II. Epidemiology
- Peak Age 10-19 years
-
Incidence
- U.S. Cases in 1968: 152,000 cases
- U.S. Cases in 2000: 338 cases
- U.S. Cases in 2015: 1057 cases
III. Pathophysiology
IV. Symptoms
- Subclinical presentation in 20-40% of cases
- Prodrome (onset after 12-25 day Incubation Period)
- Sudden onset pain, swelling, tenderness in cheeks at Parotid Gland lasting >2 days
- Starts as unilateral and becomes bilateral in 90% of cases
- Provoked by chewing or Swallowing
- Worse with sour foods or acidic foods
- Associated Symptoms
V. Signs
-
Sialadenitis
- Parotitis occurs in 30-40% of patients
- Tender swelling of all Salivary Glands in 10% of cases
- Typically bilateral involvement (but may start unilaterally)
- Skin over Parotid Gland not warm or red
- Contrast with Bacterial Sialadenitis
- Tenderness and swelling at mandibular angle (may obscure angle of jaw)
- Parotid duct (Stensen duct) opening appears red and edematous in Buccal mucosa
-
Orchitis (3-10% of postpubertal males, up to 40% of males overall)
- Occurs 7-10 days after Parotitis
- Maculopapular rash
- Variably present
- May develop over the trunk
VI. Complications
-
Orchitis (see signs as above)
- Testicular Atrophy (50%)
- Bilateral Orchitis in 30% of cases
- Infertility
- Highest risk if bilateral involvement
- Pancreatitis (usually uncomplicated)
-
Central Nervous System Involvement
- Asymptomatic Cerebrospinal Fluid Leukocytosis (50%)
- Less common causes
- Encephalitis (1 case per 400 to 6000 Mumps cases)
- Mortality: 1-2% death rate from Encephalitis
- Consider for high fever, Headache, neck stiffness or Seizures
- Aseptic Meningitis
- Typically benign, but some will develop other neurologic complications
- Paralytic Polio-like syndrome
- Transverse Myelitis
- Cerebellar Ataxia
- Encephalitis (1 case per 400 to 6000 Mumps cases)
- Miscellaneous
- Deafness (<1% in the post-Vaccine era)
- Oophoritis (ovarian inflammation)
- Subacute Thyroiditis
- Dacryoadenitis
- Optic Neuritis
- Iritis
- Conjunctivitis
- Myocarditis
- Hepatitis
- Nephritis
- Mastitis
- ThrombocytopeniaPurpura
- Interstitial Pneumonia
- Migratory polyarthritis
VII. Labs
-
Complete Blood Count
- Parotitis: Relative Lymphocytosis
- Orchitis: Marked Leukocytosis
- Serum Amylase increased
- Cerebrospinal Fluid
- White Blood Cells: 1000-2000 with Neutrophils
VIII. Diagnosis: Culture, IgG, and IgM should all be done
- Mumps PCR
- Culture
- Obtain sample within first 5 days of Parotitis
- Blood, Throat, CSF, Urine
- Immunofluorescence positive in 2-3 days
-
Serology
- Mumps IgM
- Positive after day 3 of swelling
- Titers peak by one week
- Mumps IgG
- Obtain acute baseline Mumps IgG as soon as possible
- Check Mumps IgG again 3-5 weeks after onset
- Titer increases 4 fold
- Mumps IgM
IX. Management
-
Orchitis
- Scrotal support
- NSAIDs
- Consider Interferon alpha 2b
- Reduces testicular atrophy and Infertility risk
- Intravenous Immunoglobulin (IVIG) Indications
- Guillain-Barre Syndrome
- Idiopathic Thrombocytopenia
- Post-Infectous Encephalitis
- Consider MMR Vaccine dose for contagious contacts who have been previously vaccinated (2 prior MMR doses)
- Consider third dose MMR Vaccine which may help prevent mumps infection during an outbreak
- Immunoglobulin is not effective for Post-exposure Prophylaxis
- Suspected cases
- Report to local public health department
- Follow standard isolation with droplet precautions (respiratory and Saliva sources) while in hospital
- Quarantine patient for 2 days before until 5 days after parotid swelling onset
X. Prevention
-
MMR Vaccine
- MMR Vaccine is contraindicated in pregnancy and Immunocompromised patients (Live Vaccine)
- MMR Vaccine is indicated for all children in U.S. at 12-15 months and 4-6 years
- Effective at preventing mumps in 88% of immunized patients (78% after the first dose)
- Antibody levels wane over time (esp. elderly), and may present atypically with mumps
XI. Prognosis
- Mortality: Up to 50 deaths per 1 million Mumps cases
XII. Resources
XIII. References
- Harrison and Ruttan (2019) Crit Dec Emerg Med 33(7): 3-12
- Spencer (2017) Am Fam Physician 95(12): 786-94 [PubMed]
