Mumps: An Acute Viral Infection
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Mumps is an acute viral infection caused by the mumps virus, a paramyxovirus spread through direct contact and airborne droplets. The virus typically causes fever, headache, muscle pain and swelling of the parotid salivary glands. While most infections are mild, complications can include orchitis, meningitis and deafness. The mumps virus is believed to target T cells and spread throughout the body. Vaccination with two doses of the MMR vaccine provides 88% protection against mumps, though immunity may wane over time leading to occasional outbreaks.
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Mumps: An Acute Viral Infection
- 2. 2 Definition • Mumps is an acute viral infection of childhood . • Mumps virus is an –ve sense ss RNA virus of the genus Rubulavirus ->Paramyxoviridae family • The virus is spread by Direct contact ,Airborne droplets possibly by saliva, urine.
- 3. 3 Etiological agent A B HN F L M 3 P N
- 4. 4 Life cycle
- 5. 5 Immunology
- 6. 6 Clinical presentation • The incubation period ranges from 14-24 days, peak at 17-18 days. • 30-40% of infections are subclinical.
- 7. 7 Clinical presentation Fever* Muscular pain (especially in the neck) Headache Malaise parotid swelling**
- 8. 8 Diagnosis the clinical symptoms and physical examination Routine laboratory tests The microbiologic diagnosis
- 9. 9 Differential diagnosis bacterial (suppurative) parotitis parotid duct stone Sjögren syndrome recurrent parotitis of childhood Other viruses.
- 11. 11 Complications ARTHRITIS MENINGITIS*, ENCEPHALITIS. THYROIDITIS DEAFNESS , OCULAR COMPLICATIONS
- 12. progression prodromal early acute established acute headache malaise myalgia meningitis encephalitis parotitis deafness fever pancreatitis orchitis viraemia viruria
- 13. Pathophysiology
- 14. 14 Pathophysiology •Why there is a gap…!
- 15. 15 Pathophysiology The virus entry..! • Mumps virus binds to sialic acid to enter the epithelial cells in the upper respiratory tract from both sides epithelial cells Apical entry Basolateral entry
- 16. 16 Pathophysiology The virus V Protien..! • Mumps virus infected cells might escape host immune surveillance via degradation of STAT1 and STAT3 by the mumps virus V protein. • In this way, IFN and IL-6 signaling are blocked and the virus can evade both innate and adaptive antiviral responses . • Furthermore, blockage of the IFN pathway enhances mumps virus replication*.
- 17. 17 Pathophysiology The uncertainty of the v protien…! • However, the effect of the V protein on the magnitude of the IFN and IL-6 response is unclear, because IFN and IL-6 levels appear to be elevated in mumps patients, especially in patients with meningitis and/or encephalitis.
- 18. 18 Pathophysiology The Virus dissemination and T cells…! • It has been suggested that mumps virus targets T cells, because the virus has a high affinity for T cells and efficiently replicates in these cells .Migrating mumps virus-infected T cells could facilitate spread from the respiratory tract to other sites of the body and might therefore play an important role in disease pathogenesis.
- 19. 19 Pathophysiology The Virus dissemination result..! • It has been hypothesized that lymphocytic infiltration and destruction of periductal cells that lead to blockage of the ducts in the salivary glands and the seminiferous tubules of the testes, respectively*. • MuV is highly neurotropic, with evidence of central nervous system (CNS) involvement in up to half of all cases of infection**.
- 20. 20 Treatment is entirely supportive fever acetaminophen or ibuprofen Orchitis local support and bed rest
- 21. 21 Mumps vaccine Effectiveness 88% after two doses* Duration of Immunity Generally lifelong Schedule** 1st dose at 12-15 months, 2nd after age 4 and for adults at higher risk
- 22. 22 The MMR controversy • started with the 1998 publication of a research paper in The Lancet linking the MMR vaccine and autism disorders*. • Japan is nowadays the only developed country with large measles epidemics**.
- 23. 23 Epidemiology and special aspects related to developing countries • It is distributed worldwide, virus peaks in late winter and spring*. In developed contries • Before introduction of the vaccine in 1967: 85% of infections occurred in children (5-9) year. • Now : most cases occur in young adults, producing outbreaks in colleges or in the workplace.
- 24. 24 Epidemiology and special aspects related to developing countries • Third-world countries now: -Mumps is endemic in most unvaccinated populations*. The most commonly infected group of people is school-aged children**.
- 25. 25 Epidemiology and special aspects related to developing countries
- 28. 28 Mumps Outbreaks the Scottish study..! The study recommends: the current protocol of two vaccinations is optimal* in the sense that while there are periodic large outbreaks, the severity of cases in vaccinated individuals is less than in unvaccinated individuals**. - the size of the outbreaks does not decrease sufficiently with a third booster to make economic sense.
- 29. 29 References • Steven Rubin et al, Molecular biology, pathogenesis and pathology of mumps virus, J Pathol 2015; 235: 242 – 252 • Sigrid Gouma, Marion P.G. Koopmans & Rob S. van Binnendijk (2016): Mumps virus pathogenesis: Insights and knowledge gaps, Human Vaccines & Immunotherapeutics. • HammiD et al Waning Immunity Is Associated with Periodic Large Outbreaks of Mumps: A Mathematical Modeling Study of Scottish Data Front Physiol. 2017 Apr 25;8:233. • *Wang W,et al,. IL-6 and IFNγ are elevated in severe mumps cases: a study of 960 mumps patients in China. J Infect Dev Ctries 2014;8:208–14. • Mahon,et al. (2003) Cell Mediated and Humoral Immune responses to Mumps Virus: Recent Developments. Recent Research Developments in Virology, 5. pp. 97-115
Editor's Notes
- MuV virion structure. :100 – 600 nm (A) Electron micrograph showing a typical MuV particle. (B) The enveloped particles are pleomorphic, containing the MuV RNA genome. Small spikes can be observed on the surface of the particle, corresponding to the viral HN and F glycoproteins. Function : Attaches the virus to sialic acid-containing cell receptors and thereby initiating infection. Binding of HN protein to the receptor induces a conformational change that allows the F protein to trigger virion/cell membranes fusion. MuV: mumps, HN: hemagglutinin-neuraminidase. F: fusion protein. In microbiology: pleomorphism is the ability of some micro-organisms to alter their shape or size in response to environmental conditions.
