A viral infection that affects the salivary glands that's easily preventable by a vaccine. Mumps affects the parotid glands, salivary glands below and in front of the ears. The disease spreads through infected saliva. Some people experience no symptoms. When symptoms occur, they include swollen, painful salivary glands, fever, headache, fatigue and appetite loss. Treatment focuses on symptom relief. Recovery takes about two weeks. The disease can be prevented by the MMR vaccine.

1. MUMPS

2. Etiology
• Pathogen: Mumps virus; from the family Paramyxoviridae
• Transmission
• Airborne droplets
• Direct contact with contaminated saliva or respiratory secretions
• Contaminated fomites
• Infectivity:
• Highly infectious
• Affected individuals are contagious ∼ 3 days before and up to 9 days after disease onset
(when the parotid gland becomes swollen)
• Most cases occur between the ages of 5 and 15 yr; infants are rarely affected due to
presence of trans-placentally acquired maternal antibodies.
• Man is the only reservoir of infection; carrier state does not exist.

3. Pathophysiology
• Nasopharyngeal entry →
• replication of the virus in the mucous membranes and lymph nodes→
• viremia and secondary infection of the salivary glands (particularly the parotid
gland) →
• further dissemination possible (lacrimal, thyroid, and mammary
glands, pancreas, testes, ovaries, CNS)

4. Clinical features
• Incubation period: 16–18 days
• Asymptomatic course in ∼ 20% of cases
• Prodrome:
• Duration: 3–4 days
• Low-grade fever, malaise, headache
• Classic course (in ∼ 30% of cases):inflammation of the salivary glands,
particularly parotitis
• Duration of parotitis: at least 2 days (may persist > 10 days) Swelling maybe
unilateral or bilateral
• The ear lobe may appear to be pushed upwards and outwards. The defervescence
and resolution takes about a week.
• Occasionally, other salivary glands, including the submaxillary and sublingual glands,
are affected.

5. Complication
Orchitis (< 10% of cases; most common complication in post-pubertal males)
• Primarily unilateral, although bilateral in ∼ 15% of cases
• Sudden onset of fever, nausea, vomiting
• On examination: swollen and tender affected testicle
• May lead to atrophy and, in rare cases, infertility
Aseptic meningitis (1–10% of cases): predominantly mild course; usually no permanent
sequelae
Encephalitis (< 1% of cases)
• Reduced consciousness, seizures
• Neurological deficits: cranial nerve palsy, hemiplegia, sensorineural hearing loss (rare)
Acute pancreatitis(< 1% of cases)
• Vomiting, nausea, upper abdominal pain
• ↑ Lipase in addition to ↑ amylase
• Diabetes mellitus type I (delayed complication)

6. Investigation
• Clinical diagnosis
• Positive serology confirms the diagnosis: IgG and/or IgM
• Relative lymphocytosis
• ↑ CRP, ↑ ESR
• ↑ amylase

7. Differential Diagnosis
• suppurative parotitis
• submandibular lymphadenitis
• recurrent juvenile parotitis
• calculus in Stensen duct and
• other viral infections causing parotitis, e.g. coxsackie A and cytomegalovirus

8. Treatment
• Symptomatic treatment is given in the form of antipyretics and warm saline
mouthwashes.
• Orchitis is treated by bed rest and local support.
• Steroids may be used for symptomatic relief of orchitis and arthritis but does not
alter the course of disease.
• Prophylaxis – MMR vaccine