Mumps (parotitis)

S I G I T W I D Y A T M O KO
F A K U L T A S K ED O K T E R A N
U N I V E RS I T A S M U H A M M A D I Y A H
SURAKARTA
 Introduction

Mumps is an acute respiratory tract

infectious disease caused by mumps virus
occurs primarily in school-aged children
.and adolescents
The most prominent manifestation is
nonsuppurative swelling and tenderness of
the salivary glands with
one or both parotid glands involved in most
.cases
Meningitis, meningoencephalitis,
epididymo-orchitis, oophoritis and
pancreatitis are the common extrasalivary
.gland manefestations of mumps
Mumps (parotitis)

Inflammation of the salivary glands.

Mainly the parotid glands are affected.
There are three pairs of salivary glands.
Two parotid glands, the largest, one in each cheek, over the
angle of the jaw , in front of the ear.
Two sub mandibular glands at the back of the mouth.
Two sub-lingual glands, under the floor of the mouth.
Salivary glands .
Viral etiology

Caused by mumps virus.

Family: paramyxoviridae.
Genus: parainfluenza virus.
Pleomorphic, enveloped with helical nucleocapsid.
The viral genome is ss-RNA, with negative polarity.
The viral envelope is covered with two glycoprotein spikes,
the HN which posses both hemagglutinine and
neuraminidase activities , and the fusion glycoprotein.
Viral etiology

The fusion protein enables the virus to form

multinucleated giant cell by fusing infected cells together
Sensitive to ether,ultraviolet and high temperature

Humans are the only natural host

Transmission

By inhalation of respiratory droplets, during sneezing and

coughing.
The virus sheds in saliva.
Also, the virus can be transmitted by direct contact with
saliva.
Epidemic features:
Endemic throughout the world.
The peak incidence in winter and spring.
School-aged children at high risk.
Post-infection immunity is stable and long-lasting.
 Mumps Virus

Paramyxovirus

RNA virus

One antigenic type

Rapidly inactivated by
chemical agents, heat and
ultraviolet light
 Epidemiology
Sources of infection:
Patients in early course of the disease, hosts under
covert infection.
The period of peak contagion before or at the onset
of parotitis.

Route of transmission :
Via droplet nuclei or direct contact,vomites
Pathogenesis and Pathology

The virus usually infecting glandular tissue such as

parotid, orchis or oophoron.
The main pathologic findings are nonsuppurative
inflammatory reactions.
The meningoencephalitis may involve the Fusion
protein.
Clinical features

Mumps is a highly infectious child-hood disease.

IP, about three weeks.
Mumps starts with moderate fever, malaise, pain on
chewing or swallowing, particularly acidic liquids.
Followed by inflammation of the salivary glands,
particularly the parotid glands.
The swelling appears in front of the ear.
Parotid tenderness and ipsilateral earache
within 1 or 2 days after the llness onset,
then
parotid is visibly enlarged and go to size
over next 2 to 3 days accompanied severe
pain and normal or high temperature. One
parotid enlarges after the other maximum
Other salivary glands involved include
submandibular adenitis and sublingual adenitis
Clinical meningitis occurs in 15% of patients
with mumps. Its onset averages 4-5 days after
parotitis but may before, after or in the absence
of parotitis. Clinical features are headache,
.vomiting, fever and nuchal rigidity
.CSF pleocytosis. Prognosis is benign
The onset of orchitis is abrupt with high
temperature, chills , testicular pain and
swelling. Impaired fertility is rare

ophoritis develops in 5% postpubertal

women with mumps. Impaired fertility
.is rare
Parotitis .
Parotitis .
Complications

Aseptic meningitis.
Encephalitis.
Orchitis, after puberty. Inflammation of one or both
testicles. Usually unilateral , rarely leads to sterility .
Pancreatitis.
Oophoritis.
Thyroiditis.
 Mumps Complications

CNS involvement of clinical cases 15%

Orchitis in post- 50%-20%

pubertal males

Pancreatitis 5%-2%

Deafness 1/20,000

Death Average 1 per year (1980

1999)
lab diagnosis

Isolation of mumps virus

Detection of mumps nucleic acid by PCR
Serologic testing
Positive IgM antibody
Significantincrease in IgG antibody between
acute and convalescent specimens
Prevention

A live attenuated vaccine is available (MMR).

It contains mumps, measles and rubella attenuated
virus strains.
Administered in one dose, intramuscularly or
subcutaneously.
The vaccine is protective.
History of Mumps Vaccines in US

Mumps virus isolated 1945

Inactivated vaccine developed 1948
Live attenuated vaccine licensed 1967
)Jeryl Lynn strain(
-Combined measles 1971
mumps-rubella vaccine
Routine 1-dose mumps vaccination 1977
Two-dose MMR schedule 1989
Mumps Vaccine

Composition Live virus (Jeryl Lynn strain)

Clinical Efficacy 95% (Range, 90% - 97%)

Effectiveness 1-dose: 75% - 91%

2-doses: 90%
Duration of
Immunity Lifelong
 MMR Adverse Reactions

Fever 5%-15%
Rash 5%
Joint symptoms 25%
Thrombocytopenia <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy <1/1,000,000 doses
treatment

There is no specific anti-viral drug therapy.

Treatment is supportive by treating symptoms, using
antipyretics and analgesics.
Child care

The child must rest in bed until the fever goes away.
Isolate the child, to prevent spreading the disease to
other.
Use analgesics and anti-pyretic to ease symptoms.
Avoid food that require chewing.
Avoid sour foods that stimulate saliva production.
Drink plenty of water.
Use cold compress to ease the pain of swelling glands.