History

Fact Explanation
Fever and malaise. These symptoms occur in the prodromal stage due to the plasma viremia resulting in a humoral immune response [1].
Pain and swelling in the angle of the mandible (parotid area). Symptoms are commonly bilateral. Due to direct mumps viral infection of ductal epithelium of the parotid gland and local inflammation [2].
Acute onset hearing loss. Sensorineural type deafness which is thought to occur due to endolymphatic labyrinthitis [3].
Anterior neck lump. Due to associated subacute thyroiditis [4].
Acute onst epigastric pain with chills, nausea and vomiting. Due to associated pancreatitis [2].
Headache, photophobia and vomiting. Mumps virus can cause aseptic meningitis [5].
Lower abdominal pain with testicular swelling in males and pelvic pain in females. Due to associated orchitis and oophritis, respectively [6].
References
  1. HVIID Anders, Steven RUBIN and Kathrin MUHLEMANN. Mumps. The Lancet[online] 2008, vol 371(9616): 932-944. [viewed 25 April 2014] Available from: DOI: 10.1016/S0140-6736(08)60419-5
  2. GUPTA Ravindra K., Jennifer BEST and Eithne MACMAHON. Mumps and the UK epidemic 2005. BMJ: British Medical Journal[online] 2005, vol 330(7500): 1132.[viewed 25 April 2014] Available from: DOI: 10.1136/bmj.330.7500.1132
  3. HALL R. and H. RICHARDS. Hearing loss due to mumps. Archives of disease in childhood[online] 1987, vol 62(2): 189-191. [viewed 25 April 2014] Available from: DOI: 10.1136/adc.62.2.189
  4. DESAILLOUD Rachel, and Didier HOBER. Viruses and thyroiditis: an update. Virol J[online] 2009, vol 6(5). [viewed 25 April 2014] Available from: DOI: 10.1186/1743-422X-6-5
  5. JOHNSTONE J. A., Constance A.C. ROSS and Margaret DUNN. Meningitis and Encephalitis Associated with Mumps Infection A 10-Year Survey. Archives of disease in childhood[online] 1972, vol 47(254): 647-651. [viewed 25 April 2014] Available from: DOI: 10.1136/adc.47.254.647
  6. SHANLEY John D. The resurgence of mumps in young adults and adolescents. Cleveland Clinic journal of medicine[online] 2007, vol 74(1): 42-44. [viewed 27 April 2014] Available from: DOI: 10.3949/ccjm.74.1.42

Examination

Fact Explanation
Enlarged, palpable parotid gland, the skin over which is tender and warm to touch. (Signs are commonly bilateral) Due to direct mumps viral infection of ductal epithelium of the parotid gland and local inflammation [1].
Erythema at the orifice of the parotid duct. Due to inflmmation of the duct [1].
Palpable lumps under the anterior angle of the mandible and in the floor of the mouth. Due to rare involvement of the submandibular and sublingual glands respectively, in mumps [2].
Pyrexia. Due to the plasma viremia resulting in a humoral immune response [2].
Erythematous scrotum with testicular tenderness in the male and pelvic tenderness in the female. Due to orchitis and oophoritis, respectively [3].
Tender lump in the anterior aspect of the neck which moves with deglutition associated with tremor and weight loss despite increased appetite and other features of thyrotoxicosis. Due to associated subacute thyroiditis [4].
Neck stiffness and positive Kernig's sign (Extending the knee with the hips fully flexed while the patient is supine causes pain in the hamstrings). Due to meningeal irritation as a result of meningitis [5].
References
  1. GUPTA Ravindra K., Jennifer BEST and Eithne MACMAHON. Mumps and the UK epidemic 2005. BMJ: British Medical Journal[online] 2005, vol 330(7500): 1132.[viewed 25 April 2014] Available from: DOI: 10.1136/bmj.330.7500.1132
  2. HVIID Anders, Steven RUBIN and Kathrin MUHLEMANN. Mumps. The Lancet[online] 2008, vol 371(9616): 932-944. [viewed 25 April 2014] Available from: DOI: 10.1016/S0140-6736(08)60419-5
  3. SHANLEY John D. The resurgence of mumps in young adults and adolescents. Cleveland Clinic journal of medicine[online] 2007, vol 74(1): 42-44. [viewed 27 April 2014] Available from: DOI: 10.3949/ccjm.74.1.42
  4. DESAILLOUD Rachel, and Didier HOBER. Viruses and thyroiditis: an update. Virol J[online] 2009, vol 6(5). [viewed 25 April 2014] Available from: DOI: 10.1186/1743-422X-6-5
  5. JOHNSTONE J. A., Constance A.C. ROSS and Margaret DUNN. Meningitis and Encephalitis Associated with Mumps Infection A 10-Year Survey. Archives of disease in childhood[online] 1972, vol 47(254): 647-651. [viewed 25 April 2014] Available from: DOI: 10.1136/adc.47.254.647

