Mumps

Symptoms Of Mumps

Most children are asymptomatic or demonstrate mild respiratory symptoms like a cold. Symptoms are usually seen 7 to 21 days after contracting the infection. The following are the early symptoms of mumps that can be seen in both adults and children:

• Low to moderate grade fever

• Malaise or generalised feeling of discomfort/uneasiness

• Myalgia or muscle pain

• Headache

• Anorexia or loss of appetite

These symptoms are followed by:

• A high grade fever of 103°F or 104° F (about 39.5 or 40°C)

• Parititis (swelling and discomfort in the salivary or parotid glands)

• Swollen and tender jaw

• Pain in the ears

• Difficulty in eating, chewing, swallowing (particularly acidic drinks like citrus fruit juices) or talking.

Note: Parotitis is a condition in which there is a swelling and discomfort in the salivary glands (in the front of the neck) or the parotid glands (in front of the ears). Swelling of these glands usually occurs within 24 hours after the first symptoms appear but in some cases, might take as long as 1 week. Either of these glands may get involved on one or both sides of your face. The glands are tender when touched. Swelling causes cheeks to puff out.

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Causes Of Mumps

Mumps is caused by a virus known as paramyxovirus which is a member of the rubulavirus family.

• The virus spreads easily through infected saliva and can be contacted by other people  by inhaling infected air droplets released through coughing or sneezing.

• Mumps can also spread if you use utensils or cups with someone who has already had the infection.

• It also spreads by engaging in close contact activities with an infected person such as  dancing, kissing or playing sports. 

If one contracts mumps, the virus moves from the respiratory tract (the nose, mouth, and throat) into the parotid or other glands, where it begins to reproduce. This leads to inflammation, swelling, and tenderness of the glands.

Patients are most contagious 1-2 days before onset of symptoms but they can even spread the disease at least five days before their salivary glands begin to swell and one week after the appearance of symptoms.

Risk Factors For Mumps

You are more likely to develop mumps, if you are:

• School going children

• College students 

• Living or travelling to places where there is a high prevalence of mumps 

• Being exposed to someone who has been recently infected with mumps

• Not being immunised against mumps 

• Being in a crowded setting

• Having a weak immune system 

Most cases of mumps are seen during late winters or early spring.

Diagnosis Of Mumps 

Call your healthcare provider, if your child is showing any symptoms of mumps or has come in contact with someone who has been infected with mumps. Your doctor will provide you with specific instructions before you visit their clinic so as to protect other patients from acquiring the infection.

Your doctor will perform a routine examination and record the present symptoms to confirm if your child has mumps. No tests are needed in most cases. The doctor can usually diagnose mumps by looking at the symptoms.

However, the following tests might help in confirming the diagnosis of mumps, especially in cases of viral mumps infection in the absence of any parotid swelling and/or salivary gland involvement.

1. RT-PCR test

In RT-PCR based testing, viral RNA can be extracted directly from buccal (inner cheek) swabs, throat swabs and saliva for virus detection, particularly when obtained within 2 days of the appearance of symptoms. 

The ability to detect viral RNA rapidly reduces beyond the first week after the onset of symptoms. Virus detection has been also found to be substantially lower in people who have received two doses of mumps vaccine in the past than in unvaccinated people.

2. IgM test

The mumps virus antibody IgM test is used for the laboratory diagnosis of mumps virus infection. Detection of IgM antibodies supports a clinical diagnosis of recent infection with the virus.

However, since most people are vaccinated, test results may not mount a detectable IgM response on reinfection. Thus, a negative IgM result does not necessarily rule out mumps. Moreover, IgM may not be detectable if the test is done prior to day 3 of symptom onset or beyond 6 weeks after symptom onset.

3. Ig G test

The presence of detectable quantities of IgG antibodies could mean a previous exposure to the mumps virus either through an infection or immunisation. Individuals testing positive are considered immune to the mumps virus. 

4. CSF analysis

In case of complications involving the central nervous system (CNS), a lumbar puncture (spinal tap) may be used to rule out other potential causes.

Prevention Of Mumps

The best way to protect your child from acquiring the infection is to get them vaccinated with the MMR vaccine. The MMR vaccine protects people against three diseases: measles, mumps, and rubella. This vaccine is safe in nature and works as an extremely effective prevention strategy. Children usually do not show any side effects after getting the vaccination. If seen, the side effects are extremely mild in nature and present signs such as rash or low-grade fever. 

Two shots of the vaccine are given to a child:

• The first shot is given between the ages of 12 to 15 months

• The second shot is a must for school-going children who are between the ages of 4 to 6 years old

The vaccine is effective after both the shots have been administered. A single dose cannot provide complete protection against the infection. 

The following people are also advised to get timely vaccination:

• Women who are not pregnant but are of childbearing age

• Students who attend postsecondary school or college

• People who work in healthcare facilities like hospitals or in schools or childcare centres

• People who have been born before 1957

• People who plan to travel by cruise or travel overseas

Note: People who are currently ill need to wait till they recover to get the vaccine. Also, pregnant women can wait till they deliver to get the vaccine.

