Mumps in children. diagnosis. Management

1. Mumps in children
Epidemiology, Etiology
Clinical Features, Complications, Management
Prognosis and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. (God speaking to Prophet Muhammad (PBUH)
This (the Quran) is a clear statement for all the mankind,
and a guidance for those who are conscious of Allah (the pious
persons who love Allah and abstain from His disobedience)
Al Quran surah Al-Imran 2:138
Al- Quran

3. Case scenario
• A 5 year old child presents with fever for the last 3 days
• He is vomiting for the last one day
• On examination, he has a temperature of 100 F.
• He is having a mild tender swelling in front of and below
left ear. Margins of this swelling cannot be defined
1. What is the most likely diagnosis ?
2. What complications can occur?
3. What treatment should be given ?

4. MUMPS
An infectious disease
caused by
mumps virus
and characterized by
swelling of
Parotid salivary glands

5. ETIOLOGY
Mumps virus
RNA virus
Paramyxovirus

6. Mumps – Epidemiology and Transmission
• Usual age = 5 to 9 years
• Common in unvaccinated children
• Transmission – DROPLET INFECTION
• INCUBATION PERIOD – 14 – 21 days
• Infectivity Period: Starting 2 days before upto 5 days
after onset of parotid gland enlargement

7. Clinical Features

8. CLINICAL FEATURES – 3 phases
• Prodromal phase – Low to moderate fever and Malaise
• Swelling of salivary glands –
• There is pain in parotid region
• Swelling appears in front of ear and progresses downwards
and forwards in 1 – 3 days
• Swollen area is painful and tender
• Swallowing may be painful for the child
• Recovery – Swelling and Fever slowly subsides in 3 - 7 days

9. Mumps – left Parotid enlargement

10. Mumps – Right Parotid enlargement
(visible from front and back)

11. Mumps – bilateral Parotid enlargement

12. DIAGNOSIS
• DIAGNOSIS of MUMPS is clinical
• Low to moderate Fever
• Swelling of one or both parotid glands
• Swelling more visible than palpable
• Serum Amylase level may be raised for two weeks

13. DIFFERENTIAL DIAGNOSIS
• Acute cervical lymphadenitis
– an oval swelling which is palpable and tender, multiple
nodes may be enlarged
• Chronic cervical lymphadenopathy
– chronic painless lymph node enlargement may be
seen in tuberculosis
• Acute bacterial Parotitis –
- high grade fever
- parotid gland is very tender

14. COMPLICATIONS
• Meningoencephalitis
– Subclinical infection by mumps virus is common
– Clinical symptoms of headache and raised
intracranial pressure seen in 10 % of cases
• Acute Pancreatitis
– Mild or subclinical inflammation common
• Orchitis
– Seen in adolescents
– High fever, pain and tenderness of testes
– Usually unilateral

15. MANAGEMENT
• Analgesics – Paracetamol, Ibuprofen
• Hydration - extra fluids
• Nutrition – small frequent feeds
• Antivirals are not effective
• Corticosteroids have no role in treatment
• Meningoencephalitis –
-- Vomiting - IV fluids, anti-emetics (ondansetron)
-- Reduce intracranial pressure - (mannitol)

16. Prognosis
• Most of the children recover in 5 – 7 days
• Complications usually take more time to resolve
• Orchitis in adults may lead to testicular atrophy

17. PREVENTION
• Mumps vaccine (not included in EPI)
• Given as MMR vaccine usually at 12 - 15 months of age
• Booster dose may be given at five years of age

18. Vaccination is Protection