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

Key Features

Essentials of Diagnosis

  • 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

General Considerations

  • 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

Demographics

  • 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

Clinical Findings

Symptoms and Signs

  • 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

Differential Diagnosis

  • Swelling of the parotid gland may be due to

    • Calculi in the parotid ducts

    • Tumors

    • Cysts

  • Parotitis may be produced by pyogenic organisms

    • Staphylococcus aureus

    • Gram-negative organisms

    • Drug reaction (phenothiazines, propylthiouracil)

    • Other viruses (HIV, influenza A, parainfluenza, EBV infection, coxsackieviruses, adenoviruses, HHV-6)

  • Sarcoidosis

  • Cirrhosis

  • Diabetes

  • Bulimia

  • Pilocarpine usage

  • Sjögren syndrome

Diagnosis

  • 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 ...

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