You may not need the MMR vaccination, if you:

• Have had two doses of MMR vaccination after 12 months of age 

• Have been receiving chemotherapy

• Are on a long term immunosuppressive therapy 

• Have had blood tests that indicate you have immunity against measles, mumps, and rubella (due to a previous infection)

Also, MMR vaccination is contraindicated in:

• People with a life-threatening allergy to gelatin, neomycin or any other constituents of the vaccine

• Pregnant women or women who plan to get pregnant soon 

• People with compromised immune system

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Specialist To Visit

In case your child displays any signs such as fever, swelling of salivary glands, muscle aches, fatigue, and headaches, or if there have been other cases of mumps in the school and your child has come in close contact with an infected person, you can consult the following doctors for proper diagnosis:

• General physician

• Paediatrician 

• Infectious disease specialist

Treatment Of Mumps

Mumps is mostly a self-resolving illness. It does not require any specific treatment and it can't be treated using antibiotics as it is a viral infection. Treatment is supportive care for each presenting symptom.

• Over-the-counter, non-aspirin pain relief medications like acetaminophen or ibuprofen can help to relieve symptoms. Do not give aspirin to your child since aspirin given during viral illness has been linked with cases of Reye syndrome, a life threatening disease that can cause liver failure and swelling of the brain.

• Application of warm and cold compress to the painful parotid or other salivary gland area may be helpful in relieving tenderness.

The following treatment protocols are considered for management of complications of mumps:

• Boys or men who have inflammation of the testes require bed rest. The scrotum can be supported with an athletic supporter or by an adhesive tape connecting the thighs. Elevation along with cold compression may also provide some relief from pain of tender testicles.

• Studies have shown that treatment with interferon-α2B seems to be effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. However, large scale studies are needed to establish these promising results.

• Lumbar injection can be considered to relieve a headache associated with meningitis due to mumps viral infection.

Home-care For Mumps

Mumps is a self limiting disease and its management primarily involves taking care at home. This includes making yourself comfortable and resting until your symptoms pass away. To take care at home follow the given tips. 

• The most important step is to isolate yourself or your child to prevent spreading mumps to others. The CDC recommends isolation for 5 days after the onset of parotid or other salivary glands swelling.

• Hygiene practices like thorough and frequent hand-washing, covering the mouth when sneezing or coughing along with sanitisation of regularly touched surfaces, are also important to prevent spread of disease.

• Rest up whenever you feel tired. It is quite common to experience fatigue and muscle aches. It is important to rest up during these times. 

• You can apply warm and cold compresses regularly to soothe inflamed salivary glands. 

• Drink lots of fluids like filtered water, coconut water, soups etc to avoid dehydration due to fever. 

• It is recommended to avoid intake of acidic food or sour foods, such as citrus fruits or juices during this time. Acidic food tends to increase salivation that will increase pain in your salivary glands.

• Consume a soft, bland diet including mashed potatoes, oatmeal, yoghurt, broth based soups or other soft foods that are easy to swallow and don't require a lot of chewing. 

Complications Of Mumps

Mumps can lead to several complications which include the following:

1. Orchitis: This condition is seen in 15-30% of cases in post-pubertal men. It is characterised by inflammation of the tube that carries and stores sperm and/or the testicles. The inflammation of one of both the testicles is accompanied by fever, which typically occurs during the first week of parotitis but can develop after 6 weeks of parotitis. The testis becomes painful and gets enlarged to several times its normal size. This condition resolves usually within a week. Testicular atrophy develops in 50% of the affected men but sterility is rare.

2. Oophoritis: This condition involves inflammation of one of both ovaries and occurs in 5% of women with mumps. It may be associated with lower abdominal pain and vomiting. It rarely been associated with sterility or premature menopause.

3. Mastitis: Inflammation of breast tissue can be seen in some cases of mumps.

4. Pancreatitis: This condition involves inflammation of the pancreas that is present in the abdomen. Pancreatitis is a temporary condition that resolves when mumps resolve. Some of the common symptoms include nausea, vomiting, and pain in the abdomen. 

5. Meningitis: Meningitis is the swelling of the membranes surrounding your brain and spinal cord. It is a fatal condition that requires immediate medical treatment. 

6. Encephalitis: Encephalitis is the inflammation of the brain itself. Symptoms associated with the conditions include seizures, severe headaches, and loss of consciousness. 

7. Hearing loss: Mumps, when left untreated, can lead to hearing loss in rare cases. 5 out of 10,000 cases are associated with a loss of hearing. The paramyxovirus can damage the cochlea of the ear, a structure present in the inner ear that aids in hearing. 

8. Heart problems: Rarely, mumps has been associated with abnormal heartbeat and diseases of the heart muscle.

It is wise to consult a doctor if you have any symptoms or plan to get a second opinion from a doctor. Consult India’s best doctors here.
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Alternative Therapies For Mumps

Herbal remedies 

• You can make a paste out of ginger powder and use it on the swollen part for pain relief. 

• Aloe vera has soothing properties that can bring relief from swelling and pain. 

• Neem leaves have been used since ancient times to treat mumps. Neem leaves reduce itching and swelling and can be mixed with turmeric powder to form a paste that can be applied to the swelling. 

Homoeopathy 

Homoeopathic medications may be useful in managing mumps. Aconitum and Belladonna are two homoeopathic medicines that are said to help in managing the signs of mumps. Pilocarpine can help in controlling salivation and perspiration which can work as a great remedy for mumps. 

Living With Mumps

Being diagnosed with mumps can cause stress and anxiety in parents. This medical condition can be painful for children and adults alike. However, the disease is mostly self resolving and tends to pass away in 10 to 12 days by itself. You have to simply let it run its course. However, timely diagnosis and treatment can help you get some relief from the symptoms and avoid more severe complications.

Mumps can cause muscle tiredness and fatigue. You will need to take sufficient rest and drink plenty of fluids to avoid dehydration due to fever. Use a warm and cold compress to relieve pain and swelling. Non- aspirin medications like acetaminophen or ibuprofen will help you in managing the pain associated with mumps.