Mumps. Differential diagnosis in patients with aseptic meningitis. Flashcards
what is the EPIDEMIOLOGY OF MUMPS ?
declined since the introduction of the MMR vaccine
Peak age: 5–14 years of age
Sex: ♂ = ♀ for parotitis (however, males are three times more likely to have CNS complications)
Highly infectious
what re the CHARACTERISTICS OF MUMPS VIRUS ?
from the Paramyxoviridae family - RNA virus
Humans are the sole host and reservoir
very contagious
what is the TRANSMISSION OF MUMPS VIRUS ?
virus is transmitted via airborne droplets.
Direct contact with contaminated saliva or respiratory secretions
Contaminated fomites
how long are AFFECTED CHILDREN CONTAGIOUS FOR ?
∼ 3 days before and up to 9 days after disease onset (when the parotid gland becomes swollen).
what is the PATHOGENESIS OF MUMPS ?
Nasopharyngeal entry → replicates in the epithelial linings of the nasopharynx
colonises further 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)
what is the INCUBATION PERIOD FOR MUMPS ?
16-18 days
what are the CLINICAL FEATURES OF MUMPS ?
Prodrome
Duration: 3–4 days
Symptoms: low-grade fever , malaise, headache
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Classic course: inflammation of the salivary glands, particularly parotitis
Duration of parotitis: at least 2 days (may persist > 10 days)
initial present with local tenderness, pain, and earache
Unilateral swelling of the salivary gland (lateral cheek and jaw area);
During the course of disease, both salivary glands are usually swollen.
usually bilateral
Redness in the area of the parotid duct
Possible protruding ears
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Subclinical presentation
Nonspecific or predominantly respiratory symptoms
Asymptomatic (in 15–20% of cases)
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Chronic courses are rare.
what is the DIAGNOSIS OF MUMPS ?
Real-time reverse transcriptase PCR (rRT-PCR) on serum or buccal or oral swab
Viral culture (e.g., on CSF, urine, or saliva)
Serology: Positive serum IgM suggests recent infection and confirms the diagnosis.
Relative lymphocytosis
what are the dd of mumps ?
mumps - usually bilateral
acute purulent sialadentis- unilateral
sialdenosis - uni
sialolithiasis - partial swelling
tumors of the salivary gland - unilateral
what is TREATMNET OF MUMPS ?
self limited pain medication - acetaminophen bedrest adequate fluid intake avoid acidic food ice packs
what are the COMPLICATIONS OF MUMPS ?
orchitis - torsion of testes
bilateral
sudden onset of fever , nausea , vomiting
ASEPTIC MENINGITIS - MILD COURSE AND NO PERMANENT SEQUEL
encephalitis
acute pancreatitis
Before widespread vaccination, mumps was the most common cause of what ?
acquired sensorineural hearing loss and aseptic meningitis and encephalitis in children
fever. chills. painful headache sensitivity to light, or photophobia. firm neck pain
what are the DD FOR ASEPTIC MENINGITIS ?
enterovirus - coxsackievirus b5
echovirus 6,9,30
herpesvirus
HSV1 - labialise
HSV2 0 genital
varicella zoster - another herpes virus - but only in immunocompromised
aseptic meningitis -ARBOVIRUS follows geographical and seasonal patterns
what is the IMMUNITY OF MUMPS ?
life long immunity once infected
what Are the PREVENTION METHODS OF MUMPS ?
isolate patients for up to 5 days after onset of symptoms
mass vaccination of susceptible people
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primary immunisation - live attenuated vaccine in combination with measles and rubella vaccine- MMR
two doses
- 1st - 12-15months
second - 4-6 yrs
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contraindicated in first trim pregnancy - may lead to embryonal death - SO EARLY VACCINATION SHOULD BE AVOIDED
