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Mumps (Epidemic Parotitis)(Text A)

Incidence.So far as it is known, nearly everyone is susceptible to mumps, yet this disease is less frequent than other diseases commonly encountered in children. Most cases occur between the ages of five and fifteen, although mumps in adults is not rare. Infants are rarely affected. Most cases occur during the winter and spring.

Etiology.A filterable virus capable of causing parotitis in experimental animals has been recovered from the saliva of patients with mumps. The disease is transmitted by close contact with an infected person or by contact with articles freshly soiled by the nasal or salivary secretions of such persons. The period of incubation varies considerably, usually being about eighteen days. The period of communicability is not definitely known, but is known to be from the onset of symptoms to the disappearance of all glandular enlargement. This is seldom more than twelve days after onset. Whether or not there are carriers has never been determined. Mild, unrecognized cases may contribute to the spread of the disease.

Immunity.There is little, if any, natural immunity. Everyone who has not previously had the disease is susceptible to mumps. Although one attack usually confers permanent immunity, cases occurring in previously affected individuals are not rare.

Symptoms and signs.The onset is usually marked by the development of a dull, aching pain in front of or below the lobe of the ear. This area is tender and pain is apt to be increased by movements of the jaw. Shortly after the onset of pain, swelling of the parotid gland occurs. This is usually unilateral at first, sometimes spreading later to the opposite side. The center of the swelling is just below the lobe of the ear, which appears to be pushed upward and outward. With the onset of the swelling, the temperature becomes elevated, usually to about 102° F.

The course is usually mild. Fever and parotid enlargement reach their maximum on the second or third day and then gradually decline. Bilateral parotid involvement occurs in about 10 per cent of the cases. Patients with mild cases may be well within four or five days. Severe cases with bilateral involvement may persist two or three weeks and, occasionally, longer. As a rule, children are not very ill and are difficult to keep in bed.

Complications. In children serious complications are uncommon, meningo­encephalitis being the most alarming. The incidence of this complication varies considerably in different epidemics.

Treatment. There is no specific treatment. Rest in bed during the febrile stage is the best means of preventing complications. The patient will hardly tolerate more than a liquid diet because of the difficulty in moving the jaws. Warm applications to the parotid region, analgesics, sedatives and other symptomatic measures will lead the patient to recovery. A patient dies from mumps or its complications very rarely. The patient should be isolated during the period of communicability, which is considered to last as long as the swelling of parotid gland persists.

Mumps (Epidemic Parotitis)(Text B)

This not-so-contagious viral disease is characterized by painful swelling of the salivary glands (especially the parotids) and, frequently, by CNS involvement. An overwhelming majority of sufferers (85%) belong to pediatric age group. A single attack leads to lifelong immunity.

Epidemiology. Mumps has a world-wide spread, the incidence being much higher in cities than in rural areas. Peak incidence occurs in late winter and spring. About 30 to 40 % infections are sub-clinical.

Clinical Features.Mumps has an incubation period of around 17 days, the extremes being 12 to 24 days.

Prodromal phaseis short (1 to 2 days) and is characterized by fever, malaise, sore throat, earache and pain behind the ear on chewing or swallowing.

Tender edematous swelling of parotid (unilateral or bilateral), without involving the submaxillary and sublingual salivary glands, in the subsequent 1 to 3 days, is the most important development. The enlarged gland displaces the ear-lobe upwards and outwards

Tenderness and pain subside in 1 to 3 days but it takes 7 to 10 days for the swelling to begin to regress. By this time, fever, anorexia headache and malaise also disappear. At times other glands like, submaxillary and sublingual may also be enlarged.

The opening of the parotid duct, opposite upper second molar, is puffy and red.

One-half of the cases have an asymptomatic CNS involvement.