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Mumps – what you need to know about the disease.
A case of epidemic parotitis was registered in Ivano-Frankivsk. The child was not vaccinated due to the parents’ refusal.
Epidemic parotitis parotitis epidemica; folk – mumps, mumps – an acute highly contagious infectious disease characterized by fever, general intoxication, damage to the salivary glands, parotid glands, sometimes the pancreas, thyroid or parathyroid gland, and sometimes other glands (gonadal, mammary, pancreatic), central nervous systems
Today, mumps remains one of the most widespread and contagious infections in the world. Special attention is paid to this disease due to the large number of established serious complications: male infertility, eunuchoidism, type 2 diabetes, chronic pancreatitis, damage to the central nervous system.
The disease is caused by a virus from the family of paramyxoviruses, which multiplies in the upper respiratory tract, enters the blood and affects the entire body. The disease occurs most often in children, aged 3 to 15 years, after which immunity to the disease remains for life. But adults also get sick
The virus is not resistant to environmental factors: heating and drying, irradiation and exposure to chemicals (chlorine, formalin, Lysol, etc.), but it is quite resistant to low temperatures.
The only source of infection is patients with various forms (typical and erased, subclinical) diseases. The patient begins to release the virus into the environment 3 days before the onset of acute manifestations of the disease and within 9 days after the onset of the disease
The mechanism of transmission of infection is airborne. Saliva, droplets of nasopharyngeal mucus containing the virus can be transmitted through the air to another person when sneezing, coughing, talking, or by direct contact through hands contaminated with secretions, unwashed dishes, or other contaminated objects.
Epidemic parotitis affects men 2 times more often with the occurrence of obvious (symptomatic) manifestations than girls and women. The infectious process is seasonal, the disease is observed most in the spring, especially in April and May.
Salivary gland lesions are the most common. From the entrance gates, which are the mucous membranes of the oral cavity, nose, and pharynx, the virus enters the blood and spreads throughout the body: to the salivary, genital, and pancreatic glands, the central nervous system, and other organs. In cases of parotid serous meningitis, morphological changes are nonspecific (hyperemia, cerebral edema, perivascular infiltration of meninges). Similar changes are observed in other glandular organs (testicles, pancreas, occasionally mammary glands, ovaries).
The main manifestations of epidemic parotitis develop in 3-4 days of illness and are accompanied by febrile fever, intoxication manifestations, dry mouth.
Initially, swelling of the parotid salivary gland occurs on one side or the other, and after 1-2 days, the other parotid gland may be involved in the process. In addition to the parotid salivary glands, the submandibular and sublingual salivary glands may be less often involved in the process. Frequent damage to the parotid glands, rather than other salivary glands, is associated with a low antiviral activity of the saliva of the parotid glands, greater – of the submandibular glands, and the strongest antiviral activity of the saliva of the sublingual gland.
The parotid salivary gland is enlarged, protrudes from the upper branch of the lower jaw in the form of a swelling that fills the space between the mastoid process and the branch of the lower jaw (retromaxillary). Swelling can spread to the cheek, to the nipple, and to the neck. The skin over the salivary gland has no signs of inflammation, but it looks stretched, the salivary gland is elastic, relatively painful. Patients complain of pain when chewing, especially hard food.
When the parotid salivary glands are affected, characteristic changes can be seen in the oral cavity in the form of swelling, hyperemia of the mucous membrane around the opening of the salivary parotid (stenon) duct (Moors’ symptom), discharge of thick mucus from it. The affected submandibular salivary glands are more painful on palpation, but they are also elastic to the touch. Damage to the sublingual gland is manifested by pain at the root of the tongue. From the 5th day, the reverse development of symptoms is observed.
