II. Epidemiology

  1. Peak Age 10-19 years
  2. Incidence
    1. U.S. Cases in 1968: 152,000 cases
    2. U.S. Cases in 2000: 338 cases
    3. U.S. Cases in 2015: 1057 cases

III. Pathophysiology

  1. Caused by a paramyxovirus
  2. Transmission
    1. Transmitted easily by airborne droplet spread (Saliva or nasal secretions)
    2. Also transmitted in urine
  3. Incubation: 12-25 days (typically 16-18 days)
  4. Infectious:
    1. Start: 6 days before Parotitis
    2. Ends: 2 weeks after symptom onset

IV. Symptoms

  1. Subclinical presentation in 20-40% of cases
  2. Prodrome (onset after 12-25 day Incubation Period)
    1. Fever (moderate, lasts 7 days)
    2. Malaise
    3. Headache
    4. Anorexia
    5. Myalgias
  3. Sudden onset pain, swelling, tenderness in cheeks at Parotid Gland lasting >2 days
    1. Starts as unilateral and becomes bilateral in 90% of cases
    2. Provoked by chewing or Swallowing
    3. Worse with sour foods or acidic foods
  4. Associated Symptoms
    1. Otalgia
    2. Trismus

V. Signs

  1. Sialadenitis
    1. Parotitis occurs in 30-40% of patients
    2. Tender swelling of all Salivary Glands in 10% of cases
    3. Typically bilateral involvement (but may start unilaterally)
    4. Skin over Parotid Gland not warm or red
      1. Contrast with Bacterial Sialadenitis
    5. Tenderness and swelling at mandibular angle (may obscure angle of jaw)
    6. Parotid duct (Stensen duct) opening appears red and edematous in Buccal mucosa
  2. Orchitis (3-10% of postpubertal males, up to 40% of males overall)
    1. Occurs 7-10 days after Parotitis
  3. Maculopapular rash
    1. Variably present
    2. May develop over the trunk

VI. Complications

  1. Orchitis (see signs as above)
    1. Testicular Atrophy (50%)
    2. Bilateral Orchitis in 30% of cases
    3. Infertility
      1. Highest risk if bilateral involvement
  2. Pancreatitis (usually uncomplicated)
  3. Central Nervous System Involvement
    1. Asymptomatic Cerebrospinal Fluid Leukocytosis (50%)
    2. Less common causes
      1. Encephalitis (1 case per 400 to 6000 Mumps cases)
        1. Mortality: 1-2% death rate from Encephalitis
        2. Consider for high fever, Headache, neck stiffness or Seizures
      2. Aseptic Meningitis
        1. Typically benign, but some will develop other neurologic complications
      3. Paralytic Polio-like syndrome
      4. Transverse Myelitis
      5. Cerebellar Ataxia
  4. Miscellaneous
    1. Deafness (<1% in the post-Vaccine era)
    2. Oophoritis (ovarian inflammation)
    3. Subacute Thyroiditis
    4. Dacryoadenitis
    5. Optic Neuritis
    6. Iritis
    7. Conjunctivitis
    8. Myocarditis
    9. Hepatitis
    10. Nephritis
    11. Mastitis
    12. ThrombocytopeniaPurpura
    13. Interstitial Pneumonia
    14. Migratory polyarthritis

VII. Labs

  1. Complete Blood Count
    1. Parotitis: Relative Lymphocytosis
    2. Orchitis: Marked Leukocytosis
  2. Serum Amylase increased
  3. Cerebrospinal Fluid
    1. White Blood Cells: 1000-2000 with Neutrophils

VIII. Diagnosis: Culture, IgG, and IgM should all be done

  1. Mumps PCR
  2. Culture
    1. Obtain sample within first 5 days of Parotitis
    2. Blood, Throat, CSF, Urine
    3. Immunofluorescence positive in 2-3 days
  3. Serology
    1. Mumps IgM
      1. Positive after day 3 of swelling
      2. Titers peak by one week
    2. Mumps IgG
      1. Obtain acute baseline Mumps IgG as soon as possible
      2. Check Mumps IgG again 3-5 weeks after onset
      3. Titer increases 4 fold

IX. Management

  1. Orchitis
    1. Scrotal support
    2. NSAIDs
    3. Consider Interferon alpha 2b
      1. Reduces testicular atrophy and Infertility risk
  2. Intravenous Immunoglobulin (IVIG) Indications
    1. Guillain-Barre Syndrome
    2. Idiopathic Thrombocytopenia
    3. Post-Infectous Encephalitis
  3. Consider MMR Vaccine dose for contagious contacts who have been previously vaccinated (2 prior MMR doses)
    1. Consider third dose MMR Vaccine which may help prevent mumps infection during an outbreak
    2. Immunoglobulin is not effective for Post-exposure Prophylaxis
  4. Suspected cases
    1. Report to local public health department
    2. Follow standard isolation with droplet precautions (respiratory and Saliva sources) while in hospital
    3. Quarantine patient for 2 days before until 5 days after parotid swelling onset

X. Prevention

  1. MMR Vaccine
    1. MMR Vaccine is contraindicated in pregnancy and Immunocompromised patients (Live Vaccine)
    2. MMR Vaccine is indicated for all children in U.S. at 12-15 months and 4-6 years
    3. Effective at preventing mumps in 88% of immunized patients (78% after the first dose)
    4. Antibody levels wane over time (esp. elderly), and may present atypically with mumps

XI. Prognosis

  1. Mortality: Up to 50 deaths per 1 million Mumps cases

XIII. References

  1. Harrison and Ruttan (2019) Crit Dec Emerg Med 33(7): 3-12
  2. Spencer (2017) Am Fam Physician 95(12): 786-94 [PubMed]

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Related Studies

Ontology: Mumps (C0026780)

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

  • Fever
  • Headache
  • Muscle aches
  • Tiredness
  • Loss of appetite

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, ムンプス, リュウコウセイジカセンエン, リンショウテキジカセンエン, 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
Korean 볼거리
Polish Zapalenie przyusznic nagminne, Świnka
Hungarian mumps, Epidemiás parotitis, Klinikai mumps
Norwegian Kusma, Infeksiøs parotitt, Epidemisk parotitt