Mumps

For further information, see CMDT Part 32-02: Major Vaccine-Preventable Viral Infections

Key Features

• Spread by respiratory droplets

• Produces inflammation of salivary glands (eg, parotitis) and occasionally orchitis and meningitis

Clinical Findings

• Parotid tenderness and overlying facial edema common

• Fever and malaise variable

• Orchitis 7–10 days after parotitis; rarely leads to sterility

• Meningitis third most common manifestation

• Other manifestations include

  • Pancreatitis

  • Oophoritis

  • Thyroiditis

  • Neuritis

  • Hepatitis

  • Myocarditis

  • Encephalitis

Diagnosis

• Symptom onset occurs 12–25 days postexposure

• Painful, swollen parotid and other salivary glands

• Orchitis, pancreatitis, or meningitis in setting of parotitis is usually diagnostic

• Lymphocytosis and elevated serum amylase are common

• Serologic testing may be useful but not commonly done

• Nucleic acid amplification techniques, such as real-time reverse transcriptase polymerase chain reaction (RT-PCR), are more sensitive than viral cultures

• Serum neutralization titers best for determining immunity

Treatment

• Supportive measures

• Febrile patients should be kept on bed rest and isolated while there is parotid swelling

• Orchitis

  • Can be managed with scrotal support and ice packs

  • Incision of the tunica may be necessary in severe cases

  • Pain can be relieved with opioids, or by injecting the spermatic cord at the external inguinal ring with 10–20 mL of 1% procaine solution

• Interferon alpha-2b may be useful in preventing testicular atrophy

• Prevention: mumps live virus vaccine is safe and highly effective (Table 30–7)

• Vaccine should be avoided in pregnant women and immunocompromised persons

• Vaccine probably safe in adults with asymptomatic HIV infection