Mumps, also known as infectious or epidemic parotitis, is an acute viral disease caused by a paramyxovirus. It causes painful enlargement of the salivary or parotid glands. It may also infect other organs, such as the testes, the central nervous system (CNS), and the pancreas. The prognosis for complete recovery is good, although mumps sometimes causes complications.
The mumps paramyxovirus is found in the saliva of an infected person and is transmitted by droplets or by direct contact. The virus is present in the saliva 6 days before to 9 days after onset of parotid gland swelling; the 48-hour period immediately preceding onset of swelling is probably the time of highest communicability. The incubation period ranges from 14 to 25 days (the average is 18). One attack of mumps (even if unilateral) almost always confers lifelong immunity.
Mumps is most prevalent in children between ages 6 and 8. Infants younger than age 1 seldom get this disease because of the passive immunity received from maternal antibodies. Peak incidence occurs during late winter and early spring.
The clinical features of mumps vary widely. An estimated 30% of susceptible people have subclinical illness.
Mumps usually begins with prodromal symptoms that last for 24 hours and include myalgia, anorexia, malaise, headache, and low-grade fever followed by an earache that's aggravated by chewing; parotid gland tenderness and swelling; a temperature of 101° to 104° F (38.3° to 40° C); and pain when chewing or when drinking sour or acidic liquids. Simultaneously with the swelling of the parotid gland or several days later, one or more of the other salivary glands may become swollen.
Complications can include epididymo-orchitis and mumps meningitis. In approximately 25% of postpubertal males who contract mumps, epididymo-orchitis occurs and produces abrupt onset of testicular swelling and tenderness, scrotal erythema, lower abdominal pain, nausea, vomiting, fever, and chills. Swelling and tenderness may last for several weeks; epididymitis may precede or accompany the orchitis. In 50% of men with mumps-induced orchitis, the testicles show some atrophy, but sterility is extremely rare.
Mumps meningitis complicates the disease in 10% of patients and affects three to five times more males than females. Signs and symptoms include fever, meningeal irritation (nuchal rigidity, headache, and irritability), vomiting, drowsiness, and a cerebrospinal fluid lymphocyte count ranging from 500 to 2,000/µl. Recovery is usually complete. Less common effects are pancreatitis, deafness, arthritis, myocarditis, encephalitis, pericarditis, oophoritis, and nephritis.
Diagnosis is usually made after the characteristic signs and symptoms develop, especially parotid gland enlargement with a history of exposure to mumps. Serologic antibody testing can verify the diagnosis when parotid or other salivary gland enlargement is absent. If comparison between a blood specimen obtained during the acute phase of illness and another specimen obtained 3 weeks later shows a fourfold rise in antibody titer, the patient most likely had mumps.
Treatment includes analgesics for pain, antipyretics for fever, and adequate fluid intake to prevent dehydration from fever and anorexia. If the patient can't swallow, consider I.V. fluid replacement. Warm salt-water gargles, soft foods, and extra fluids may also help relieve symptoms.
❑Stress the need for bed rest during the febrile period. Give analgesics and apply warm or cool compresses to the neck to relieve pain. Give antipyretics and tepid sponge baths for fever. To prevent dehydration, encourage the patient to drink fluids; to minimize pain and anorexia, advise him to avoid spicy, irritating foods and those that require a lot of chewing. Offer a soft, bland diet.
❑During the acute phase, observe the patient closely for signs of CNS involvement, such as altered level of consciousness and nuchal rigidity.
❑Because the mumps virus is present in the saliva throughout the course of the disease, follow droplet precautions until symptoms subside.
❑Emphasize the importance of routine immunization with live attenuated mumps virus (paramyxovirus) at age 15 months and for susceptible patients (especially males) who are approaching or are past puberty. Remember, immunization within 24 hours of exposure may prevent or attenuate the actual disease. Immunity against mumps lasts at least 12 years.
❑Report all cases of mumps to local public health authorities.
Review other book chapters online related to Mumps:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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