Mumps and Pertuses
Dr.shihab ahmed
Lecturer in TUCOM
OBJECTIVES
⚫
Clarify the epidemiology of mumps.
⚫
Identify the clinical features of mumps.
⚫
Outline the management of mumps.
⚫
List the complications of mumps.
⚫
Identify the stages of pertuses.
⚫
Clarify who to diagnose pertuses.
⚫
Outline the prevention of pertuses.
Mumps
⚫
Mumps is an important childhood disease that was
historically widespread but now occur very
infrequently. It is an acute viral infection
characterized by painful enlargement of salivary
glands, chiefly the parotids, as the usual presenting
sign.
⚫
Mumps caused by RNA virus paramyxovirus in the
family paramyxoviridae, which also includes the Para
influenza viruses. Only one serotype is known.
Epidemiology
⚫
Mumps is endemic in most unvaccinated
populations; the virus is spread from human
reservoir by direct contact, airborne droplets, fomites
contaminated by saliva, and possibly by urine.
⚫
It is distributed worldwide and affects both sexes
equally.
⚫
Before the introduction of vaccine, the peak
incidence of the disease occurred in children 5-9
years of age; now must cases occur in young adults.
Cilnical manifestations
⚫
The incubation period range from 14-24 days, with a peak at 17-18
days. Approximately 30-40% of cases are sub clinical. In children,
prodromal manifestations are rare but may be manifested by fever,
muscular pain ( especially in the neck ) , headache and malaise.
⚫
Salivary glands; pain and swelling in one or more parotid glands.
Edema of the skin and soft tissues usually extends further and obscure
the limit of the glandular swelling, so that the swelling is more readily
appreciated by sight more than by palpation, the swelling is proceed
gradually and reach the peak within 1-3 days pushing the earlobe
upward and outward and the angle of the mandible is on longer be
visible, the swelling slowly subside within 3-7 days but occasionally
stay longer. One parotid gland usually swell a day ore two before the
other, but in approximately quarter of cases the disease remains
unilateral. The swollen area is tender and painful especially when
tasting sour liquids such us lemon juice. Redness and swelling around
opening of stensen duct is common. Edema of the homolateral
pharnyx and displace the tonsil medially.
⚫
In 10-15% of patients only the sub mandibular glands may be swollen,
redness and swelling of Wharton duct common in such a case.
Diagnosis and differential diagnosis
⚫
Diagnosis is usually by clinical symptoms and physical
examination.
⚫
Routine laboratory tests are nonspecific such as leucopenia
and relative lymphocytosis.
⚫
The microbiological diagnosis is by serology and viral culture.
⚫
Serology; seroconersion , four folds rise of IgG titer is
diagnostic.
⚫
DIFFERENTIAL DIAGNOSIS.
⚫
Other viral causes of parotitis include HIV, influenza and Para
influenza virus, CMV , coxsackieviruses.
⚫
Acute suppurative parotitis is bacterial infection caused by
staphylococcus aureus in which pus can be expressed from the
duct. A salivary calculus obstructing either parotid or sub
mandibular duct may also leads to dland swelling.
treatment
⚫
No specific anti viral therapy.
⚫
Treatment is entirely supportive.
⚫
Antipyretics, such as acetaminophen and ibuprofen
are indicated for fever.
⚫
Bed rest should be guided by patients needs.
⚫
Diet should be adjusted according to ability to chew.
⚫
Mumps arthritis may be treated by 2 weeks of non-
steroidal anti inflammatory agents or corticosteroids,
salicylates don
’t appear to be effective.
Complications of mumps
⚫
Meningoencephalomylitis, which is the most frequent
complication in childhood, it occurs either as a primary viral
infection to the neurons, or post infectious demylinating
encephalitis.
⚫
Orchitis and epididymitis.
⚫
Oophoritis.
⚫
Pancreatitis.
⚫
Myocarditis.
⚫
Arthritis.
⚫
Thyroditis.
⚫
Deafness.
⚫
Ocular complications; dacryoadenitis and optic neuritis.
pertussis
⚫
Pertussis is an acute respiratory tract infection
caused by Bordetella pertussis and pordetella para
pertussis, its preferable than whooping couph
because most infected individuals don
’t whoop.
⚫
Bordetella organisms are tiny gram negative
coccobacilli that grow aerobically on starch blood
agar, and producing pertussis toxin which is the most
virulent protein.
Clinical manifestations
⚫
Classically, pertussis is a 6 weeks disease, divided into catarrhal,
paroxysmal, and convalescent stages.
⚫
Catarrhal stage begins after an incubation period 3-12 days of non
specific symptoms of congestion and rhinorrhea accompanied by low
grade fever, sneezing, lacrimation and conjactival injection. As initial
symptoms wane, coughing marks the onset of the disease.
⚫
Paroxysmal stage; the cough at first is dry, intermittent and irritative
evolve to severe paroxysms that are the hallmark of pertussis.
⚫
Whoop (forceful inspiratory gasp) infrequently occur in infants less
than 3 months of age who are exhausted or lack of muscular strength
to create a sudden negative intra thoracic pressure.
⚫
Post tussive emesis is common in pertussis at all ages and is a
specific clue to the diagnosis.
⚫
Convalescent stage; as paroxysmal stage fade, the number, severity
and duration of episodes diminished.
Contd.
⚫
Paradoxically in infants, cough and whoops may become more
louder and classic in convalescent stage.
⚫
Immunized children have shortening of all stages of pertussis.
In infants younger than 3 months, the catarrhal phase is few
days or even not recognized at all when apnea, chocking, or
gasping coughing herald the onset of the disease;
convalescence include intermittent paroxysms of coughing
throughout the fist year of life including exacerbations with
subsequent respiratory illnesses; these are not due to
reinfection or reactivation of B. pertussis.
⚫
Finding on physical examination are non specific, signs of lower
respiratory tract disease are not expected. Conjunctival
hemorrhage and petechiae on the upper body are common.
Diagnosis
⚫
Pertussis should be suspected in any patient who predominant
complaint of cough especially if the following are absent: fever,
malaise or myalgia, exanthem or enanthem, sore throat,
hoarseness, whease or tachypnea and rales.
⚫
Cough more than 14 days with at least on associated symptom
of paroxysms, whoop, or post tussive emesis has sensitivity of
81%.
⚫
Apnea or cyanosis ( before appreciation of cough) is a clue in
infant less than 3 months.
⚫
Leukocytosis (15,000-20,000) due to absolute lymphocytosis is
characteristic in catarrhal stage.
⚫
Isolation of B.pertussis in culture remain the gold stander for
diagnosis.
Treatment
⚫
Goals of treatment are to limit the number of
paroxysms, maximize nutrition, rest, and recovery
without sequelae.
⚫
Erythromycin 40-50 mg/kg 4 times a day for 14 days.
Clarithromycin 15-20 mg/kg/day twice daily for 7
days. Azithromycin 10 mg/kg once daily for 5 days.
⚫
Isolation; patients are placed in respiratory isolation
for more than 5 days after initiation of erythromycin
therapy.
⚫
Children should be excluded from school until
erythromycin has been taken for 5 days .
Prevention
⚫
Universal immunization of children less than 7 years
of age with pertussis vaccine, beginning in infancy.
⚫
ACELLULAR VACCINE. Multiple diphtheria and
tetanus toxoids combined with acellular pertussis
vaccine (DTaP) vaccines currently are licensed in the
united state and are preferred over those containing
whole cell pertussis vaccine because of fewer
adverse reactions.