Differential Diagnoses

Fact Explanation
Calculus in the parotid duct. It causes repetitive parotid swelling mainly during meals [1].
Parotid hemangioma. It presents as a rapidly growing mass most commonly beginning in the first few weeks of life [2].
Suppurative bacterial parotitis. Purulent discharge from the parotid duct is pathognomonic [3].
Testicular torsion in males. Presents with acute scrotal pain and testicular ascent [4].
Ovarian torsion in females. The lower abdominal pain would radiate to the flank or groin. A history of previous episodes may be given [5].
Scrotal hematoma. There will be a history of trauma to the scrotum [6].
References
  1. RAIF J., M. VARDI, O. NAHLIELI and I. GANNOT. An Er:YAG laser endoscopic fiber delivery system for lithotripsy of salivary stones. Lasers Surg. Med.[online] 2006, 38: 580–587. [viewed 25 April 2014] available from: DOI: 10.1002/lsm.20344
  2. WEISS I. O. T. M., et al. Current treatment of parotid hemangiomas. The Laryngoscope[online] 2011, 121: 1642–1650. [viewed 25 April 2014] available from: DOI: 10.1002/lary.21358
  3. ÖZDEMIR Halil, et al. Acute neonatal suppurative parotitis: a case report and review of the literature. International Journal of Infectious Diseases[online] 2011, vol 15(7) : e500-e502. [viewed 25 April 2014] available from: DOI: 10.1016/j.ijid.2011.04.002
  4. FAVORITO Luciano A., André G. CAVALCANTE and Waldiar S. COSTA. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. International braz j urol[online] 2004, vol 30(5): 420-424. [viewed 27 April 2014] available from: DOI: 10.1590/S1677-55382004000500014
  5. HOURY Debra and Jean T. ABBOTT. Ovarian torsion: a fifteen-year review. Annals of emergency medicine[online] 2001, vol 38(2): 156-159. [viewed 27 April 2014] available from: DOI: 10.1067/mem.2001.114303
  6. MOSCHOURIS H., et al. Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?. International braz j urol[online] 2009, vol 35(6): 692-705. [viewed 27 April 2014] available from: DOI: 10.1590/S1677-55382009000600008