- *Immunology:, including interferon, are followed by the appearance of and cell-mediated responses then antibodies. Reinfection occurs, but the frequency and severity of disease decrease with age.
- In children, -Fever -Muscular pain (especially in the neck) , Headache ,Malaise,( typically precede the parotid swelling by 24 hour) -parotid swelling on the side of parotid involvement Discomfort with eating or drinking acidic food Parotid pain is most pronounced during the first few days of swelling. The swollen parotid gland lifts the earlobe upward and outward.
- *fever, usually resolve within 3 to 5 days **parotid swelling subsides within 7 to 10 days ( Adolescents and adults have more severe disease than young (if unvaccinated)).
- The diagnosis of mumps parotitis is usually apparent from the - clinical symptoms and physical examination -Routine laboratory tests are nonspecific; usually leukopenia is present with relative lymphocytosis. An elevation in serum amylase levels is common; the rise tends to parallel the parotid swelling and then to return to normal within 2 wk. -The microbiologic diagnosis is by serology or virus culture Enzyme . IgM antibodies are detectable in the first few days of illness and are considered diagnostic -Mumps virus can be cultured from the saliva, cerebrospinal fluid, blood, urine, brain, and other infected tissues. Primary cultures of human or monkey kidney cells are used for viral isolation - The mumps skin test is unreliable for diagnosis of mumps and for determination of susceptibility to infection
- *The affected testis becomes tender and swollen, and the adjacent skin is edematous and red. .The average duration of illness is 4 days. Approximately 30-40% of affected testes atrophy, leaving a cosmetic imbalance. Infertility is rare even with bilateral orchitis. **Mild or subclinical pancreatic involvement is common, (serum amylase value is characteristically present in patients with mumps, with or without clinical manifestations of pancreatitis). ***Serious cardiac manifestations are extremely rare , mostly depression of the ST segment, in 13% of adults in one series. Such involvement may explain the precordial pain, bradycardia, and fatigue sometimes noted among adolescents and adults with mumps.
- *in the pre-vaccination era up to 15% of the mumps patients developed meningitis .
- 1-in the pre-vaccine era, little is known about the pathogenesis of the disease. Much is inferred by comparison with related viruses. 2-the lack of relevant animal models. Mice and ferrets do not develop clinical symptoms and are considered poor. 3-Much of our current understanding of mumps virus pathogenesis is based on hamster and monkey models, but the unnatural routes of inoculation and the inability to distinguish attenuated mumps virus strains from wild-type strains weakens the relevance of these findings .
- Apical entry facilitates transmission of virus to neighboring cells. Then, Mumps virus is predominantly released from the apical side of epithelial cells, which enables virus replication in the glandular epithelium and mumps virus shedding in saliva basolateral entry is probably important for secondary infection via the bloodstream .
- *IFN inhibitors promote mumps virus replication in vitro STAT=TRANSCRIPTION FACTORS= SIGNAL TRANSDUCER AND ACTIVATOR TRANSCRIPTION FACTOR
- *Viremia results in dissemination of the virus to other organs, including the (kidneys,….) . the degree and duration of parotitis may be related to the amount of virus replication in the parotid gland and the development of a vigorous immune response. ** based on pleocytosis of the cerebrospinal fluid.
- treatment is entirely supportive. -Antipyretics (acetaminophen or ibuprofen) are indicated for fever. -Bed rest should be guided by the patient's needs, but no evidence indicates that it prevents complications. -The diet should be adjusted to the patient's ability to chew. -Orchitis should be treated with local support and bed rest. -Mumps arthritis may respond to a 2-wk course of a nonsteroidal anti-inflammatory agent or corticosteroids. Salicylates do not appear to be effective
- *Developed from the Jeryl Lynn strain (genotype B) **Administered with measles and rubella (MMR)
- *Described as the most damaging medical hoax of the last 100 years, the study was refuted and revoked in 2004 and 2010 ,respectively. ** Autism cases is still increasing in Japan .In other words, Correlation ≠ Causation ..! The curious case of Japan..! The anti-thiomersal theory .. Celeb and media Carrey
- *but it can occurs in other time.
- *Notify that , It is highly contagious and has a similar contagious level as influenza and rubella, but it is less contagious than measles or varicella. **Notify that , You are more likely to get mumps if you have a weakened immune system, such as being infected with HIV or medication (oral steroid use for more than two weeks). The MMR vaccine is very important for preventing being infected with Mumps and spreading it.
- *The PREDOMINANT hypothesis that Outbreaks appear to be primarily related to a lack of immunization, Especially in an under immunized cohort of children born from 1967-1977, rather than to waning to immunity.
- Is there some kind of similarity between The US and Scotland outbreaks..!
- *This recommendation relies on continuous efforts to maintain high levels of vaccination uptake. **MMR vaccination reduces the development of bilateral parotitis and orchitis and shedding of mumps virus in urine .