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==Overview==
==Overview==
Mumps is a highly contagious viral disease that leads to [[Salivary gland enlargement|painful swelling of the salivary glands]] and is caused by the mumps virus. Mumps is spread through direct contact with an infected person. Symptoms include [[fever]], [[Salivary gland enlargement|glandular swelling]], [[headache]], [[sore throat]], and [[orchitis]]. Mumps is a self-limiting disease, and the prognosis is generally good, even if other organs are involved.
Mumps virus (MuV) is an enveloped, non-segmented, [[Negative-sense ssRNA virus|negative-sense RNA virus]] belonging to the [[Paramyxovirus]] family that causes mumps. Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the [[upper respiratory tract]] [[epithelium]] and disseminates through the [[lymphatic system]] to cause systemic infection. Replication in the [[parotid gland]] (or other salivary gland) causes [[mononuclear cell]] infiltration, [[hemorrhage]], [[edema]], and [[necrosis]]. The average incubation period for MuV is 16-18 days. Nonspecific [[prodromal symptoms]] develop and last 3-4 days. Several days after onset of [[prodrome]], one or both of the [[Parotid gland|parotid]] salivary glands begin to swell ([[parotitis]]). One [[Parotid gland|parotid]] may swell before the other, and in 25% of patients, only one side swells. Complications include: [[orchitis]] in post-pubertal males, [[Oophoritis]] and/or [[mastitis]] in post-pubertal females, transient [[sensorineural hearing loss]], [[Meningitis]], [[Encephalitis]], [[Pancreatitis]], and [[Spontaneous abortion]] during the first trimester of [[pregnancy]]. Mumps is [[self-limiting]] and prognosis is excellent for uncomplicated mumps. The characteristic presentation of mumps is tender, swollen [[Parotid gland|parotid glands]]. Inflammation of [[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual salivary glands]] is palpable in 10% of patients. [[Sialoadenitis|Sialoadenitits]] is usually preceded by a low-grade [[fever]]. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. Mumps must be differentiated from other diseases or [[Pathogen|pathogens]] that cause [[upper respiratory infection]], [[prodromal symptoms]], swelling of salivary glands ([[sialadenitis]]), particularly [[parotitis]]. Etiologic agents that cause similar symptoms include: [[parainfluenza virus]], [[adenovirus]], [[Epstein-Barr virus]], [[coxsackievirus]], [[influenza A]], [[parvovirus B19]], [[human herpesvirus 6]]. Non-infectious causes include: salivary [[calculi]], [[tumor]], [[sarcoid]], [[Sjögren’s syndrome]], [[thiazide]] drug reaction, [[iodine]] sensitivity. Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for [[IgM|IgM antibody]] or detecting a significant rise in [[IgG|IgG antibody]] confirms a mumps diagnosis.  Antigen detection by [[PCR|polymerase chain reaction (PCR)]] is an efficient and rapid method to determine mumps as a diagnosis. umps can be prevented with the [[MMR vaccine]]. The United States is replacing MMR with the [[MMRV vaccine]], which also protects against [[chickenpox]]. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. Since the initiation of the MMR vaccination program in the United States in 1967, the incidence of mumps has declined by 99%.


==Historical Perspective==
==Historical Perspective==
Mumps may have first been described by Hippocrates as a disease causing [[parotitis]] and [[orchitis]] in the 5th century. Prior to the [[vaccination]] program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in mumps cases. [[Outbreaks]] in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.
Mumps may have first been described by Hippocrates as a disease causing [[parotitis]] and [[orchitis]] in the 5th century. Prior to the [[vaccination]] program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in incidence rates. [[Outbreaks]] in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.


