Mumps: Pathology, Clinical Presentations, complications, Diagnosis, Treatment And Prevention
Physical Presentations Of Mumps
A General Overview Of Mumps
This common childhood infection is caused by mumps virus which belongs to the group of paramyxoviruses. The infection is worldwide in distribution and spreads through droplets. The disease runs a subclinical course in 30 to 40% of cases. Man is the only known host and the infection spreads directly from man to man. Infectivity rate among contacts is not high. Second attacks do not occur since mumps produce solid lifelong immunity.
Pathology: Organisms enter through the respiratory tract. The virus is present in the saliva from 7 days before to 8 days after the onset of parotitis. In susceptible hosts, viral multiplication leads to viremia. Thereafter the virus localizes in several organs, such as salivary glands, pancreas, central nervous system, testes, ovaries, thyroid gland and others. The salivary glands are enlarged and histology shows mononuclear infiltration. Neurological lesions take the form of meningoencephalitis or encephalomyelitis. Testicular lesions include intense interstitial edema, perivasuclar lymphocytic exudates, focal hemorrhages and destruction of germinal epithelium, which may be patchy or generalized.
Complications Of Mumps
The Clinical Manifestations Of Mumps
Incubation period is 18 days (range 12 to 21 days). Initial symptoms are fever, pain over the region of the parotid gland, especially on opening the jaw, trismus, dryness of the mouth, headache. Soon the parotids and less commonly, the other salivary glands become tender and enlarged. Unlike suppurative parotitis, redness and edema are absent. Sialadenitis is usually bilateral, but rarely it may be unilateral.
After 5 to 7 days, the fever and glandular enlargement subside. In the uncomplicated cases, there is leucopenia which is relative lymphocytosis. A few atypical lymphocytes may be present. When complications occur, neutrophil leucocytosis may develop. Around 50% of cases, show CSF pleocytosis.
Complications: In the vast majority, the course is benign and uncomplicated. If the disease occurs in adult males, 25% develop uni- or bilateral orchitis. The affected testes are red, swollen, tender and painful. Reactive hydrocele may develop. Oophoritis may develop in women. Though parotitis is present in most of such cases, rarely gonadal lesions occur without obvious parotitis.
Pancreatitis should be suspected when patients with mumps complian of upper abdominal pain. In a few cases, serum amylase level may be increased. Pancreatitis usually subsides without sequel. Thyroiditis develops in some cases. The occurrence of meningitis is heralded by intense headache and signs of meningeal irritation. The CSF shows lymphocytic pleocytosis. Encephalomyelitis is a rare complication. Arthritis follows the acute illness after 2 to 3 weeks.
How can Mumps Be Prevented?
Diagnosis And Treatment Of Mumps
Diagnosis: Bilateral enlargement of the parotid and other salivary glands with mild constitutional disturbances should suggest the possibility of mumps. The diagnosis is easy, during outbreaks but it may be difficult when the presentation is atypical such as unilateral parotitis or meningitis.
Virological confirmation is possible by demonstrating complement fixing antibodies and by isolation of the virus from the saliva or CSF.
Treatment: Symptomatic treatment consists of analgesics, antipyretics in addition to bed rest. This is all that is required in most of the cases. Troublesome dryness of the mouth can be relieved by frequent sips of water.
When orchitis is present, local dressing with ichthyol glycerine and supportive bandage give relief. Predinisolone 40 mg daily for 4 to 7 days may help in reducing the inflammation. The meningitis also subsides with symptomatic measures. Corticosteroids produce early clinical improvement though there is not objective benefit demonstrated by controlled studies.
Prevention: Specific prophylactic measures are not generally required, since the infection runs a bening course and produces lasting immunity. A live attenuated vaccine (Jeryl-Lynn strain) is available in the USA for use in selected groups. This produces a noncommunicable subclinical infection. The vaccine is administered to children above the age of 13 months. Measles and mumps vaccine can be given together as a single injection safely between the age of 13 to 15 months.
© 2014 Funom Theophilus Makama