Mumps - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Fever and malaise. These symptoms occur in the prodromal stage due to the plasma viremia resulting in a humoral immune response . Fever and malaise.
These symptoms occur in the prodromal stage due to the plasma viremia resulting in a humoral immune response .
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 . 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 .
Acute onset hearing loss. Sensorineural type deafness which is thought to occur due to endolymphatic labyrinthitis . Acute onset hearing loss.
Sensorineural type deafness which is thought to occur due to endolymphatic labyrinthitis .
Anterior neck lump. Due to associated subacute thyroiditis . Anterior neck lump.
Due to associated subacute thyroiditis .
Acute onst epigastric pain with chills, nausea and vomiting. Due to associated pancreatitis . Acute onst epigastric pain with chills, nausea and vomiting.
Due to associated pancreatitis .
Headache, photophobia and vomiting. Mumps virus can cause aseptic meningitis . Headache, photophobia and vomiting.
Mumps virus can cause aseptic meningitis .
Lower abdominal pain with testicular swelling in males and pelvic pain in females. Due to associated orchitis and oophritis, respectively . Lower abdominal pain with testicular swelling in males and pelvic pain in females.
Due to associated orchitis and oophritis, respectively .

Clinicals - 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 . 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 .
Erythema at the orifice of the parotid duct. Due to inflmmation of the duct . Erythema at the orifice of the parotid duct.
Due to inflmmation of the duct .
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 . 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 .
Pyrexia. Due to the plasma viremia resulting in a humoral immune response . Pyrexia.
Due to the plasma viremia resulting in a humoral immune response .
Erythematous scrotum with testicular tenderness in the male and pelvic tenderness in the female. Due to orchitis and oophoritis, respectively . Erythematous scrotum with testicular tenderness in the male and pelvic tenderness in the female.
Due to orchitis and oophoritis, respectively .
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 . 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 .
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 . 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 .

Investigations - 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 .
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 .
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 . 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 .
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 . 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 .
Positive mumps IgM titre in serum. Mumps specific IgM is detectable in serum just about 11 days after exposure . Positive mumps IgM titre in serum.
Mumps specific IgM is detectable in serum just about 11 days after exposure .
Computed tomography of the abdomen. To diagnose pancreatitis which could occur in mumps . Computed tomography of the abdomen.
To diagnose pancreatitis which could occur in mumps .
Lumbar puncture. To detect the mumps virus through either RT-PCR or mumps specific IgM in cerebrospinal fluid . Lumbar puncture.
To detect the mumps virus through either RT-PCR or mumps specific IgM in cerebrospinal fluid .
Color doppler ultrasound scan of the scrotum. It helps differentiate inflammatory lesions from other acute scrotal diseases . Color doppler ultrasound scan of the scrotum.
It helps differentiate inflammatory lesions from other acute scrotal diseases .

Investigations - Management

Fact Explanation
Auditory testing. Sensorineural deafness can occur due to endolymphatic labyrinthitis . Auditory testing.
Sensorineural deafness can occur due to endolymphatic labyrinthitis .

Management - Supportive

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 .
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 .
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 . 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 .
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 . 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 .

Management - Specific

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 . Inpatient care for intravenous fluid stabilization and close observation for patients with complications.
When complications such as meningitis, pancreatits and myocarditis can occur .
MMR vaccine to susceptible contacts. To develop antibodies against the virus . MMR vaccine to susceptible contacts.
To develop antibodies against the virus .

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