==Pathophysiology==
==Pathophysiology==
Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs or sneezes. Most mumps transmission occurs before the [[Salivary gland enlargement|enlargement of the salivary glands]] and within the 5 days after the swelling begins. Therefore, [http://www.cdc.gov/mumps/about/index.html CDC] recommends isolating mumps patients for 5 days after their glands begin to swell.
Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the [[upper respiratory tract]] [[epithelium]] by binding to extracellular [[sialic acid]] via the hemagglutinin-neuraminidase (HN) [[glycoprotein]]. MuV is able to evade an immune response with small hydrophobic (SH) protein, which blocks [[Tumor necrosis factor-alpha|TNFα-mediated apoptosis]], and with the V proteins, which inhibit [[IFN]] production and signaling. MuV disseminates through the [[lymphatic system]] to cause systemic infection. Replication in the [[parotid gland]] (or other salivary gland) causes [[mononuclear cell]] infiltration, [[hemorrhage]], [[edema]], and [[necrosis]].


==Causes==
==Causes==
Mumps is caused by a [[paramyxovirus]], and transmission of the virus occurs via respiratory secretions such as infected [[saliva]], [[droplet|air droplets]] or via direct contact with articles that have been contaminated with infected saliva. The [[incubation period]] is usually 18 to 21 days. Infected patients remain contagious from approximately 6 days before the onset of symptoms until about 9 days after the onset of symptoms.
Mumps virus (MuV) is an enveloped, non-segmented, [[Negative-sense ssRNA virus|negative-sense RNA virus]] that causes mumps. MuV belongs to the genus [[Rubulavirus]] and family [[Paramyxovirus]]. Humans are the only natural host of MuV. MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV is able to bind to host [[epithelial cells]] via haemagglutinin-neuraminidase (HN) and fusion (F) [[Glycoprotein|glycoproteins]]. Small hydrophobic (SH) protein is presumed to block [[Tumor necrosis factor-alpha|TNFα-mediated apoptosis]]. Non-structural proteins NS1 and NS2 (V proteins) inhibit [[IFN]] production and signaling.


==Differential Diagnosis==
==Differential Diagnosis==
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==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
The average incubation period for Rubulavirus is 16-18 days. Nonspecific [[prodromal symptoms]] develop and last 3-4 days. Several days after onset of [[prodrome]], one or both of the [[Parotid gland|parotid]] salivary glands begin to swell ([[parotitis]]). One [[Parotid gland|parotid]] may swell before the other, and in 25% of patients, only one side swells. Other salivary glands ([[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual]]) under the floor of the mouth also may swell but do so less frequently (10%). [[Parotitis]], lasts at least 2 days, but may persist longer than 10 days. Complications include: [[orchitis]] in post-pubertal males, [[Oophoritis]] and/or [[mastitis]] in post-pubertal females, transient [[sensorineural hearing loss]], [[Meningitis]], [[Encephalitis]], [[Pancreatitis]], and [[Spontaneous abortion]] during the first trimester of [[pregnancy]]. Mumps is [[self-limiting]] and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.
The average incubation period for mumps virus is 16-18 days. Nonspecific [[prodromal symptoms]] develop and last 3-4 days. Several days after onset of [[prodrome]], one or both of the [[Parotid gland|parotid]] salivary glands begin to swell ([[parotitis]]). One [[Parotid gland|parotid]] may swell before the other, and in 25% of patients, only one side swells. Other salivary glands ([[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual]]) under the floor of the mouth also may swell but do so less frequently (10%). [[Parotitis]], lasts at least 2 days, but may persist longer than 10 days. Complications include: [[orchitis]] in post-pubertal males, [[Oophoritis]] and/or [[mastitis]] in post-pubertal females, transient [[sensorineural hearing loss]], [[Meningitis]], [[Encephalitis]], [[Pancreatitis]], and [[Spontaneous abortion]] during the first trimester of [[pregnancy]]. Mumps is [[self-limiting]] and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.


