Mumps, mumps, mumps, mumps - these are all the names of one acute infectious viral disease, which affects the central nervous system, salivary glands and glandular organs. The transmission mechanism of the pathogen is aspiration. This common disease is most often diagnosed in the pediatric population and in some cases has long-term adverse effects. The rise is recorded in the winter-spring period. The age category of three to six years is most susceptible to infection. Babies up to a year receiving breast milk, thanks to passive immunity, are resistant to the pathogen. After the disease, immunity lasts for life, and after vaccination, stable immunity is formed over twenty years.
A bit of history. Etiology
This disease was first described by Hippocrates. In the distant 1790, it was discovered that with mumps, the genitals and central nervous system are affected. A detailed study of this infection was carried out by a group of Russian scientists later. In 1934, the causative agent of mumps infection was first isolated, which belongs to the paramyxovirus family and accordingly has characteristics inherent in this family, including irregular spherical shape, large size. By its antigenic structure, it is close to the parainfluenza virus. Only one serotype of the virus is known. It retains its viability for up to four to six days at a temperature of 20 degrees. Instantly dies when boiled, dried, afraid of ultraviolet radiation and disinfectants with chlorine. It is very resistant to low temperatures and can exist in such conditions for up to six months.
Epidemiology of Mumps Infection
The only source of the virus are individuals with asymptomatic infection, as well as with erased and typical forms of pathology. A day or two before and during the first six to nine days of illness, patients are considered contagious. A sick individual from the third to fifth day of illness is especially dangerous. It is during these periods that the virus is detected in blood and saliva. Basically, the pathogen is transmitted during a conversation by airborne droplets, as it is in the patient's saliva. However, isolated cases of infection through objects on which saliva was known are known.
The virus is not volatile, therefore transmission is possible only with close contact. Due to the absence of catarrhal phenomena (runny nose, cough), the intensive distribution of the pathogen is not observed. The focus of infection can exist for a long time, up to several months, since the virus is transmitted slowly. This is facilitated by a rather long incubation period, as well as an increase in the number of patients with an erased clinical picture. For the epidemiology of mumps infection, it is characteristic that after the ninth day it is not possible to isolate the virus and the patient ceases to be considered infectious. However, there is a reason that enhances the ability to infect others - these are concomitant acute respiratory viral infections in a patient with mumps. Thus, the virus spreads faster when coughing or sneezing. The susceptibility to the disease is high at around 85 percent. Thanks to vaccination, the incidence in the age category from one to ten years has decreased. However, there has been an increase in sick teenagers and adult citizens up to 25 years. After 50 years, mumps are rarely diagnosed. After the illness, immunity is lifelong.
Pathogenesis
The mucous membranes of the upper respiratory tract and oropharynx are called the entrance gate of infection. In the epithelial tissues of the mucous membrane, the virus reproduces its own offspring and then spreads throughout the body. It is concentrated in the epithelial cells of glandular organs, mainly in the salivary gland. Serous inflammation occurs in it and the death of secretory cells is observed. Isolation of the virus with saliva determines the airborne transmission route. With the initial presence of the virus in the blood, clinical manifestations may not be. A more massive release of the pathogen is carried out from the affected glands. As a result of the secondary form of mumps infection, the pancreas and thyroid gland, testicles, and mammary glands are affected. The virus enters the central nervous system through the blood-brain barrier, provoking serous meningoencephalitis. Due to the rapid formation of specific immunity, the pathogen dies, recovery comes.
Diagnostics
With a typical clinic, diagnosis is not difficult. Diagnosis is based on the following symptoms:
- fever;
- swelling and tenderness of the parotid glands.
It is more difficult to identify it when there is an atypical variant of the disease or an isolated lesion of an organ without involving the salivary parotid glands in this process. In this case, a correctly assembled epidemiological history helps (cases of the disease in kindergarten, family). The diagnosis is confirmed using an enzyme-linked immunosorbent assay, identifying a specific immunoglobulin M (antibodies that form upon first contact with the infection), which confirms the presence of an active infection in the body. With mumps infection in children, antibodies are detected in all forms of pathology, including isolated localizations: meningitis, pancreatitis, orchitis. The virological method is not used in practical medicine; it is very long and laborious. Serological - used for retrospective diagnosis. In recent years, polymerase chain reaction method has been widely used in medical institutions to diagnose the disease.
Classification
Forms of mumps infection are divided into typical and atypical. The first is:
- Glandular - mumps, orchitis, pancreatitis, thyroiditis, sublingitis, epididymitis, submaxillitis, oophoritis, dacryoadenitis.
- Nervous - neuritis, meningitis, cochlear neuritis with hearing loss, meningoencephalitis, Guillain-Barre polyradiculitis.
- Combined - these are various combinations of the above forms.
Atypical is divided into erased and subclinical form.
In the form of severity, mumps infection happens:
- Light - signs of intoxication are weak, the glands are slightly enlarged.
