EPIDEMIC Mumps ( synonym : mumps, mumps) is an acute infectious disease characterized by damage to the glandular organs (parotid and submandibular salivary glands, genital glands, more often the testicles, pancreas, etc.). as well as the central nervous system. The causative agent is a virus pathogenic to humans and monkeys.
The source of infectious agents is a patient with mumps, starting from the last days of the incubation period until the 9th day of illness. An infectious agent is excreted from the patient’s body with saliva; its transmission occurs predominantly by airborne droplets, but the possibility of infection through household items (toys, towels, etc.) infected with the patient’s saliva is not excluded. Transplacental transmission of the virus from a sick pregnant woman to the fetus is described. Children between the ages of 5 and 15 are especially susceptible to the disease, and infants and adults are less likely to get sick. As a rule, there are sporadic cases of the disease. The maximum incidence occurs in the winter and spring months, when epidemic outbreaks can be observed in children's institutions, less often in adult groups. The outbreaks contribute to the crowding of the population.
The clinical picture . The incubation period usually lasts from 11 to 26 (usually 15 to 20 days). Often a detailed picture of the disease is preceded by a prodromal period, manifested by malaise, loss of appetite, headache, hyperemia of the pharynx. Distinguish between typical and atypical (erased, asymptomatic) course of the disease.
Most often, the disease begins with an increase in body temperature to 38–39 ° C, a slight chill occurs, the parotid gland (usually on one side) swells, becomes painful. After 1-2 days, the second gland is usually affected, while the patient’s face acquires a characteristic appearance, as a result of which the disease is called “mumps”. The patient complains of pain in the parotid region, aggravated by chewing, opening the mouth, sometimes when swallowing. In some cases, pain radiates to the ear, and tinnitus appears. The voice becomes muffled, with a nasal tone. In the early days of the disease, the swelling is determined in front of the ear, then spreads posteriorly and downwards (around the angle of the lower jaw), filling the fossa between the lower jaw and the mastoid process of the temporal bone, while the earlobe is slightly protruding. The skin above the enlarged gland becomes tense, shiny, its color, as a rule, does not change. On palpation in the center of the gland, a slight pain is determined, the consistency of the gland in the center is densely elastic, softer along the periphery. When examining the oral cavity, swelling and hyperemia of the mouth of the duct of the parotid gland are noted.
Sometimes other salivary glands may be involved in the process: submandibular, less often sublingual. With damage to the submandibular glands (submaxillitis) inward from the edge of the lower jaw, a dense painful swelling is determined.
An increase in the affected salivary glands is usually observed until the 4th - 5th day of illness, then the swelling decreases and in most cases completely disappears by the 6th – 9th day. The total duration of the febrile period is more often 3 to 4 days, in severe cases - 6 to 9 days. Fever is usually of a constant type with a lytic drop in temperature. A repeated increase in temperature is an indicator of the involvement of other organs (testicles, central nervous system, etc.) in the pathological process or the addition of complications (pleurisy, nephritis, arthritis, polyneuritis, etc.).
A common symptom in adolescents and adult men is a testicular lesion - orchitis . As a rule, he joins mumps on the 6-8th day of illness. The defeat of the testicle can be single or double-sided. The general condition of the patient noticeably worsens, body temperature rises again (up to 40–41 ° C), sharp pains in the testicle soon arise. The testicle increases 2 to 3 times, the skin of the scrotum becomes hyperemic, swollen. On palpation, the testicle is sharply painful, dense. After 2 to 3 days, the inflammatory phenomena gradually subside and usually disappear by the end of the 1st or 2nd week.
Damage to the pancreas is quite common - pancreatitis , which usually develops after damage to the salivary glands. Sharp abdominal pains, nausea , vomiting , loss of appetite, constipation or diarrhea, tightness and dryness of the tongue are noted. All symptoms usually disappear after 5-10 days.
Serous meningitis usually develops in children 10-12 years old 3-6 days after the occurrence of mumps or submaxillitis, sometimes simultaneously with damage to the glands. At the same time, body temperature rises, vomiting , a sharp headache , sometimes cramps are noted, symptoms of Kernig, Brudzinsky and other meningeal symptoms appear, which last 3-10 days. In some cases, encephalitis (meningoencephalitis) may join. Serous meningitis and meningoencephalitis of mumps etiology can develop in isolation without damage to the salivary glands and other glandular organs.
The diagnosis is based on the clinical picture, data of an epidemiological history (contact with a patient with mumps) and the results of laboratory tests. Leukopenia and lymphocytosis are detected in the blood, leukocytosis is possible in the early days of the disease. ESR is slightly increased. In doubtful cases, virological and serological methods are used (complement binding reaction, etc.), intradermal reactions with mumps antigen.
The differential diagnosis of lesions of the parotid glands is more often carried out with bacterial mumps, with submaxillitis - with submandibular lymphadenitis. Bacterial mumps and lymphadenitis are characterized by flushing of the skin over the affected gland or lymph node, severe soreness, fluctuation, severe leukocytosis and an increase in ESR.
Treatment for salivary gland lesions is symptomatic, usually carried out at home. Assign bed rest, drink plenty of fluids (tea, juices, mineral water), food in the first 3 to 4 days should be liquid or semi-liquid. After eating, it is recommended to rinse the oral cavity with boiled water, a weak solution of potassium permanganate, 2% sodium bicarbonate solution. Dry heat is recommended on the affected salivary glands. With the development of orchitis, pancreatitis, serous meningitis or meningoencephalitis, the patient must be hospitalized urgently.
The prognosis in most cases is favorable. Sometimes after a bilateral bilateral orchitis infertility occurs. In patients who have suffered damage to the nervous system, in rare cases, residual effects in the form of paresis, paralysis, damage to the auditory nerve with the development of deafness can be noted.
Prevention Patients with mumps should be isolated at home or in the hospital. Given the great epidemiological significance of patients with erased and asymptomatic forms of the disease, which in children under 4 years of age are approximately 2 times more likely than clinically expressed, careful identification of these patients in the focus of infection (including using serological methods) and their isolation are necessary. Specific prophylaxis is carried out with a dry live vaccine.