Indications for Testing

• Generally diagnosed by clinical presentation
• Atypical presentation of secondary complications

Laboratory Testing

• Limited role for laboratory testing
• IgM antibody response normally appears 7-14 days after disease onset
  • IgM antibody response may be delayed or absent in previously vaccinated patients and the period of viral excretion may be shorter
• Assays for IgM are more useful than IgG assays for acute infections because cross-reactions have not been observed with IgM
  • Cross reactivity can occur with assays for IgG, particularly with parainfluenza 1 and 3
• IgG antibody levels induced by vaccine are lower than those from natural infection
• Culture  – saliva, throat, urine and cerebrospinal fluid
• RT-PCR

Differential Diagnosis

• Viral
  • Parainfluenza virus – types 1, 2, 3
  • Influenza virus– type A
  • Coxsackievirus
  • Epstein-Barr virus
  • Adenovirus
  • Herpesvirus 6
  • HIV
• Bacterial parotitis – unilateral
• Parotid gland neoplasm – unilateral
• Salivary stones – unilateral
• Metabolic disorders
  • Diabetes mellitus
  • Cirrhosis
  • Uremia
• Sjögren syndrome

Mumps is an acute, contagious disease of short duration (generally self-limiting) and characterized by swelling of the parotid gland.

Epidemiology

• Prevalence – <300 cases in U.S. from 2001 to 2003
  • Since 2003 – several outbreaks involving >1,000 people
• Incidence has decreased greatly since the MMR (measles, mumps, rubella) vaccine was introduced in 1971
• Age – highest incidence at 16-24 years
• Transmission
  • Disease is highly contagious and transmitted by droplets spread from the upper respiratory tract

Organism

• Paramyxoviridae family; Rubulavirus genus
• Single-stranded RNA virus
• Immunity after infection appears to be lifelong
  • Silent reinfection occurs infrequently

Clinical Presentation

• Incubation period – 18-21 days
  • 25-30% of all infections are silent
• Most common clinical feature is bilateral or unilateral parotitis (60-70% of infections)
• Secondary complications can involve the following
  • Testes (orchitis)
    • Mumps orchitis, particularly in teenagers, can lead to decreased fertility or infertility
  • Ovaries (oophoritis)
  • Central nervous system – aseptic meningitis, encephalitis
  • Rare – pancreas, peripheral nervous system, eye, inner ear, myocardium (myocarditis)

Treatment

• Supportive

Prevention

• Vaccination with MMR vaccine (75-90% effective)
• Mumps is uncommon in the U.S.; secondary to current vaccination programs
• Administer vaccine to infants (age 12-15 months) with revaccination during childhood (age 4-12 years)
• Because the vaccine is a live, attenuated virus, vaccination is not recommended for patients who are
  • Significantly immunosuppressed (eg, HIV, cancer, chronic corticosteroid therapy)
  • Allergic to gelatin (component of the vaccine)
  • Pregnant

Tests generally appear in the order most useful for common clinical situations

Guidelines

• Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0 through 18 years---United States, 2010. MMWR 2010;58(51&52). [Accessed: 28 Apr 2011] 

General

• Andersen E. Mumps--new face on an old disease. AAOHN J. 2006; 54 (10) :425-426.PubMed
• Campos-Outcalt D. Mumps epidemic in 2006: are you prepared to detect and prevent it?. J Fam Pract. 2006; 55 (6) :500-502.PubMed
• Hviid A, Rubin S, Muhlemann K. Mumps. Lancet. 2008; 371 (9616) :932-944.PubMed
• Kancherla VS, Hanson IC. Mumps resurgence in the United States. J Allergy Clin Immunol. 2006; 118 (4) :938-941.PubMed
• Kyaw MH, Bellini WJ, Dayan GH. Mumps surveillance and prevention: putting mumps back on our radar screen. Cleve Clin J Med. 2007; 74 (1) :13-15.PubMed
• Senanayake SN. Mumps: a resurgent disease with protean manifestations. Med J Aust. 2008; 189 (8) :456-459.PubMed
• Shanley JD. The resurgence of mumps in young adults and adolescents. Cleve Clin J Med. 2007; 74 (1) :42-48.PubMed

Infertility
Meningitis, Acute