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Essentials of Diagnosis
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Exposure 12–25 days before onset
Painful, swollen salivary glands, usually parotid
Frequent involvement of testes, pancreas, and meninges in unvaccinated individuals
Mumps can occur in appropriately vaccinated persons in highly vaccinated communities
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General Considerations
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Children are most commonly affected; however, in outbreaks, infection can affect patients in their second or third decades of life
Mumps is more serious in adults than in children and appears to occur more commonly in males
Incubation period is 12–25 days (average, 16–18 days)
Transmission
Direct contact with respiratory secretions or saliva or infected surfaces
Can also be airborne or via droplets
Can spread rapidly in congregate settings, such as colleges and schools
Up to one-third of affected individuals have subclinical infection, which is still transmissible
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From January 2016 to June 2017, 9200 cases were reported, including a large outbreak of close to 3000 cases in one Arkansas community
Between January 1 and September 13, 2019, 47 states and the District of Columbia in the United States reported 2363 mumps cases
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Fever and malaise are variable but often minimal in young children
Parotid tenderness and overlying facial edema
Most common physical findings
Typically develop within 48 hours of the prodromal symptoms
Usually, one parotid gland enlarges before the other, but unilateral parotitis occurs in 25% of patients
The parotid duct (orifice of Stensen) may be red and swollen
Trismus may result from parotitis
Involvement of other salivary glands (submaxillary and sublingual) occurs in 10% of cases
Orchitis
Testes most common extra salivary disease site in adults
High fever, testicular swelling, and tenderness (unilateral in 75% of cases)
Usually develops 7–10 days after the onset of parotitis
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Differential Diagnosis
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An elevated mumps-specific serum IgM is considered diagnostic
Repeat testing 2–3 weeks after the onset of symptoms is recommended if the first assay is negative because the rise in IgM may be delayed
Nucleic acid amplification techniques, such as real-time PCR, are more sensitive than viral cultures
A fourfold rise in complement-fixing antibodies to mumps virus in paired serum IgG also confirms infection
Anti-mumps IgM and IgG in the CSF can confirm the diagnosis of mumps-associated meningitis
The virus can also be isolated from CSF early in aseptic meningitis
Mild leukopenia with relative ...