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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

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