secondary to the involvment of [[parotid gland]] and suspected [[pancreatitis]] associated with mumps <ref name="pmid499265">{{cite journal |author=Skrha J, Stĕpán J, Sixtová E |title=Amylase isoenzymes in mumps |journal=[[European Journal of Pediatrics]] |volume=132 |issue=2 |pages=99–105 |year=1979 |month=October |pmid=499265 |doi= |url= |accessdate=2012-03-08}}</ref>
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| *Elevated [[serum lipase]] secondary to [[pancreatitis]]
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| *Elevated [[C-reactive protein]] may be seen secondary to [[orchitis]]
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| ==Serology==
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| *Significant rise in [[IgG]] or [[IgM]] antibodies may be helpful to confirm the diagnosis.
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| *However, laboratory confirmation of mumps in previously vaccinated or previously infected individuals is challenging, and failure to detect [[IgM|mumps IgM]] in previously vaccinated persons has been well documented including the cross reactivity of mumps and parainfluenza viruses.<ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 | accessdate = 30 October 2011 }}</ref>
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| :'''''Persons with a history of mumps vaccination may not have detectable mumps IgM antibody regardless of timing of specimen collection.'''''[http://www.cdc.gov/mumps/lab/overview-serology.html CDC]
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| *The ability to detect [[IgM]] varies by vaccination status and is:
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| :*highest in unvaccinated persons (80%–100%),<ref name="pmid3833873">{{cite journal |author=Sakata H, Tsurudome M, Hishiyama M, Ito Y, Sugiura A |title=Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay |journal=[[Journal of Virological Methods]] |volume=12 |issue=3-4 |pages=303–11 |year=1985 |month=December |pmid=3833873 |doi= |url= |accessdate=2012-03-13}}</ref>
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| :*intermediate in one-dose vaccine recipients (60%–80%),<ref name="pmid8277201">{{cite journal |author=Briss PA, Fehrs LJ, Parker RA, Wright PF, Sannella EC, Hutcheson RH, Schaffner W |title=Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity |journal=[[The Journal of Infectious Diseases]] |volume=169 |issue=1 |pages=77–82 |year=1994 |month=January |pmid=8277201 |doi= |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=8277201 |accessdate=2012-03-13}}</ref><ref name="pmid9801337">{{cite journal |author=Narita M, Matsuzono Y, Takekoshi Y, Yamada S, Itakura O, Kubota M, Kikuta H, Togashi T |title=Analysis of mumps vaccine failure by means of avidity testing for mumps virus-specific immunoglobulin G |journal=[[Clinical and Diagnostic Laboratory Immunology]] |volume=5 |issue=6 |pages=799–803 |year=1998 |month=November |pmid=9801337 |pmc=96204 |doi= |url=http://cvi.asm.org/cgi/pmidlookup?view=long&pmid=9801337 |accessdate=2012-03-13}}</ref>
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| :*lowest in two-dose vaccine recipients (13%–14%)<ref name="pmid18184850">{{cite journal |author=Bitsko RH, Cortese MM, Dayan GH, Rota PA, Lowe L, Iversen SC, Bellini WJ |title=Detection of RNA of mumps virus during an outbreak in a population with a high level of measles, mumps, and rubella vaccine coverage |journal=[[Journal of Clinical Microbiology]] |volume=46 |issue=3 |pages=1101–3 |year=2008 |month=March |pmid=18184850 |pmc=2268349 |doi=10.1128/JCM.01803-07 |url=http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=18184850 |accessdate=2012-03-13}}</ref><ref name="pmid21666213">{{cite journal |author=Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ |title=Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission |journal=[[The Journal of Infectious Diseases]] |volume=204 Suppl 1 |issue= |pages=S559–63 |year=2011 |month=July |pmid=21666213 |doi=10.1093/infdis/jir098 |url=http://www.jid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21666213 |accessdate=2012-03-13}}</ref>
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| =====Adapted from CDC [http://www.cdc.gov/mumps/lab/overview-serology.html]=====
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| {| border="1" align="center" style="background:lightskyblue"
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| |-align="center"
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| | bgcolor="CornFlowerBlue" |'''Mumps Exposure History'''
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| | bgcolor="CornFlowerBlue" |'''IgM'''
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| | bgcolor="CornFlowerBlue" |'''IgG'''
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| | bgcolor="CornFlowerBlue" |'''Comments'''
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| |-
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| | Unvaccinated; No history of mumps
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| | +
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| | + or -
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| | [[IgM]] may be detected for weeks to months; low levels of [[IgG]] may be present at symptom onset<ref name="pmid6286705">{{cite journal |author=Meurman O, Hänninen P, Krishna RV, Ziegler T |title=Determination of IgG- and IgM-class antibodies to mumps virus by solid-phase enzyme immunoassay |journal=[[Journal of Virological Methods]] |volume=4 |issue=4-5 |pages=249–56 |year=1982 |month=May |pmid=6286705 |doi= |url= |accessdate=2012-03-13}}</ref><ref name="pmid3833873">{{cite journal |author=Sakata H, Tsurudome M, Hishiyama M, Ito Y, Sugiura A |title=Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay |journal=[[Journal of Virological Methods]] |volume=12 |issue=3-4 |pages=303–11 |year=1985 |month=December |pmid=3833873 |doi= |url= |accessdate=2012-03-13}}</ref>
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| |-
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| | 1-dose vaccine history
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| | + or -
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| | Likely +
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| | 50% of serum samples collected 1–10 days after symptom onset were [[IgM|IgM positive]]; 50%–80% of serum samples collected more than 10 days after symptom onset were [[IgM|IgM positive]]
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| |-
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| | 2-dose vaccine history
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| | + or -
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| | Likely +
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| | 13%–15% of serum samples collected 1–3 days after symptom onset were [[IgM|IgM-positive]]
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| (30%–35% of buccal samples collected 1–3 days after symptom onset were positive by real-time RT-PCR among persons with 2 doses of MMR)
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| |}
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| ==Virus Isolation==
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| *Infected patients remain contagious approximately '''''6 days before the onset of parotitis until about 9 days after the onset of parotitis''''', during which time the virus can be isolated. <ref name="pmid14133666">{{cite journal |author=UTZ JP, HOUK VN, ALLING DW |title=CLINICAL AND LABORATORY STUDIES OF MUMPS |journal=[[The New England Journal of Medicine]] |volume=270 |issue= |pages=1283–6 |year=1964 |month=June |pmid=14133666 |doi=10.1056/NEJM196406112702404 |url=http://www.nejm.org/doi/abs/10.1056/NEJM196406112702404?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-03-09}}</ref>
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| *Virus can be isolated in a cell culture inoculated with the virus obtained from swabs of affected salivary ducts, serum or urine.
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| *Antigen detection by [[PCR|polymerase chain reaction (PCR)]] is reserved for patients with secondary CNS infection.
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| ==References==
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| {{reflist|2}}
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