==Diagnosis==
==Diagnosis==
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===History and Symptoms===
===History and Symptoms===
Approximately 20-30% cases infected with mumps may remain asymptomatic.<ref name="pmid16601665">{{cite journal |author= |title=Mumps epidemic--Iowa, 2006 |journal=[[MMWR. Morbidity and Mortality Weekly Report]] |volume=55 |issue=13 |pages=366–8 |year=2006 |month=April |pmid=16601665 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm |accessdate=2012-03-08}}</ref> Mumps typically starts with a few days of [[fever]], [[headache]], [[Myalgia|muscle aches]], [[fatigue|tiredness]], and [[loss of appetite]], and is followed by [[Salivary gland enlargement|swelling of salivary glands]] (classically the [[parotid gland]]).<ref name="Barron">{{cite book | author = Enders G | title = Paramyxoviruses&ndash;Mumps virus. ''In:'' Barron's Medical Microbiology (Barron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.3150 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref> Painful [[testicle|testicular swelling]] and [[rash]] may also occur.
The most common symptoms of mumps are a [[prodrome]] with low grade [[fever]], [[myalgia]], [[anorexia]], [[malaise]], and [[headache]], followed by painful, bilateral [[parotitis]]. Less common symptoms include [[orchitis]] in post-pubertal males, [[oophoritis]] or [[mastitis]] in post-pubertal females, [[encephalitis]], and transient [[sensorineural hearing loss]]. Approximately 15-20% of patients may be asymptomatic.


===Physical Examination===
===Physical Examination===
The characteristic presentation of mumps is tender, swollen [[Parotid gland|parotid glands]]. Inflammation of [[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual salivary glands]] is palpable in 10% of patients. [[Sialoadenitis|Sialoadenitits]] is usually preceded by a low-grade [[fever]]. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. 25% of patients present with unilateral swelling. [[Stensen's duct]] orifice may be inflamed and erythematous. [[Lymph node]] swelling can be differentiated by the well-defined borders of the lymph nodes, location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the jaw angle.


===Laboratory Findings===
===Laboratory Findings===
Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, antigen detection by PCR, and serologic testing for [[IgM|IgM antibody]] or a significant rise in [[IgG|IgG antibody]]. However, there are many important caveats to be aware of when interpreting the results.<ref>{{cite web | url = http://www.cdc.gov/mumps/lab/qa-lab-test-infect.html | title = Mumps: Lab Testing for Mumps Infection | work = Centers for Disease Control and Prevention | date = 13 April 2010 |  accessdate = 30 October 2011 }}</ref>
Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for [[IgM|IgM antibody]] or detecting a significant rise in [[IgG|IgG antibody]] confirms a mumps diagnosis. However, there are many important caveats to be aware of when interpreting the results. Antigen detection by [[PCR|polymerase chain reaction (PCR)]] is an efficient and rapid method to determine mumps as a diagnosis. It may be necessary to test for antibodies for other infections causing [[parotitis]] including: [[Epstein-Barr Virus]], [[parainfluenza virus]], [[parvovirus B19]], [[adenovirus]], and [[enterovirus]].


===CT===
===CT===
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==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
Currently, there is no specific treatment for mumps. In addition, the disease itself is generally self-limiting, and runs its course before waning. Supportive care with [[analgesics]] may provide symptomatic benefit.
No antiviral agent currently exists and therefore supportive care is indicated for patients with mumps. Supportive care includes prescribing [[analgesics]], application of warm or cold packs to swollen areas, warm salt water gargles, and fluid intake. Patients should avoid acidic foods or juices. Patients should be isolated for at least 5 days after onset of symptoms.


===Primary Prevention===
===Primary Prevention===
 
Mumps can be prevented with the [[MMR vaccine]]. The United States is replacing MMR with the [[MMRV vaccine]], which also protects against [[chickenpox]]. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. In general all age groups should receive 2 doses of MMR or MMRV vaccine unless an individual has evidence of immunity. The [[vaccine]] is contraindicated in pregnant women, individuals with egg or [[neomycin]] [[Allergy|allergies]] and immune-compromised or severely immune-suppressed individuals.
===Secondary Prevention===


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Dermatology]]
[[Category:Dermatology]]

Latest revision as of 18:07, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Nate Michalak, B.A.