Investigations - for Diagnosis

Fact Explanation
It is commonly diagnosed when a child presents with acute onset of unilateral or bilateral swelling of the parotid or other salivary glands, lasting 2 or more days without any other apparent cause. Mumps is mainly a clinical diagnosis and laboratory studies are used only to confirm unusual presentations or clinical suspicions [1].
Elevated serum amylase. Amylase is an enzyme secreted both by the parotid gland and the exocrine pancreas. In most cases of parotitis and and pancreatitis serum amylase will be elevated [2].
Reverse transcription polymerase chain reaction RT-PCR. Mumps is an RNA virus and RT-PCR has the ability to detect mumps virus RNA with high specificity, sensitivity and accuracy [3].
Positive mumps IgM titre in serum. Mumps specific IgM is detectable in serum just about 11 days after exposure [4].
Computed tomography of the abdomen. To diagnose pancreatitis which could occur in mumps [4].
Lumbar puncture. To detect the mumps virus through either RT-PCR or mumps specific IgM in cerebrospinal fluid [2].
Color doppler ultrasound scan of the scrotum. It helps differentiate inflammatory lesions from other acute scrotal diseases [5].
References
  1. SHANLEY John D. The resurgence of mumps in young adults and adolescents. Cleveland Clinic journal of medicine[online] 2007, vol 74(1): 42-44. [viewed 27 April 2014] Available from: DOI: 10.3949/ccjm.74.1.42
  2. HVIID Anders, Steven RUBIN and Kathrin MUHLEMANN. Mumps. The Lancet[online] 2008, vol 371(9616): 932-944. [viewed 25 April 2014] Available from: DOI: 10.1016/S0140-6736(08)60419-5
  3. BODDICKER Jennifer D., et al. Real-time reverse transcription-PCR assay for detection of mumps virus RNA in clinical specimens. Journal of clinical microbiology[online] 2007, 45(9): 2902-2908. [viewed 26 April 2014] Available from: DOI: 10.1128/JCM.00614-07
  4. GUPTA Ravindra K., Jennifer BEST and Eithne MACMAHON. Mumps and the UK epidemic 2005. BMJ: British Medical Journal[online] 2005, vol 330(7500): 1132.[viewed 25 April 2014] Available from: DOI: 10.1136/bmj.330.7500.1132
  5. BASEKIM C. Ç., et al. Mumps epididymo-orchitis: sonography and color Doppler sonographic findings. Abdominal imaging[online] 2000, vol 25(3): 322-325. [viewed 27 April 2014] Available from: DOI: 10.1007/s002610000039

Investigations - Screening/Staging

Fact Explanation
Auditory testing. Sensorineural deafness can occur due to endolymphatic labyrinthitis [1].
References
  1. HALL R. and H. RICHARDS. Hearing loss due to mumps. Archives of disease in childhood[online] 1987, vol 62(2): 189-191. [viewed 25 April 2014] Available from: DOI: 10.1136/adc.62.2.189

Management - General Measures

Fact Explanation
Patient isolation for 5 days from the onset of symptoms. It is a highly contagious infection and transmission of the virus is by direct contact, droplet spread, or contaminated fomites [1].
Ibuprofen. (10 mg/kg/dose 8 hourly, taken with food). It is an analgesic, antipyretic and anti inflammatory drug and acts by inhibition of prostaglandin synthesis [2].
Adequate hydration and good oral supplimentation for uncomplicated mumps. Mumps eventually resolves on its own, and since no virus-specific treatment exists, care is supportive to ensure fitness of the body and immune system [3].
References
  1. HVIID Anders, Steven RUBIN and Kathrin MUHLEMANN. Mumps. The Lancet[online] 2008, vol 371(9616): 932-944. [viewed 25 April 2014] Available from: DOI: 10.1016/S0140-6736(08)60419-5
  2. NEUPERT W., et al. Effects of ibuprofen enantiomers and its coenzyme A thioesters on human prostaglandin endoperoxide synthases. British Journal of Pharmacology[online] 1997, 122: 487–492. [viewed 26 April 2014] Available from: DOI: 10.1038/sj.bjp.0701415
  3. SHANLEY John D. The resurgence of mumps in young adults and adolescents. Cleveland Clinic journal of medicine[online] 2007, vol 74(1): 42-44. [viewed 27 April 2014] Available from: DOI: 10.3949/ccjm.74.1.42

Management - Specific Treatments

Fact Explanation
Inpatient care for intravenous fluid stabilization and close observation for patients with complications. When complications such as meningitis, pancreatits and myocarditis can occur [1].
MMR vaccine to susceptible contacts. To develop antibodies against the virus [2].
References
  1. GUPTA Ravindra K., Jennifer BEST and Eithne MACMAHON. Mumps and the UK epidemic 2005. BMJ: British Medical Journal[online] 2005, vol 330(7500): 1132.[viewed 25 April 2014] Available from: DOI: 10.1136/bmj.330.7500.1132
  2. AMANNA Ian J., Nichole E. CARLSON and Mark K. SLIFKA. Duration of humoral immunity to common viral and vaccine antigens. New England Journal of Medicine[online] 2007, vol 357(19): 1903-1915. [viewed 26 April 2014] available from: DOI: 10.1056/NEJMoa066092