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Thursday, July 3, 2014

Mumps ::

Mumps (epidemic parotitis) is a systemic viral infection characterised by swelling of the parotid glands. Infection is endemic world-wide and peaks at 5–9 years of age. Vaccination has reduced the incidence in children but incompl
ete coverage has increased susceptibility amongst older non-immune adults. Infection is spread by respiratory droplets.

Clinical features :-

The median incubation period is 19 days, with a range of 15–24 days. Classical tender parotid enlargement, which is bilateral in 75%, follows a prodrome of pyrexia and headache. In non-vaccinated communities, mumps is the most common cause of sporadic viral meningitis, and meningitis complicates up to 10% of cases. The cerebrospinal fluid (CSF) reveals a lymphocytic pleocytosis, or less commonly neutrophils. Rare complications include encephalitis, transient hearing loss, labyrinthitis, electrocardiographic abnormalities, pancreatitis and arthritis.
Approximately 25% of post-pubertal males with mumps develop epididymo-orchitis but, although testicular atrophy occurs, sterility is unlikely. Oophoritis is much less common. Abortion may occur if infection takes place in the first trimester of pregnancy. Complications may occur in the absence of parotitis.

Diagnosis :-

The diagnosis is usually clinical. In atypical presentations without parotitis, serology for mumps-specific IgM or IgG seroconversion (four-fold rise in IgG convalescent titre) confirms the diagnosis. Virus can also be cultured from urine in the first week of infection or detected by PCR in urine, saliva or CSF.

Management and prevention :-

There is no specific treatment for mumps. Symptoms may be relieved by analgesia. Warm saltwater gargles, soft foods, and extra fluids may also help relieve symptoms. Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful. Mumps vaccine is one of the components of the combined MMR vaccine.