Mumps

Question 1

What is the aetiology of mumps

Answer 1

Acute infectious disease caused by a paramyxovirus
Transmitted via respiratory droplets, fomites or saliva
Most infectious from around 1-2 days before symptom onset, to about 9 days afterwards
Replicates in the upper airway respiratory mucosa
Incubation period 16-18 days

Question 2

What is the epidemiology of mumps

Answer 2

In 2017, over 90% of confirmed cases were in people aged 15 years or over.
Children <1 year rarely get mumps as they usually acquire passive immunity from placental transfer of maternal antibodies

Question 3

What are the symptoms of mumps

Answer 3

Asymptomatic mumps infection is common in children

Swollen parotid glands (sides of the face)
- One parotid gland is affected first, reaching maximal size after 2-3 days and the other gland closely follows it
- 1/4 have unilateral parotitis
- The ear lobe over the affected gland may be deflected upward and outward
- The angle of the mandible may be obscured
Tender glands
Earache
Difficulty with pronunciation of words and chewing
Non-specific symptoms: fever, headache, malaise, muscle ache, low appetite

Abdominal pain → consider pancreatic involvement

Question 4

What are the differentials for mumps

Answer 4

EBV
Parainfluenza
Adenovirus
Influenza type A
Coxsackivirus
Parvovirus B19
Acute suppurative parotitis from acute bacterial infection
parotid duct obstruction (salivary stones/cysts/tumours)
Sjogren’s syndrome

Question 5

What investigations should be done for mumps

Answer 5

Clinical diagnosis

Saliva/oral fluid swab: IgM mumps antibody present

Question 6

What is the management for mumps

Answer 6

1. Notify the local health protection unit (HPU)
2. Advice
   - Self-limiting, takes 1-2 weeks
   - No long-term consequences, Abx not required
   - Warm or cold packs to the parotid gland to ease discomfort
   - Isolate for 5 days after development of parotitis
3. Safety net: severe headache, vomiting, neck stiffness, altered consciousness, pain and swelling of testicles

+ follow up 1 week after parotitis onset

Question 7

What is the management for exposure to a close contact with mumps

Answer 7

Not fully immunised → offer MMR vaccine
Pregnant women → seek medical advice (MMR contraindicated)
Immunocompromised → do not routinely give the MMR

Question 8

What are the complications for mumps

Answer 8

Submandibular and sublingual salivary gland enlargement → obstruction of lymphatic drainage → pre-sternal oedema
Epididymo-orchitis → subfertility
Encephalitis (seizures, decreased level of consciousness, and focal neurological symptoms)
Oophoritis (7% of childbearing women)
Aseptic meningitis
Transient hearing loss, deafness (1 in 20,000)
Myocardial complications
Pancreatitis
Spontaneous abortion

Question 9

What is the prognosis for mumps

Answer 9

Usually a self-limiting illness that resolves 1-2 weeks
Most people recover without any long-term complications
Nearly all people develop life-long immunity to mumps after one episode of infection
However 1-2% of cases are through to be re-infections