Overview

Mumps virus (MuV) is an enveloped, non-segmented, negative-sense RNA virus belonging to the Paramyxovirus family that causes mumps. Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the upper respiratory tract epithelium and disseminates through the lymphatic system to cause systemic infection. Replication in the parotid gland (or other salivary gland) causes mononuclear cell infiltration, hemorrhage, edema, and necrosis. The average incubation period for MuV is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. The characteristic presentation of mumps is tender, swollen parotid glands. Inflammation of submandibular and sublingual salivary glands is palpable in 10% of patients. Sialoadenitits is usually preceded by a low-grade fever. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity. Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for IgM antibody or detecting a significant rise in IgG antibody confirms a mumps diagnosis. Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagnosis. umps can be prevented with the MMR vaccine. The United States is replacing MMR with the MMRV vaccine, which also protects against chickenpox. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. Since the initiation of the MMR vaccination program in the United States in 1967, the incidence of mumps has declined by 99%.

Historical Perspective

Mumps may have first been described by Hippocrates as a disease causing parotitis and orchitis in the 5th century. Prior to the vaccination program, which started in the United States in 1967, approximately 186,000 cases occurred each year. Implementation of the vaccination program resulted in an approximate 99% decrease in incidence rates. Outbreaks in 2006 and 2009 in the United States resulted in 6,584 and over 3,000 affected people, respectively.

Pathophysiology

Humans are the only natural host for mumps virus (MuV). MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV infects the upper respiratory tract epithelium by binding to extracellular sialic acid via the hemagglutinin-neuraminidase (HN) glycoprotein. MuV is able to evade an immune response with small hydrophobic (SH) protein, which blocks TNFα-mediated apoptosis, and with the V proteins, which inhibit IFN production and signaling. MuV disseminates through the lymphatic system to cause systemic infection. Replication in the parotid gland (or other salivary gland) causes mononuclear cell infiltration, hemorrhage, edema, and necrosis.

Causes

Mumps virus (MuV) is an enveloped, non-segmented, negative-sense RNA virus that causes mumps. MuV belongs to the genus Rubulavirus and family Paramyxovirus. Humans are the only natural host of MuV. MuV is transmitted through respiratory droplets (saliva or mucus), direct contact, or contact with surfaces carrying MuV. MuV is able to bind to host epithelial cells via haemagglutinin-neuraminidase (HN) and fusion (F) glycoproteins. Small hydrophobic (SH) protein is presumed to block TNFα-mediated apoptosis. Non-structural proteins NS1 and NS2 (V proteins) inhibit IFN production and signaling.

Differential Diagnosis

Mumps must be differentiated from other diseases or pathogens that cause upper respiratory infection, prodromal symptoms, swelling of salivary glands (sialadenitis), particularly parotitis. Etiologic agents that cause similar symptoms include: parainfluenza virus, adenovirus, Epstein-Barr virus, coxsackievirus, influenza A, parvovirus B19, human herpesvirus 6. Non-infectious causes include: salivary calculi, tumor, sarcoid, Sjögren’s syndrome, thiazide drug reaction, iodine sensitivity.

Epidemiology and Demographics

Since the initiation of the MMR vaccination program in the United States, the incidence of mumps has declined by 99%. Currently, the number of cases per year ranges from a couple hundred to a couple thousand. Mumps predominantly occurs in school-age children (5-14 years) but outbreaks have occurred in adolescents and adults. There is currently no significant difference in mumps incidence between sexes and races. Mumps is uncommon in the United States and other developed countries. However sporadic outbreaks have occurred, predominantly in environments that involve close contact or high level of social interaction. Only 57% of countries belonging to the World Health Organization use a mumps vaccine. Most of these countries are developing and mumps remains endemic in these regions.

Risk Factors

Risk factors for mumps include: unvaccinated individuals who do not have evidence of immunity, belonging to the age group 2-12 years, international travel, especially to countries without mumps vaccination programs, working or living in close proximity to individual(s) infected with Rubulavirus, and being in states of immunodeficiency.

