Mumps

Background

• Contagious viral infection caused by a paramyxovirus
• Mumps cases in US range from few hundreds to thousands per year
• Highly infectious and is transmitted by respiratory droplets, direct contact, or fomites
• The incubation period is usually 16 to 18 days (range 12 to 25 days) from exposure to onset of symptom

Clinical Features

Patient before (left) and after (right) being infected with Mumps.

Child with mumps.

• Initially presents with headache, fever, myalgias, fatigue, anorexia
• 48-hours later develop salivary gland swelling
• Parotitis (can be unilateral, bilateral)- lasts up to 10 days
• Usually self limiting

Complications

• Orchitis/oophoritis (most common complication)
  • Tends to affect post pubertal males
  • Usually occurs 5 – 10 days after parotitis and is accompanied by fever
• Neurologic complications
  • Meningitis
  • Encephalitis
  • Deafness
• Less common complications - arthritis, pancreatitis, thyroiditis, myocardial involvement

Differential Diagnosis

Bilateral Parotitis

• Viral infections
  • Viral parotitis
  • Parainfluenza
  • Coxsackie virus
  • influenza A
  • Epstein-Barr virus
  • Adenovirus
  • HIV
  • Cytomegalovirus
• Bacterial infections
  • Staphylococcus aureus
• Noninfectious
  • Salivary calculi
  • Tumors
  • Sarcoidosis
  • Sjögren’s syndrome
  • Thiazide diuretics

Facial Swelling

• Buccal space infections
• Dental problems
• Canine space infection
• Facial cellulitis
• Herpes zoster
• Masticator space infections
• Maxillofacial trauma
• Neoplasm
• Parapharyngeal space infection
• Salivary gland diagnoses
  • Parotitis
    • Bilateral parotitis
    • Suppurative parotitis
    • Viral parotitis (Mumps)
  • Ranula
  • Sialoadenitis
  • Sialolithiasis
• Superior vena cava syndrome

Testicular Diagnoses

• Scrotal cellulitis
• Epididymitis
• Fournier gangrene
• Hematocele
• Hydrocele
  • Hydrocele (peds)
• Indirect inguinal hernia
• Inguinal lymph node (Lymphadenitis)
• Orchitis
• Scrotal abscess
• Spermatocele
• Tinea cruris
• Testicular rupture
• Testicular torsion
• Testicular trauma
• Testicular tumor
• Torsion of testicular appendage
• Varicocele
• Pyocele
• Testicular malignancy
• Scrotal wall hematoma

Evaluation

• Usually clinical diagnosis- symptoms, vaccination status
• Lab testing
  • RT-PCR
  • Serology

Management

• Supportive care

Disposition

• Typically treated as an outpatient
• Consider admission for serious complications (e.g., meningitis, encephalitis, myocarditis, nephritis, pancreatitis)

See Also

• Viral parotitis
• Orchitis