MUMPS
Definition: -Is an infection with a myxovirus of single immunotype that affect only humans . The incubation period is usually 16 – 18 days .Transmission by droplet infection ,6 days before to 9 days after parotid enlargement.It gives a life long immunity .
Pathology:
The virus affect the cells of the respiratory endothelium to be transmitted to lymphatics followed by viraemia spreading infection to different organs with predilection to salivary gland ,mostly the parotid .
Clinical features :-One third of the persons remain asymptomatic , others will start with fever , muscle pain , headache, malaise , earache and pain in the parotid gland ,uni. Or bilateral with swelling , tenderness and redness that last for 3- 7 days. Inside the mouth Stensons duct appear oedematous and congested with clear secretions . The enlarged gland is below the pinna of the ear . The imagenary line bisecting the pinna if extended downwards will bisect the parotid swelling in two equal halves. There may be involvement of the submandibular or sublingual salivary glands in association or separately .There may be oedema over the manuberium sterni region as a result of lymphatic obstruction .
Complications:-
1- aseptic meningitis or encephalitis , rarely transverse myelitis or facial palsy .
2- Orchitis occur in 30 % of adults and adolescents a week after parotid swelling , involving one or two testicles with pain and tenderness ,may lead to testicular atrophy but sterility is rare . Oopharitis with abdominal pain and tenderness that mimic appendicitis may occasionally happen in adolescent females .
3 – Pancreatitis – epigastric pain , tenderness and vomiting .
4- Rarely – nephritis ,thyroiditis, deafness , arthritis and myocarditis are often mild and self-limited.
Diagnosis: -
On clinical ground including exposure and vaccination history. Blood show leucopenia, raised serum amylase ,antibody rise in 4 weeks time by immunofleurescent or other teckniques. Virsl isolation may be done in blood saliva or urine.Differential Diagnosis :-
1 – Parotid swelling from other viruses like entero.,CMV ,influenza and others .
2- Suppurative parotitis – usually due to staph. Aurius ,especially seen in debilitated persons ,often with high temperature and more pain and tenderness with discharging pus from parotid duct containing staph. Aurius,blood shows neutrophil leucocytosis.
3- Recurrent parotitis – likely to be allergic condition with clear discharge containing eosinophils.
4- Cervical adenitis.
5- Calculus obstructing parotid duct.
6 – lymphoma or con. Tiss. Diseases like SLE .
Treatment:-
analgesics for pain .Prognossis is excellent.
Prevention:
MMR 2 doses pone at 12 – 15 monthes and second at 4 – 6 years. Side effects,p arotid swelling, aseptic meningitis.
IDEAL GROUP
A.H.Yahia