Natural History, Complications and Prognosis

The average incubation period for mumps virus is 16-18 days. Nonspecific prodromal symptoms develop and last 3-4 days. Several days after onset of prodrome, one or both of the parotid salivary glands begin to swell (parotitis). One parotid may swell before the other, and in 25% of patients, only one side swells. Other salivary glands (submandibular and sublingual) under the floor of the mouth also may swell but do so less frequently (10%). Parotitis, lasts at least 2 days, but may persist longer than 10 days. Complications include: orchitis in post-pubertal males, Oophoritis and/or mastitis in post-pubertal females, transient sensorineural hearing loss, Meningitis, Encephalitis, Pancreatitis, and Spontaneous abortion during the first trimester of pregnancy. Mumps is self-limiting and prognosis is excellent for uncomplicated mumps. Adolescents and adults are more likely than children to develop complications but these are rare, and prognosis is still favorable.

Diagnosis

Diagnostic Criteria

Suspected mumps involves parotitis, orchitis, or oophoritis unexplained by another diagnosis OR a positive lab result with no mumps clinical symptoms. Probable mumps involves parotitis or other salivary gland swelling lasting at least 2 days, or orchitis or oophoritis unexplained by another more likely diagnosis, in a person with a positive test for serum anti-mumps immunoglobulin M (IgM) antibody OR person with epidemiologic linkage to another probable or confirmed case or linkage to a group/community defined by public health during an outbreak of mumps. Confirmed mumps involves positive mumps laboratory confirmation for mumps virus with reverse transcription polymerase chain reaction (RT-PCR) or culture in a patient any of the following symptoms: acute parotitis or other salivary gland swelling, lasting at least 2 days, aseptic meningitis, encephalitis, hearing loss, orchitis, oophoritis, mastitis, pancreatitis.

History and Symptoms

The most common symptoms of mumps are a prodrome with low grade fever, myalgia, anorexia, malaise, and headache, followed by painful, bilateral parotitis. Less common symptoms include orchitis in post-pubertal males, oophoritis or mastitis in post-pubertal females, encephalitis, and transient sensorineural hearing loss. Approximately 15-20% of patients may be asymptomatic.

Physical Examination

The characteristic presentation of mumps is tender, swollen parotid glands. Inflammation of submandibular and sublingual salivary glands is palpable in 10% of patients. Sialoadenitits is usually preceded by a low-grade fever. The jawbone is often not palpable and swelling pushes the angle of the ear out and up. 25% of patients present with unilateral swelling. Stensen's duct orifice may be inflamed and erythematous. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the jaw angle.

Laboratory Findings

Laboratory findings for the mumps virus can be useful, and may include virus isolation from swabs of affected salivary ducts, urine, or serum samples. Serologic testing for IgM antibody or detecting a significant rise in IgG antibody confirms a mumps diagnosis. However, there are many important caveats to be aware of when interpreting the results. Antigen detection by polymerase chain reaction (PCR) is an efficient and rapid method to determine mumps as a diagnosis. It may be necessary to test for antibodies for other infections causing parotitis including: Epstein-Barr Virus, parainfluenza virus, parvovirus B19, adenovirus, and enterovirus.

CT

Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as a CT scan, may be helpful in patients with secondary complications.

Ultrasound

Mumps is a clinical diagnosis. Imaging studies do not play a role in the initial diagnosis of mumps. However, imaging studies, such as an ultrasound, may be helpful in patients with secondary complications.

Other Diagnostic Studies

Mumps is a clinical diagnosis. Further testing may be required in patients with secondary complications.

Treatment

Medical Therapy

No antiviral agent currently exists and therefore supportive care is indicated for patients with mumps. Supportive care includes prescribing analgesics, application of warm or cold packs to swollen areas, warm salt water gargles, and fluid intake. Patients should avoid acidic foods or juices. Patients should be isolated for at least 5 days after onset of symptoms.

Primary Prevention

Mumps can be prevented with the MMR vaccine. The United States is replacing MMR with the MMRV vaccine, which also protects against chickenpox. A single dose is on average 78% effective at preventing mumps while 2 doses is on average 88% effective. In general all age groups should receive 2 doses of MMR or MMRV vaccine unless an individual has evidence of immunity. The vaccine is contraindicated in pregnant women, individuals with egg or neomycin allergies and immune-compromised or severely immune-suppressed individuals.

References


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