- Medium - there is a multiple lesion of the glandular organs and the central nervous system, hyperthermia.
- Severe - convulsive syndrome, toxicosis.
With the flow:
- Spicy or smooth.
- Non-smooth. Such a course is observed in the case of complications, when secondary forms of mumps infection are layered or existing chronic pathologies are aggravated. Residual effects appear: infertility, testicular atrophy, psychosensory disorders, asthenic syndrome, hydrocephalus, hypertensive syndrome for three to four months.
Clinical manifestations of mumps infection in children
Symptoms begin after infection in 11-21 days. The first symptom is a fever. The temperature is usually high and rises to 39 degrees. In addition to her, intoxication is observed, which is expressed by weakness, lack of or poor appetite, headache. The disease can take a long time, since different glands are involved in turn in the pathological process.
Each new inflammatory process provokes a jump in temperature. The glandular organs that are affected by mumps infection are as follows:
- Salivary gland. One of the most common symptoms is inflammation in the parotid salivary glands. A pain syndrome appears in the behind-the-ear region and in the fossa, which intensifies with chewing. Dry mouth is felt. A swelling forms in front of the auricle due to an increase in the parotid salivary gland. Bloating extends to the cheeks, neck and rises to the mastoid process of the temporal bone as a result, the baby hardly opens his mouth. Derma over the inflamed gland does not change color, but becomes tense and glossy. After a short period of time (one or two days), the other salivary gland located on the opposite side is also subjected to the pathological process. As a result of bilateral lesions, the lower part of the face significantly increases in size, compared with the upper. The baby’s face looks like a pig’s head, which is why this disease is often called mumps. The largest increase in the salivary glands occurs on the third to fifth day of the disease. In addition to the existing symptoms, hearing loss and tinnitus join them. Palpation of the gland does not cause unpleasant or painful sensations. A pit does not form when pressed on it. On the sixth to ninth day, the swelling gradually decreases. With mumps infection in children, other glands are also involved in the pathological process.
- The defeat of the testicles. Inflammatory process - orchitis is observed in children and adolescents. Most often, one testicle is affected. Orchitis is characterized by a feeling of chills, headache, fever, severe pain in the scrotum, which gives in the groin and intensifies with movement. The testicle grows in size two or three times. The scrotum blushes, swells, stretches. On palpation, the testicle is dense, the child feels severe pain.
- Damage to the pancreas does not occur in all cases, but is quite common. It develops before or after inflammation of the salivary glands. Symptoms that are manifested by girdle pains in the abdomen, stool disorders, fever, headache, decreased appetite go away after five to ten days and recovery occurs.
Lesions of the nervous system can be combined with inflammation of the glands or be independent. In the first case, signs are observed on the third or sixth day of the disease and result in serous meningitis, which begins acutely. The child is concerned about vomiting, headache, temperature. He becomes lethargic and sleepy, cramps, loss of consciousness, hallucinations are possible. If this disease is suspected, cerebrospinal fluid is taken for examination. Meningitis lasts about eight days. After the inflammation that accompanied mumps, the children recover. However, for several months they will be concerned about the residual effects - mood swings, lethargy, low concentration of attention.
Symptoms of mumps in adults
The incubation period for mumps infection can last in adults 15-19 days. Between this period and the disease itself, malaise appears, appetite decreases, headache, and bruising. These phenomena precede the clinical picture. The onset of the disease is acute and is accompanied by an increase in temperature up to 40 degrees. Some individuals have no fever. Further, there are unpleasant sensations in the salivary gland and swelling. The inflammatory process affects both salivary glands, their swelling in adults lasts up to 16 days. At night, the patient is very worried about pain and tension in the gland. In case of compression of the Eustachian tube, noise and pain appear in the ears. The most important sign of mumps is pain behind the earlobe when pressing on this area. Catarrhal phenomena are not characteristic of mumps infection.
Orchitis in men is common. The defeat of the testicles occurs without inflammation of the salivary glands. Mostly one testicle is affected. Past inflammation can cause infertility, impaired potency and some other disorders. In women, inflammation in the ovaries sometimes forms. Due to the fact that the clinical picture is poorly expressed, this phenomenon remains without the attention of the doctor. As in children, it is possible damage to the pancreas and nervous system. People after 50 years rarely get mumps, and their susceptibility to this disease decreases. However, they can become infected from sick grandchildren. The disease in this category is both asymptomatic and severe. Exacerbates the course of the disease exacerbation of existing chronic pathologies.
Mumps treatment in children
Patients receive symptomatic and pathogenetic therapy on an outpatient basis in accordance with clinical recommendations. Mumps infection in children does not require specific treatment aimed at killing the virus. To reduce some symptoms, the doctor prescribes medications:
- "Paracetamol", "Ibuprofen" - to reduce the temperature.
- "Papaverine", "Drotaverinum" - with severe abdominal pain.
