PAROTITIS

EPIDEMIC PAROTHYT (syn: zaushnitsa, mumps) is an acute infectious disease characterized by the defeat of glandular organs (parotid and submandibular salivary glands, gonads, more often testicles, pancreas, etc.). As well as the central nervous system. Pathogen is a virus that is pathogenic to humans and monkeys.

The source of infectious agents is a patient with epidemic parotitis, from the last days of the incubation period to the 9th day of the disease. From the patient's organism, the pathogen of infection is excreted with saliva; Its transmission takes place mainly by airborne droplets, but the possibility of infection through objects of everyday use (toys, towels, etc.) infected with the patient's saliva is not ruled out. A transplacental transmission of the virus from a sick pregnant woman to a fetus is described. Particularly susceptible to the disease, children aged 5 to 15 years, are less likely to have children of an early age and adults. As a rule, sporadic cases of the disease occur. The maximum incidence is in the winter and spring months, when in children's institutions, less often in groups of adults, there may be epidemic outbreaks. The outbreak of outbreaks is facilitated by population overcrowding.

Clinical picture . The incubation period usually lasts from 11 to 26 (usually 15 to 20 days). Often the unfolded picture of the disease is preceded by a prodromal period, manifested by malaise, loss of appetite, headache, hyperemia of pharynx. Distinguish typical and atypical (erased, asymptomatic) course of the disease.

Most often the disease begins with an increase in body temperature to 38-39 ° C, there is a slight chill, the parotid gland (more often on one side) swells, becomes painful. After 1-2 days, the second gland is usually affected, and the patient's face acquires a characteristic appearance, resulting in the disease being called "mumps". The patient complains of pains in the parotid region, aggravated by chewing, opening the mouth, sometimes with swallowing. In some cases, the pain radiates into the ear, there is a noise in the ears. The voice becomes muffled, with a nasal hue. In the early days of the disease, the swelling is determined in front of the ear, then spreads posteriorly and downward (by the angle of the lower jaw), filling the pit between the lower jaw and the mastoid process of the temporal bone, while the ear lobe is somewhat protruding. The skin over the enlarged gland becomes taut, shiny, its color, as a rule, does not change. When palpation in the center of the gland is determined by a slight soreness, the consistency of the gland in the center is dense-elastic, the periphery is softer. When examining the oral cavity, swelling and hyperemia of the mouth of the parotid duct are noted.

Sometimes other salivary glands may also be involved in the process: submandibular, less often hyoid. When the submaxillary glands are affected (submaxillitis), a dense painful swelling is determined from the edge of the lower jaw.

The increase in the affected salivary glands is usually observed before the 4th-5th day of the disease, then the swelling decreases and in most cases disappears completely on the 6th-9th day. The total duration of the febrile period is usually 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 serves as an indicator of involvement in the pathological process of other organs (testes, CNS, etc.) or complications (pleurisy, nephritis, arthritis, polyneuritis, etc.).

A frequent symptom in adolescents and adult men is testicular damage - orchitis . As a rule, he joins mumps on the 6th-8th day of the disease. The defeat of the testicle can be one- or two-sided. The general condition of the patient noticeably worsens, the body temperature rises again (to 40-41 ° C), acute pain in the testicle soon occurs. The testicle increases 2 to 3 times, the skin of the scrotum becomes hyperemic, edematous. At palpation the testicle is sharply painful, dense. After 2 - 3 days, inflammatory phenomena gradually subside and usually disappear by the end of the 1st or the 2nd week.

Quite often there is a pancreatic lesion - pancreatitis , which usually develops after the defeat of the salivary glands. There are sharp pains in the abdomen, nausea , vomiting , a decrease in appetite, constipation or diarrhea, nausea and dryness of the tongue. All symptoms usually disappear after 5-10 days.

Serous meningitis develops usually in children 10-12 years 3 to 6 days after the onset of mumps or submaxillitis, sometimes simultaneously with the defeat of the glands. At the same time, body temperature rises, vomiting , severe headache , sometimes convulsions, there are symptoms of Kernig, Brudzinsky and other meningeal symptoms that last for 3-10 days. In a number of cases, encephalitis (meningoencephalitis) can join. Serous meningitis and meningoencephalitis of parotitis etiology can develop in isolation without lesion of the salivary glands and other glandular organs.

The diagnosis is based on the clinical picture, the epidemiological history (contact with the diseased mumps) and the results of laboratory studies. In the blood, leukopenia and lymphocytosis are detected, in the early days of the disease, leukocytosis is possible. ESR slightly increased. In doubtful cases, virological, serological methods (complement fixation reaction, etc.), intradermal reactions with parotite antigen are used.

Differential diagnosis for parotid gland involvement is often carried out with bacterial mumps, with submaxillitis - with submaxillary lymphadenitis. Bacterial parotitis and lymphadenitis are characterized by skin hyperemia over the affected gland or lymph node, severe soreness, fluctuation, pronounced leukocytosis and increased ESR.

Treatment for lesions of the salivary glands is symptomatic, usually performed at home. Assign bed rest, copious drink (tea, juice, mineral water), food in the first 3 - 4 days should be liquid or semi-liquid. After eating, rinse the mouth with boiled water, a weak solution of potassium permanganate, 2% sodium hydrogen carbonate solution. To the affected salivary glands recommend dry heat. With the development of orchitis, pancreatitis, serous meningitis or meningoencephalitis, the patient must be urgently hospitalized.

The forecast is favorable in most cases. Sometimes after a bilateral bilateral orchitis comes infertility . In patients who have suffered a defeat of the nervous system, in rare cases, residual phenomena can occur in the form of paresis, paralysis, and damage to the auditory nerve with the development of deafness.

Prevention. Patients with mumps are to be isolated at home or in the hospital. Considering the great epidemiological significance of patients with erased and asymptomatic forms of the disease, which are about 2 times more common in children under 4 years of age than those clinically pronounced, careful identification of these patients in the outbreak center (including using serological methods) and their isolation is necessary. Specific prophylaxis is carried out with a dry live vaccine.