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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
The average incubation period for Rubulavirus is 16-18 days. Nonspecific [[prodromal symptoms]] develop and last 3-4 days. Several days after onset of [[prodrome]], one or both of the [[Parotid gland|parotid]] salivary glands begin to swell ([[parotitis]]). One [[Parotid gland|parotid]] may swell before the other, and in 25% of patients, only one side swells. Other salivary glands ([[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual]]) under the floor of the mouth also may swell but do so less frequently (10%). [[Parotitis]], lasts at least 2 days, but may persist longer than 10 days. Complications include: [[orchitis]] in post-pubertal males, [[Oophoritis]] and/or [[mastitis]] in post-pubertal females, transient [[sensorineural hearing loss]], [[Meningitis]], [[Encephalitis]], [[Pancreatitis]], and [[Spontaneous abortion]] during the first trimester of [[pregnancy]]. Mumps is [[self-limiting]] and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable. | |||
==Diagnosis== | ==Diagnosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.
Overview
Mumps is a highly contagious viral disease that leads to painful swelling of the salivary glands and is caused by the mumps virus. Mumps is spread through direct contact with an infected person. Symptoms include fever, glandular swelling, headache, sore throat, and orchitis. Mumps is a self-limiting disease, and the prognosis is generally good, even if other organs are involved.
Historical Perspective
Mumps may have first been described by Hippocrates as a disease causing parotitis and orchitis in the 5th century. Prior to the vaccination program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in mumps cases. Outbreaks in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.
Pathophysiology
Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs or sneezes. Most mumps transmission occurs before the enlargement of the salivary glands and within the 5 days after the swelling begins. Therefore, CDC recommends isolating mumps patients for 5 days after their glands begin to swell.
Causes
Mumps is caused by a paramyxovirus, and transmission of the virus occurs via respiratory secretions such as infected saliva, air droplets or via direct contact with articles that have been contaminated with infected saliva. The incubation period is usually 18 to 21 days. Infected patients remain contagious from approximately 6 days before the onset of symptoms until about 9 days after the onset of symptoms.
Differential Diagnosis
Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity.
Epidemiology and Demographics
Since the initiation of the MMR vaccination program in the United States, the incidence of mumps has declined by 99%. Currently, the number of cases per year ranges from a couple hundred to a couple thousand. Mumps predominantly occurs in school-age children (5-14 years) but outbreaks have occurred in adolescents and adults. There is currently no significant difference in mumps incidence between sexes and races. Mumps is uncommon in the United States and other developed countries. However sporadic outbreaks have occurred, predominantly in environments that involve close contact or high level of social interaction. Only 57% of countries belonging to the World Health Organization use a mumps vaccine. Most of these countries are developing and mumps remains endemic in these regions.
Risk Factors
Risk factors for mumps include: unvaccinated individuals who do not have evidence of immunity, belonging to the age group 2-12 years, international travel, especially to countries without mumps vaccination programs, working or living in close proximity to individual(s) infected with Rubulavirus, and being in states of immunodeficiency.
Natural History, Complications and Prognosis
The average incubation period for Rubulavirus is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%). Parotitis, lasts at least 2 days, but may persist longer than 10 days. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.
Diagnosis
Diagnostic Criteria
Suspected mumps involves parotitis, orchitis, or oophoritis unexplained by another diagnosis OR a positive lab result with no mumps clinical symptoms. Probable mumps involves parotitis or other salivary gland swelling lasting at least 2 days, or orchitis or oophoritis unexplained by another more likely diagnosis, in a person with a positive test for serum anti-mumps immunoglobulin M (IgM) antibody OR person with epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps. Confirmed mumps involves positive mumps laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient any of the following symptoms: acute parotitis or other salivary gland swelling, lasting at least 2 days, aseptic meningitis, encephalitis, hearing loss, orchitis, oophoritis, mastitis, pancreatitis.
History and Symptoms
Approximately 20-30% cases infected with mumps may remain asymptomatic.[1] Mumps typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands (classically the parotid gland).[2] Painful testicular swelling and rash may also occur.
Physical Examination
Laboratory Findings
Laboratory findings for the 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 antibody or a significant rise in IgG antibody. However, there are many important caveats to be aware of when interpreting the results.[3]
CT
Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as a CT scan, may be helpful in patients with secondary complications.
Ultrasound
Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as an ultrasound, may be helpful in patients with secondary complications.
Other Diagnostic Studies
Mumps is a clinical diagnosis. Further testing may be required in patients with secondary complications.
Treatment
Medical Therapy
Currently, there is no specific treatment for mumps. In addition, the disease itself is generally self-limiting, and runs its course before waning. Supportive care with analgesics may provide symptomatic benefit.
Primary Prevention
Secondary Prevention
References
- ↑ "Mumps epidemic--Iowa, 2006". MMWR. Morbidity and Mortality Weekly Report. 55 (13): 366–8. 2006. PMID 16601665. Retrieved 2012-03-08. Unknown parameter
|month=ignored (help) - ↑ Enders G (1996). Paramyxoviruses–Mumps virus. In: Barron's Medical Microbiology (Barron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
- ↑ "Mumps: Lab Testing for Mumps Infection". Centers for Disease Control and Prevention. 13 April 2010. Retrieved 30 October 2011.