- "Contrical" - to reduce the activity of digestive enzymes.
- "Pancreatin" - to improve digestion is recommended during the recovery period with inflammation of the pancreas.
It is especially important to observe the child:
- bed rest until body temperature is normalized;
- oral hygiene. With a solution of furacilin or sodium bicarbonate, irrigate the oral mucosa.
Dry heat is indicated on the swollen area of the salivary glands.
Children with severe mumps infection are subject to treatment in the hospital. The clinical recommendations on which the doctor is based in the management of such patients help to choose a therapy based on the course of the disease and the individual characteristics of the child:
- Orchitis. In this case, bed rest is required. A special supporting dressing is applied to the scrotum area of the child, which is removed only after the symptoms of testicular inflammation disappear. Usually this manipulation is done in the acute period of the disease. The patient is advised by a surgeon. If necessary, corticosteroid drugs are prescribed.
- Serous meningitis. Strict bed rest is indicated for two weeks. The patient takes diuretics until the symptoms of the disease disappear under constant medical supervision.
- Polyneuritis, meningoencephalitis. In these cases, bed rest is also recommended. Dehydration and detoxification therapy is carried out. The child is prescribed hormonal, antiallergic and vitamin preparations.
Mumps treatment in adults
Adults should call a doctor at home if they suspect a mumps infection. Clinical recommendations for the management of such patients do not establish uniform patterns; they contain an algorithm of the doctor’s actions using effective treatment methods. Therapy of any patient is individual, and the specific treatment tactics are determined by the attending physician.
With a mild and uncomplicated form of mumps, the patient is treated at home. Compliance with diet and regimen are the main components of a successful cure. With severe intoxication, heavy drinking is indicated. Treatment is primarily aimed at relieving and alleviating the symptoms. With inflammation of the central nervous system and orchitis, hormonal agents are used. To increase immunity, vitamin preparations and immunostimulants are prescribed. In severe illness and complications, the patient is hospitalized.
Mumps diet
Treatment of mumps infection also involves following a special diet. To reduce the burden on the digestive system, fractional nutrition in puree or liquid form and small volumes is recommended. The preference is given to dairy and plant foods. Products with salivary action are excluded only in the first days of the disease. In the future, their use helps to improve the discharge of glandular secretion. In the presence of pancreatitis, a strict diet is indicated. For the discharge of the digestive tract, in the first two days, hunger is recommended. Further, food is introduced gradually. Twelve days later, patients are transferred to a special diet.
Effects
Complications of mumps infection are manifested in the form of the following conditions:
- encephalitis;
- after orchitis, testicular atrophy is possible. With bilateral damage, infertility develops;
- cerebral edema;
- pancreatitis, which provokes the development of diabetes;
- unilateral hearing loss without the possibility of recovery;
- female infertility is associated with early inflammation of the gonads;
- increased intracerebral pressure (hypertension syndrome).
Complications do not occur in all patients; weakened children suffer the most. The consequences of the disease in adults are more common and are mainly caused by a secondary infection.
Prevention
Preventive measures come down to:
- Isolation of the patient for at least ten days, i.e., until the disappearance of clinical signs.
- Children under the age of ten who are in contact with the patient are disconnected from the eleventh to the twenty-first day since the last contact. In the institution where the patient was identified, quarantine is introduced for a period of 21 days, the countdown is from the ninth day of the disease.
- Immunization
Mumps vaccination
The incidence of mumps infection has decreased significantly due to routine vaccination. In order to prevent vaccination, children from 12 months old are vaccinated with the “Mumps Cultural Vaccine Live” vaccine. Vaccination for children without mumps is carried out twice - per year and at six years. Emergency prevention is possible for babies from 12 months old, adolescents and adults who were in contact with a sick individual, did not suffer from mumps and were not vaccinated before. The introduction of the vaccine is recommended no later than 72 hours after contact with the infected. In addition, vaccination with a comprehensive vaccination against three infections is possible: mumps, rubella and measles. It is also carried out in accordance with the vaccination calendar. This vaccine is administered three times. The first is at 12 months. The timing of revaccination against mumps, measles and rubella is as follows:
- the first - at 6–7 years old;
- the second - at 15-17 years old.
Revaccination is necessary, since not all children develop immunity to the above infections after the first injection. In addition, immunity acquired artificially over time weakens. On average, a vaccination is valid for about ten years. Repeated administration of the vaccine in adolescence is warranted for the following reasons:
- For young girls, this is an extension of protection against the rubella virus and mumps, since the development of these infections during pregnancy is very dangerous. Mumps in a pregnant woman can cause a miscarriage.
- For young men, mumps at this age is undesirable due to the fact that male infertility is one of the complications of the infection.
The vaccination rate is 96 percent. Before treatment, the attending doctor will recommend which immunobiological drug to give preference to. Both vaccines are well tolerated. Complications and adverse reactions are rare.