MUMPS ( Gondongan )

Stephanie Widodo Subagio

Kasus
A 6 years old boy is brought to your office for evaluation of fever, ear pain, and swollen cheeks. His mother reports that hes had 3 or 4 days of low grade fever and seemed tired. Yesterday he developed the sudden onset of ear pain and swelling of the cheeks along with higher fever. He is an only child, and neither of the parents has been ill recently.

He has had no significant medical illnesses in his life, but his parents decided not to give him the MMR vaccine because they read that it could cause autism. On examination his temperature is 38,6C and his pulse is 105 beats/min. He has swollen parotid glands bilaterally. His tympanic membranes appears normal. Opening mouth causes pain, but the posterior pharynx appears normal. You do note some erythema and swelling of Stensen duct. He has bilateral cervical

Pengantar
The mumps virus is primarily a childhood disease that causes acute, painful swelling of the parotid and other glands. It is a highly communicable disease that has one known serotype and infects only humans. Mumps is endemic around the world, with approximately 90% of children being infected by the age of 15. it is now an uncommon illnes in countries such as United States, where a live attenuated vaccine is widely used.

The MMR vaccine, a combination vaccine of measles, mumps, and rubella, has resulted in a greater than 99% reduction in the incidence of mumps. Almost all cases of mumps now seen are in the unvaccinated or in person with depressed cellular immunity.

Agent : Mumps Virus

Family : Paramyxoviridae Single stranded, negative senses RNA genome Enveloped virus, contains two glycoproteins :

Hemagglutinin neuroamidase protein involved in attachment Membrane fusion protein

Pathogenesis
Contaminated respiratory droplets or saliva Virus fuses with the host cell membrane, results in binding to sialic acid in target cell membrane

Transcription, replication, protein synthesis, and assembly occur in the cytoplasm of the host cell Ater initial infection and replication in the nasal or upper respiratory tract, viral infection spreads to the salivary glands.

Clinical Manifestation

35 percent of these infections are subclinical Acute onset of fever and malaise Painful bilateral or unilateral swelling of the parotid (parotitis) or other salivary glands

Clinical Manifestation
Orchitis testis atrophy Oophoritis Pancreatitis 10-20% of cases may progress to more severe with CNS involvement Aseptic meningitis Mumps encephalitis neurolysis and ependymitis deafness, obstructive hydrocephalus in children Post-infectious-type mumps encephalitis

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Host defenses
Interferon production Antibody

IgM 3 days 2 / 3 months IgG later lifelong

Cellular mediated immunity Passive immunity is transferred from mothers to newborns, and thus, mumps is rarely seen in infants less than 6 months old.

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Diagnosis
Typical clinical appearance (parotitis) Laboratory confirmation

isolating the virus from saliva, cerebrospinal fluid or urine Serology : ELISA/ immunofluorescence test
IgM , IgG (serum) IgA (saliva)
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Treatment
Usually self limiting Treated with supportive care : fluids, rest, anti-inflammatories. Patients with mumps or suspected mumps should be isolated for up to a week after symptoms begin or until infection is ruled out.

Prevention

Active immunization ( MMR vaccine )

Diberikan pada anak usia 15-18 bulan minimal dengan interval 6 bulan antara imunisasi campak (usia 9 bulan). Dapat diberikan pada usia 12 bulan apabila hingga usia 12 bulan anak belum menerima imunisasi campak.