Summary
Mumps is a highly contagious viral infection that is transmitted via airborne droplets. The incidence is now very low in the US because of the combined measles, mumps, and rubella (MMR) vaccine. The condition primarily affects children between the ages of five and fourteen. Classically, it manifests with parotitis, which initially occurs unilaterally, but typically progresses to involve both sides. The lateral cheek and jaw area usually show marked swelling and the ears may protrude. Other symptoms include low-grade fever, malaise, headache, and possible swelling of other salivary glands. The diagnosis of mumps is largely based on clinical findings. Many cases, however, present with nonspecific features and are not easily recognizable as mumps. If possible, diagnosis should be confirmed with laboratory tests. Treatment is symptomatic. Rare complications include orchitis, aseptic meningitis, hearing loss, and pancreatitis. Mumps is a self-limiting disease, followed by lifelong immunity. The prognosis in uncomplicated cases is very good. The mumps vaccine is a combination vaccine that protects against measles, mumps, and rubella (MMR vaccine); the MMRV vaccine also protects against varicella. Immunization is recommended for all children, in addition to adults without evidence of immunity to measles, mumps, and/or rubella. Immunization offers the best protection against future exposure.
Epidemiology
- Incidence: drastically declined in the US since the introduction of the MMR vaccine [1][2]
- Peak age: 5–14 years of age
- Sex: ♂ = ♀ for parotitis; (however, males are three times more likely to have CNS complications) [3]
- Risk factors: See “Risk factors for measles, mumps, and/or rubella.”
Epidemiological data refers to the US, unless otherwise specified.
Etiology
- Pathogen: Mumps virus from the Paramyxoviridae family
- Transmission [4]
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Infectivity [4][5]
- Highly infectious
- Affected individuals are contagious ∼ 3 days before and up to 9 days after disease onset (when the parotid gland becomes swollen).
Asymptomatic cases are also contagious.
Pathophysiology
- Nasopharyngeal entry → replication of the virus in the mucous membranes and lymph nodes → viremia and secondary infection of the salivary glands (particularly the parotid gland) → further dissemination possible (lacrimal, thyroid, and mammary glands, pancreas, testes, ovaries, CNS)
Clinical features
- Incubation period: 16–18 days [6]
- Prodrome
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Classic course: inflammation of the salivary glands, particularly parotitis ; [5][7]
- Duration of parotitis: at least 2 days (may persist > 10 days)
- Symptoms
- May initially present with local tenderness, pain, and earache
- Unilateral swelling of the salivary gland (lateral cheek and jaw area); During the course of disease, both salivary glands are usually swollen.
- Redness in the area of the parotid duct
- Possible protruding ears
- A flat, red rash that begins on the face and disseminates to the rest of the body can occur.
- Chronic courses are rare.
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Subclinical presentation [6]
- Nonspecific or predominantly respiratory symptoms
- Asymptomatic (in 15–20% of cases) [4]
Diagnostics
Laboratory tests, if available, should be conducted to confirm the suspected cases (especially if presentation is atypical or there is a mumps outbreak). [4][6][7]
Differential diagnoses
| Differential diagnosis of parotid swelling [7] | |||||
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| Features | Mumps | Acute purulent sialadenitis | Sialadenosis (sialosis) | Sialolithiasis (salivary stones) | Tumors of the salivary glands |
| Parotid swelling |
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| Pain |
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| Fever |
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| Other findings |
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- Differential diagnosis of orchitis: epididymitis, testicular torsion
- Differential diagnosis of aseptic meningitis (See “Meningitis.”)
The differential diagnoses listed here are not exhaustive.
Treatment
Mumps is usually self-limited with a good prognosis (unless complications arise). Treatment is mainly supportive care.
- Medication for pain and fever (e.g., acetaminophen)
- Bedrest
- Adequate fluid intake
- Avoidance of acidic foods and drinks
- Ice packs to soothe parotitis
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Isolate the patient. [8]
- All patients: Isolate for 5 days from the development of parotid swelling.
- Hospitalized patients: Initiate droplet precautions.
Mumps is a nationally notifiable disease; report all cases to the appropriate health departments. [5]
Complications
Orchitis
- Definition: inflammation of the testis
- Epidemiology: most common complication of mumps in postpubertal male individuals (20–30% in unvaccinated postpubertal and 6–7% in vaccinated males) [6][9]
- Clinical features
- Complications: : may lead to atrophy and, in rare cases, hypofertility
Other complications [4]
- Aseptic meningitis: (1–10% of cases): predominantly mild course and usually no permanent sequelae
-
Encephalitis (< 1% of cases)
- Reduced consciousness, seizures
- Neurological deficits: cranial nerve palsy, hemiplegia, sensorineural hearing loss (rare)
- Acute pancreatitis (< 1% of cases)
- Hearing loss (extremely rare)
The MEN of the PANamanian ORCHestra know how to throw a good PARty: MENingitis, PANncreatitis, ORCHhitis, and PARotitis are the most important complications of mumps.
We list the most important complications. The selection is not exhaustive.
Prevention
Vaccination [10][11][12]
Administer a live attenuated mumps vaccine; (i.e., MMR vaccine, MMRV vaccine) according to the ACIP immunization schedule. See the following:
- Immunizations for measles, mumps, and rubella
- ACIP immunization schedule
- Contraindications to live vaccines (e.g., pregnancy, immunocompromise)
Exposure control [8][13]
- Confirmed case of mumps: Isolate for 5 days from the development of parotid swelling.
- Exposed contacts without evidence of immunity to mumps, measles, and/or rubella:
- Quarantine starting from the 10th day after first exposure through to the 25th day after the last exposure. [8][13]
- Administer a mumps vaccine.
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