Mumps is a contagious viral illness caused by the mumps virus (Rubula virus), affecting both children and adults.

  • Typically presents with a prodrome of headache, fever, fatigue, anorexia, malaise followed by parotitis.
  • Parotitis (unilatral or bilateral) is hallmark of disease.
  • Aassociated with feature of URTI.
  • It usually lasts about 3 to 7 days (average 5 days); most cases resolve within 10 days.

History and Examination

  • Unvaccinated or partially vaccinated children, close contact with an infected individual
  • Crowded living conditions, school going, recent travel to endemic areas

Symptoms

  • Parotitis, swollen and painful parotid glands, usually bilateral but unilateral swelling can occur
  • Fever (Low grade)
  • Headache
  • Muscle aches
  • Fatigue
  • Loss of appetite

Signs

  • Unilateral or bilateral parotid gland swelling
  • -Swelling and erythema of the stenson duct
  • Orchitis (in postpubertal males)
  • Oophoritis (in females)

Differential Diagnosis (D/D) & Complications

D/D

  • Bacterial parotitis (severe pain, purulent discharge, systemic signs of infection)
  • Adenitis
  • Allergic reactions
  • Drug reactions
  • Encephalitis
  • Mastoiditis
  • Measles
  • Viral infections (influenza, Epstein-Barr virus, cytomegalovirus)
  • Salivary gland obstruction or tumor

Complications

  • Orchitis (Painful swelling, enlargement, and tenderness of the testes, often bilateral) and oophoritis (most common); may develop testicular atrophy but no risk of sterility or subfertility
  • Mastitis
  • Aseptic meningitis
  • Pancreatitis
  • Hearing loss (rare)
  • Encephalitis (rare)

Investigation

Laboratory testing is not routinely necessary to confirm a mumps viral infection.

  • Mumps IgM serology and/or viral PCR from saliva or urine (Investigation of choice)
  • Complete blood count (CBC)
  • C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR)

Admission Criteria

  • Severe complications or inability to tolerate oral intake
  • Suspected encephalitis or meningitis
  • Suspicion of bacterial parotitis

Management

Medical

– Supportive care and symptomatic relief

– Oral or intravenous hydration

– Antipyretics and analgesics

Rx:

  1. Flexon( Ibuprofen +Paracetamol) 10 mg/kg/dose TID or Paracetamol 10-15 mg/kg/dose TID for fever or pain relief
  2. Add Amoxyclav if high grade fever or suspicion of bacterial parotidis
  3. Use Belladonna plaster

Advices

  • Encourage adequate hydration and rest
  • Avoid salty and hot food
  • Post-mumps fatigue can occur
  • Isolate the affected child until at least 5 days after the onset of parotitis
  • It can occurs in fully vaccinated person but severity and complication is less.
  • Reinfection can occur in weeks or months later
  • Educate the family on the importance of vaccination and prevention

Referral

  • If complications develop or there is no improvement after 7-10 days

Follow up

– Schedule a follow-up visit within 2-4 weeks after recovery

– Monitor for any complications or signs of post-mumps fatigue

Additional Points:

  • Belladona Plaster: Belladonna plaster is a topical treatment containing extracts from the Atropa belladonna plant. The primary active components are alkaloids atropine, hyoscyamine, and scopolamine, which possess anti-inflammatory, analgesic and muscle relaxant properties. Applied directly to the skin, the medication is absorbed locally, providing targeted relief.
  • Post mumps fatigue: After recovering from mumps, it is common to experience post-mumps fatigue. This fatigue can persist for several weeks or even months after the acute symptoms of mumps have resolved
  • Treat testicular swelling and tenderness with elevation and cold compression

References

1. Hviid A, Rubin S, Mühlemann K. Mumps. Lancet. 2008;371(9616):932-944.

2. Rubin SA, Plotkin SA. Mumps vaccine. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 6th ed. Philadelphia, PA: Saunders Elsevier; 2013:419-446.

3. Centers for Disease Control and Prevention. Mumps. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington D.C.: Public Health Foundation; 2015:225-240.