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Related Studies
| Definition (MSHFRE) | Maladie infectieuse aiguë due à un rubulavirus. La transmission se fait par contact direct, par des goutellettes aéroportées, par des objets souillés par de la salive infectieuse et peut-être par l'urine. Bien que des adultes puissent être infectés, l'infection survient principalement chez les enfants de moins de 15 ans. ( Extr. Dorland, 28ème éd.) |
| Definition (MEDLINEPLUS) |
Mumps is an illness caused by the mumps virus. It starts with
After that, the salivary glands under the ears or jaw become swollen and tender. The swelling can be on one or both sides of the face. Symptoms last 7 to 10 days. Serious complications are rare. You can catch mumps by being with another person who has it. There is no treatment for mumps, but the measles-mumps-rubella (MMR) vaccine can prevent it. Before the routine vaccination program in the United States, mumps was a common illness in infants, children and young adults. Now it is a rare disease in the U.S. Centers for Disease Control and Prevention |
| Definition (NCI) | A contagious viral infection caused by the mumps virus. Symptoms include swollen and tender parotid glands, fever, muscle aches and fatigue. Due to vaccination programs, mumps has become a rare disease. |
| Definition (MSH) | An acute infectious disease caused by RUBULAVIRUS, spread by direct contact, airborne droplet nuclei, fomites contaminated by infectious saliva, and perhaps urine, and usually seen in children under the age of 15, although adults may also be affected. (From Dorland, 28th ed) |
| Definition (CSP) | acute, inflammatory, contagious disease caused by Rubulavirus and characterized by swelling of the salivary glands, especially the parotids, and sometimes of the pancreas, ovaries, or testes; spread by direct contact, airborne droplet nuclei, fomites contaminated by infectious saliva, and perhaps urine. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009107 |
| ICD9 | 072 |
| ICD10 | B26 , B26.9 |
| SnomedCT | 154352008, 186652008, 186651001, 240526004, 36989005 |
| LNC | LP32627-9, LA10491-1 |
| English | Mumps, Epidemic Parotitides, Parotitides, Epidemic, Parotitis, Epidemic, epidemic parotiditis, mumps (diagnosis), parotitis infectious, infectious parotitis (diagnosis), mumps, epidemic parotitis (diagnosis), parotitis epidemic, infectious parotitis, epidemic parotitis, Clinical mumps, Mumps NOS, Mumps parotitis NOS, Mumps [Disease/Finding], mumps parotitis, Parotitis - epidemic, Epidemic parotitis, Infectious parotitis, Mumps parotitis, Mumps (disorder), Mumps parotitis (disorder), epidemic; parotitis, infectious; parotitis, parotitis; epidemic, parotitis; infectious, Mumps, NOS, Epidemic Parotitis |
| Dutch | epidemische parotitis, klinische bof, epidemica; parotitis, infectieus; parotitis, parotitis; epidemica, parotitis; infectieus, bof, Bof, Parotitis epidemica |
| French | Parotidite épidémique, Cas cliniques d'oreillons, Oreillons |
| German | klinischer Mumps, epidemische Parotitis, Mumps, Parotitis epidemica |
| Italian | Parotite clinica, Parotite epidemica, Orecchioni |
| Portuguese | Papeira clínica, Parotidite epidémica, Papeira, Trasorelho, Parotite Epidêmica, Caxumba, Parotidite Epidêmica |
| Spanish | Parotiditis epidémica, Infecto-Fiebre Urliana, Parotiditis Urliana, Parotitis Epidémica, Fiebre Urliana, paperas, fiebre urliana, parotiditis (trastorno), parotiditis epidémica, parotiditis infecciosa, parotiditis urliana (trastorno), parotiditis urliana, parotiditis, Paperas, Parotiditis Epidémica |
| Japanese | 臨床的耳下腺炎, ﾑﾝﾌﾟｽ, ﾘｭｳｺｳｾｲｼﾞｶｾﾝｴﾝ, ﾘﾝｼｮｳﾃｷｼﾞｶｾﾝｴﾝ, おたふくかぜ, ムンプス, マンプス, 流行性耳下腺炎, 耳下腺炎-流行性 |
| Swedish | Påssjuka |
| Czech | příušnice, Manifestní parotitis epidemica, Epidemická parotitida, Parotitis epidemica, parotitis epidemica |
| Finnish | Sikotauti |
| Russian | SVINKA, PAROTIT EPIDEMICHESKII, ПАРОТИТ ЭПИДЕМИЧЕСКИЙ, СВИНКА |
| Korean | 볼거리 |
| Croatian | ZAUŠNJACI |
| Polish | Zapalenie przyusznic nagminne, Świnka |
| Hungarian | mumps, Epidemiás parotitis, Klinikai mumps |
| Norwegian | Kusma, Infeksiøs parotitt, Epidemisk parotitt |