A longer period of fever and intoxication is noted in cases where the infection spreads to other glands. Each spread of the virus to other glands is accompanied by a new rise in fever, often with moderate chills. The criteria for the severity of the course of epidemic parotitis are determined by how significant the general and local signs of the disease are: fever, intoxication, the presence or absence of complications. Uncomplicated epidemic parotitis is usually mild, less often it is of moderate severity, and severe forms always have complications (often multiple):
- Orchitis, orchoepididymitis (joining inflammation of the epididymis occurs in 1 in 4 men with epidemic parotitis) is more often observed in adolescents and adults. Signs of orchitis often appear a few days after the onset of the disease and are characterized by a new wave of fever (up to 39-40°C), the appearance of severe pain in the scrotum and testicle, which radiates to the lower parts, an increase in the testicle, sometimes together with its appendage. These changes last up to 7-8 days, then the symptoms regress and the testicle gradually returns to its previous size. In the future, signs of testicular atrophy may appear. Bilateral orchitis in childhood, adolescence or young age can be complicated by subsequent infertility. It is believed that 18% of cases of male infertility are caused by transmitted epidemic parotitis.
- Acute pancreatitis appears on the 4-7th day of the disease. As a rule, hemorrhagic pancreatitis or pancreatic necrosis do not develop. Pancreatic edema predominates. Sharp pain in the epigastric area, nausea, repeated vomiting, fever appear, during examination, some patients have tension in the abdominal muscles and symptoms of peritoneal irritation. At the same time, cases of pancreatitis without distinct subjective manifestations are noted. Both clinically significant cases and asymptomatic episodes are characterized by a very significant increase in urinary amylase activity, which persists for up to a month, while other symptoms of pancreatitis are observed within 7-10 days. In the future, a chronic non-specific lesion of the pancreas can develop, which can lead to its fibrosis and the formation of type II diabetes.
- Meningitis is a complication that is more common in children than in adults. The frequency of this complication is 10%. Meningitis develops 3 times more often in men than in women. As a rule, symptoms of damage to the nervous system appear after the inflammation of the salivary glands, but simultaneous damage to the salivary glands and the nervous system is possible, or the development of meningitis even before the appearance of an increase in the salivary glands. In some cases of epidemic parotitis, meningeal signs may not be accompanied by significant changes in the salivary glands. Meningitis begins acutely, is often accompanied by chills, increased body temperature, severe headache, vomiting, and meningeal symptoms. Cerebrospinal fluid is transparent, flows out under pressure, is characterized by significant lymphocytic pleocytosis (often thousands of cells in 1 μl), a moderate increase in protein. Usually, the reverse development of meningitis symptoms occurs in 10-12 days, while the cerebrospinal fluid clears up much later. Some patients, in addition to meningeal symptoms, develop signs of damage to the brain substance — meningoencephalitis, or, occasionally, even meningoencephalomyelitis. Patients have impaired consciousness, lethargy, drowsiness, unevenness of tendon reflexes, paresis of the facial nerve, decreased pupillary reflexes, pyramidal signs, hemiparesis.
- Inflammation of the ovaries and/or mammary gland (oophoritis and mastitis, respectively) occurs rarely, more often in women with endocrine gynecological pathology. As a rule, this complication is not accompanied by distinct subjective complaints, it is more benign than orchitis.
- In cases of mumps in the 1st trimester of pregnancy, a 2-fold increase in the number of spontaneous abortions was noted.
- Damage to the organ of hearing sometimes leads to complete deafness. The first sign is the appearance of noise and ringing in the ears. The defeat of the labyrinth is indicated by the appearance of vomiting, symptoms of dizziness and impaired coordination. Deafness is usually unilateral. Hearing is not restored during the convalescence period.
- Complications from the side of the joints occur infrequently and mainly in adults, and more often in men than in women. They are usually observed after damage to the salivary glands, although their appearance is possible even before the change of the glands. Damage to large joints (carpal, elbow, shoulder, knee, and ankle) is characteristic, accompanied by complaints of pain, swelling, and sometimes serous effusion. Arthritis symptoms can persist for several months.
Thanks to routine vaccination against infection, outbreaks of mumps are relatively rare today, and occur mainly in crowded, closed spaces such as schools, orphanages, military camps, etc. And mostly unvaccinated, unvaccinated people get sick
Vaccinate on time. Take care of your health!
Epidemiologist, Department of Epidemiological Surveillance and Prevention of Infectious Diseases of the Yavoriv District Department of the Lviv Regional Center for Disease Control and Prevention
Vera Levitska