also known as Epidemic Parotitis). MUMPS also known as Epidemic Parotitis). DR (MRS) M.B. FETUGA

MUMPS VIRUS Caused by Mumps virus (It is an RNA virus of the paramyxoviridae group (parainfluenza, measles). Only one serotype is known. Mumps is endemic in most urban populatn The occurrence of the infection in epidemics is probably related to lack of immunity DR (MRS) M.B. FETUGA

EPIDEMIOLOGY Mumps is an acute generalized viral disease with painful enlargement of the salivary glands.(pancreas, gonads & brain) Its spread occurs from human reservoir by direct contact, airborne droplets and items contaminated by body fluids containing the virus. It occurs predominantly in children but least frequent in infancy. DR (MRS) M.B. FETUGA

PATHOGENESIS After entry through the epithelial lining of the respiratory tract, viraemia occurs by which the virus is distributed to many tissues particularly the salivary glands. The virus may be isolated in saliva up to 6 days before and up to 9 days after the appearance of the swellings Transmission does not occur later than 3 days after the swelling has subsided. DR (MRS) M.B. FETUGA

CLINICAL FEATURES 1 Incubation period: 14 to 24 days with a peak of 18 days. 30 to 40% of infections are subclinical hence difficult to trace source. Prodromes are unusual & mild- fever, malaise, myalgia (esplly in the neck) and headache may be present before the appearance of the swellings. The parotid glands are most frequently affected. The submandibular are affected in about 15% of cases. The sublingual are the least affected (but the most painful). DR (MRS) M.B. FETUGA

CLINICAL FEATURES 2 The glands are painful, tender & interfere with mouth opening. There is oedema of skin & soft tissue surrounding the gland; earlobe is pushed upwards & outwards. Manubrium < no longer visible Pain heralds the swelling in one or both parotid glands (one gland usually swells 1 – 2 days before the other). It is bilateral in ¾ of cases & unilateral in ¼ of cases. The swelling peaks in 1-3 days & usually regresses within 3 – 7 days. DR (MRS) M.B. FETUGA

CLINICAL FEATURES 3 Pain is elicited by tasting sour liquids like vinegar and lemon. Swelling is more readily appreciated by sight than by palpation & accompanied by moderate fever, 40oC or more is rare (Normal in 20%). Redness of the opening of the Stensen duct on the buccal mucosa & pharyngeal oedema and oedema over the manubrium (from lymphatic obstruction) may also occur. Equal Male : Female DR (MRS) M.B. FETUGA

CLINICAL FEATURES 4 Lifelong immunity usually follows clinical or subclinical infection. 20 infection has however been documented. Transplacental Abs seem to be protective of infants in the 1st 6-8 months of life. Infants born to mothers who have mumps in the week prior to delivery may have clinical mumps at birth or develop illness in the NN period. DR (MRS) M.B. FETUGA

DIAGNOSIS Suspected during epidemics. Most laboratory tests are non-specific. Leukopenia with relative lymphocytosis. Elevated serum amylase level. Polymorphonuclear leucocytosis observed with complications. Serology using ELISA to detect anti-mumps IgM and IgG antibodies. Viral culture from saliva, CSF, blood and urine, brain. DR (MRS) M.B. FETUGA

DIFFERENTNIAL DIAGNOSIS Other viral parotitis (HIV, CMV, influenza, parainfluenza) Suppurative parotitis due to Staphylococcus aureus or Streptococcus pyogenes. Salivary calculus obstructing the flow of saliva and resulting in distension of the glands. Pre-auricular and anterior cervical adenitis. Branchial cysts. PEM- painless enlargement DR (MRS) M.B. FETUGA

COMPLICATIONS 1 Meningoencephalitis- CSF-↑lymphocyte & slight ↑ in protein Polyneuritis with polio-like paralysis (typified by total neurologic recovery). Orchitis and epididymitis occur usually in post-pubertal boys (within 8 days). May occur without evidence of salivary gland infection. -Both testes in 30%. -30-40% of affected testes atrophy -Impairment of fertility in about 13% -Absolute infertility is rare DR (MRS) M.B. FETUGA

COMPLICATIONS 2 Oophoritis in post-pubertal females-xterized by lower abdominal pain. No evidence of impairment of fertility. Rarer than orchitis Pancreatitis – rare (epigastric pain, vomiting, fever, chills, ↑ serum amylase. Myocarditis (depressed ST segment common on ECG). DR (MRS) M.B. FETUGA

COMPLICATIONS 3 Deafness usually unilateral. Dacroadenitis (Inflammation of the lacrimal gland) usually bilaterally. Thyroiditis – uncommon in children DR (MRS) M.B. FETUGA

MANAGEMENT No specific treatment protocol. Essentially supportive. Antipyretics (acetaminophen) for fever. Adjust diet to patient’s ability to chew. Bed rest for orchitis and CNS involvement. Benefit of use of large doses of steroids in orchitis is controversial. Antibiotics are not indicated except in cases of secondary bacterial infection. DR (MRS) M.B. FETUGA

PREVENTION Active immunization with an attenuated live vaccine. The vaccine is given along with those of Measles and Rubella (MMR) in the developed world. MMR is available in some centres in Nigeria but it has not been incorporated into the National Programme on Immunization. Improved personal & public hygiene may be helpful. DR (MRS) M.B. FETUGA