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Chapter 10: Viruses of Mumps, Measles, Rubella, and Other Childhood Exanthems

INTRODUCTION

They wondered

If wheezeles

Could turn

Into measles,

If sneazles

Would turn

Into mumps

—A.A. Milne, Now We Are Six

The major viruses described in this chapter are mumps, measles, rubella, and the human parvovirus B19, which are from different virus families and genetically unrelated, but share several common epidemiologic and clinical characteristics, including (1) worldwide distribution, with a high incidence of infection in nonimmune individuals; (2) humans as sole reservoir of infection; and (3) person-to-person spread primarily by the respiratory (aerosol) route.

The other diseases discussed in this chapter are roseola infantum and rubella-like rashes caused by many different viruses that are mainly common illnesses occurring in early life. Key characteristics of these major viruses are summarized in Table 10–1.

TABLE 10–1Comparison of Mumps, Measles, Rubella and Other Exanthems
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TABLE 10–1 Comparison of Mumps, Measles, Rubella and Other Exanthems
FEATURE MUMPS MEASLES RUBELLA PARVOVIRUS B19 ROSEOLA
Virus type Paramyxoviridae (Paramyxovirus) enveloped, helical, single-stranded (-) RNA Paramyxovirus (Morbillivirus) enveloped, helical, single-stranded (-) RNA Togavirus (Rubivirus) enveloped, icosahedral, single-stranded (+) RNA Parvovirus, naked capsid, icosahedral, single-stranded DNA Human herpesviruses 6 or 7, enveloped, icosahedral, double-stranded DNA
Transmission Respiratory Respiratory Respiratory Respiratory Oral secretions
Incubation period (days) 12-29 (average 16-18) 7-18 (average 9-11) 14-21 (average 16) 4-12 Unknown
Symptoms Fever, parotitis Fever, cough, conjunctivitis, Koplik spots Fever (low grade), upper respiratory symptoms Mild fever, malaise, headache, myalgia, itching High fever, occasional late sudden rash
Characteristic rash None Widespread, maculopapular Faint, macular Macular, reticular, often faint Transient, faint macular
Duration of illness 7-10 days 3-5 days 1-3 days 1-2 weeks 3-5 days
Severity and/or complications Meningitis, encephalitis, pancreatitis, orchitis, oophoritis Bacterial superinfection, encephalitis, keratitis, reactivation of tuberculosis, subacute sclerosing panencephalitis (rare) Overt arthritis, congenital infection Aplastic crisis (in chronica hemolytic diseases), arthritis, arthralgias  
Fetal infection Noa Noa Yes—multiple defects Yes—stillbirth, fetal hydrops Noa
Vaccine Live attenuated Live attenuated Live attenuated No No

aFetal infection may rarely occur, but with no apparent consequences.

MUMPS

MUMPS Overview

Mumps virus, a member of paramyxoviridae family and paramyxovirus genus, is a negative-sense single-stranded RNA, helical, enveloped virus with glycoprotein spikes, HN, and F that replicates in the cytoplasm by using viral RNA polymerase. Mumps is transmitted through respiratory tract and replicate in the respiratory tract epithelium and local lymph nodes followed by fever and swelling of parotid glands (parotitis) unilateral or bilateral. The incubation period is 12 to 29 days and the symptoms persist for 7 to 10 days. The development of viremia allows the virus to travel to all body organs, including salivary glands and central nervous system. The complications of mumps include aseptic meningitis, encephalitis, pancreatitis, orchitis, and oophoritis. Pathogenesis involves cell necrosis and inflammation with predominant infiltration of mononuclear cells. Humoral and cell-mediated immunity are involved in containing the infection; however, IgG ...

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