MUMPS

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MUMPS

• XIE QIFENG
• Dept. of Infectious Disease

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Introduction

• Mumps is an acute respiratory tract
  infectious disease caused by mumps virus,
• it 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.

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Introduction

• Meningitis, meningoencephalitis,
  epididymo-orchitis, oophoritis and pancreatitis
  are the common extrasalivary gland
  manefestations of mumps.

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Etiology

• Mumps virus (Paramyxovirus parotitis) belongs to
  Paramyxoviridae family. RNA virus.
• 6 major proteins. nucleocapsid associated
• (S antigen) for diagnosis. Hemagglutinin-neuram
  inidase(V antigen) for protection.

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Etiology

• Sensitive to ether,ultraviolet and high
  temperature
• Humans are the only natural host

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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,fomites

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• 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.

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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.

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Clinical Manifestations

• Incubation period averages 16 to 18 days
  with a range of 2 to 4 weeks.
• Prodromal symptoms include low- grade fever,
  anorexia,malaise and headache.
• Parotid tenderness and ipsilateral earache within
  1 or 2 days after the illness onset,then
• parotid is visibly enlarged and go to maximum

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• size over next 2 to 3 days accompanied severe
• pain and normal or high temperature. One
  parotid enlarges after the other. The orifice of
  Stensens duct is edematous and erythematous.
  Parotid returns to normal size within a week.
• Patients with parotitis have difficulty
  with
• pronunciation and mastication. Citrus fruits
  and juices exacerbates the pain.
• Other salivary glands involved include
  submandibular adenitis and sublingual adenitis.

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• 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.

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• Oophoritis develops in 5 postpubertal women with
  mumps. Impaired fertility is
• rare.
• Pancreatitis is manifested by severe epigastric
  pain and tenderness,fever,nausea,and vomiting.

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Diagnosis

• In most instances, the diagnosis of mumps is made
  on the basis of a exposure history and of parotid
  swelling and tenderness accompanied
• other symptoms.
• Laboratory confirmation is unnecessary in typical
  cases, exception the absence or recurrence of
  parotitis and extrasalivary glands
• involved. Serologic tests,viral isolation.
  Amylase and lipase.

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Differential Diagnosis

• Suppurative parotitis
• Other viral parotitis caused by parainfluenza
  
• virus, coxsackievirus and influenza A virus.
• ---serologic tests or viral culture
• Parotid enlargement caused by other reasons

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Prognosis

• Benign and self-limited
• Major death causes are severe mumps
• encephalitis

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Treatment

• Supportive and symptomatic treatment
• Anti-viral therapy ribavirin and interferon
• Dexamethason for meningoencephalitis
• Diethylstilbestrol for orchitis

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Prenvention

• Patients should be isolated.
• Attenuated mumps virus vaccine has been
  available. More than 90 vaccine recipients
  produced protective antibody.
• Aseptic meningitis associated with
  vaccine virus occurred in 0.025 recipients.
• Mumps vaccine should not be administered
  to pregnant women or persons with
  immunodeficiencies.

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• Thanks!