Epidemic parotitis (mumps) is a widespread viral disease that occurs with damage to the glandular organs (often the salivary glands, especially the parotid, less often the pancreas, the genital, mammary glands, etc.), and the nervous system ( meningitis , meningoencephalitis).
Causes of Mumps
Source of Mumps – sick person, contagious within 9 days of illness. The route of transmission is airborne. The most affected contingent is children of school age. With age, the number of cases of mumps decreases due to an increase in the number of immune individuals. Cases of the disease among children of the first year of life are extremely rare. Rarely, the disease occurs in patients older than 40 years.
The incubation period is from 11 to 21 days.
In some patients, 1–2 days before the development of a typical picture of mumps, pre-painful phenomena are observed in the form of weakness, malaise, muscle pain, headache, chilling, sleep disorders and appetite.
With the development of inflammatory changes in the salivary gland, these phenomena become more pronounced, signs associated with damage to the salivary glands are noted – dry mouth, pain in the ear, aggravated by chewing, talking.
In typical cases, the fever reaches maximum severity on the 1-2 day of illness and lasts 4-7 days.
A characteristic symptom of mumps is the defeat of the salivary glands (in most patients – parotid). The area of the enlarged gland is painful with palpation. The pain is especially pronounced at some points: in front of the earlobe, behind the earlobe and in the region of the mastoid process.
With an enlarged salivary gland, there is also a lesion on the skin above it (depending on the degree of enlargement). The skin becomes tense, shiny, swelling can spread to the neck. The increase in the salivary gland is rapidly increasing and reaches a maximum within 3 days. At this level, swelling lasts for 2–3 days and then gradually (within 7–10 days) decreases.
In case of epidemic parotitis, complications are more often manifested in the defeat of the glandular organs and the central nervous system. In children, one of the most frequent complications is inflammation of the meninges (meningitis). The frequency of this complication exceeds 10%. In males, meningitis develops 3 times more often than women. As a rule, signs of damage to the nervous system appear after inflammation of the salivary glands, but one-stage damage to the salivary glands and nervous system is also possible (in 25–30% of patients). Meningitis often begins violently (usually on the 4–7th day of the illness): chills appear, the body temperature rises again (up to 39 ° C and higher), severe headache, vomiting worries.
Orchitis (inflammation of the testicles) is more common in adults. Symptoms of orchitis occur on days 5–7 from the onset of mumps and are characterized by a new wave of fever (up to 39–40 ° C), the appearance of severe pain in the scrotum and testicle, sometimes spreading to the lower abdomen. The testicle increases, reaching the size of a goose egg. Fever lasts 3–7 days, testicular enlargement lasts 5–8 days. Then the pain passes, and the testicle gradually decreases in size. In the future (after 1-2 months), signs of testicular atrophy may occur, which are observed in 50% of patients undergoing orchitis (if not given corticosteroids at the beginning of the development of complications).
Inflammation of the pancreas develops on the 4–7th day of the disease. There are sharp pains in the pit of the stomach, nausea, repeated vomiting, fever.
Damage to the organ of hearing sometimes results in complete deafness. The first sign is the appearance of noise and ringing in the ears. Vertigo, vomiting, incoordination of movements indicate inflammation of the inner ear. Deafness is usually one-sided (on the side of the damage of the salivary gland). In the recovery period, hearing is not restored.
Inflammation of the joints develops in about 0.5% of cases, more often in adults, and in men more often than in women. They are observed in the first 1-2 weeks after the defeat of the salivary glands, although they may appear before the glands change. Large joints are often affected (wrist, elbow, shoulder, knee and ankle). Joints swell up, become painful. The duration of arthritis is usually 1–2 weeks, in some patients the damage to the joints lasts up to 1-3 months.
It is now established that the virus parotitis in pregnant women can cause fetal damage. In particular, children have a peculiar heart change – the so-called primary myocardial fibroelastosis. Other complications ( prostatitis, oophoritis, mastitis, thyroiditis, bartonility, nephritis, myocarditis, thrombocytopenic purpura) are rarely observed.
- Virus isolation: traditional isolation of viruses from the nasopharyngeal mucus biomaterial;
- Detection of antibodies to antigens of the virus: RSK, RTNGA (diagnostic titer 1:80 and above). In evaluating the results of the study, a possible post-vaccination reaction is taken into account;
- Allergological method: setting intradermal allergic reaction with parotid diagnosis; currently rarely used;
- Blood test;
- Analysis of urine.
There is no specific treatment. An important task of treatment is the prevention of complications. It is necessary to comply with bed rest for at least 10 days. In men who did not observe bed rest during the first week, orchitis develops about three times more often than in persons hospitalized in the first three days of the disease.
To prevent inflammation of the pancreas, in addition, you must follow a certain diet: avoid overeating, reduce the amount of white bread, pasta, fat, cabbage. The diet should be milky-vegetable. From cereals it is better to eat rice, black bread, potatoes are allowed.
With orchitis, prednisone is prescribed as early as possible for 5–7 days, starting at 40–60 mg and reducing the dose each day by 5 mg, or other hormones, corticosteroids at equivalent doses.
For meningitis use the same course of treatment with corticosteroids. The course of parotitis meningitis is favored by a spinal puncture with the extraction of a small amount of cerebrospinal fluid.
When inflammation of the pancreas is prescribed a liquid sparing diet, atropine, papaverine, cold on the stomach, with vomiting – aminazine, as well as drugs that inhibit enzymes, in particular, contrycal (trasilol), which is administered intramuscularly (slowly) in a glucose solution, on the first day 50 000 IU, then 3 days for 25,000 IU / day. and another 5 days at 15,000 IU / day. Local warming compresses.
The prognosis for mumps is favorable, deaths are very rare (1 per 100,000 cases); however, you should consider the possibility of deafness and atrophy of the testicles, followed by infertility.
Vaccination with mumps vaccine at the age of 12 months. Revaccination at 6 years of age: use domestic or foreign drugs (including combined ones).
There are observations of cases of mumps among previously vaccinated children. The disease in these cases proceeds relatively easily with the involvement of the salivary glands only. Children of the first 10 years who have had contact with the patient are separated on the 21st day after the isolation of the patient.