Mumps: diagnosis and medical treatment

2021-07-22 10:38 PM

Mumps is transmitted directly through the respiratory tract, in addition to causing painful swelling of the parotid salivary glands, not pus, in addition, inflammation of the gonads.

Mumps is a contagious viral disease that is largely preventable by vaccination. Usually, it begins with a few days of fever, headache, muscle aches, fatigue, and loss of appetite, followed by rhinitis; The disease is usually self-limited.

Mumps occurs worldwide; Peak incidence is usually in late winter to early spring, although sporadic outbreaks occur at any time of year. Mumps occurs most commonly in school-age children and college-age young adults; Very rare in infants under one year of age, protected through maternal antibodies.

Mumps is an acute infectious disease, transmitted directly through the respiratory tract, the causative agent is the mumps virus, in addition to causing painless swelling of the parotid salivary glands, in addition, inflammation of the gonads meningitis, pancreatitis, and some other organs.

The disease is benign, self-healing, and causes lasting immunity.

Mumps virus is an RNA virus, belonging to the group of Paramyxoviruses, with a number of thin strands of RNA in the center of the spiral, the outer envelope is covered with lipids and proteins.

Clinical

Parotid salivary gland inflammation

This is the most common type in clinical practice.

Acute illness, fever 38°C-39°C or higher, headache, fatigue, joint pain, poor sleep.

The first manifestation is pain, appearing around the outer ear canal, then spreading around causing difficulty speaking, swallowing, and opening the mouth. Two authors, Rilliet and Barthez, note three pain points suggestive of parotid inflammation, which are:

Temporomandibular joint point.

Cylindrical point.

Submandibular lymph node.

Parotid gland

The swelling is large, spreading to the area before the ears, the mastoid process, spreading to the lower jaw, and losing the groove under the jaw.

The enlarged gland causes the ear lobe to be pushed outward and upward.

When the parotid gland is enlarged, sometimes the face is deformed.

Swollen skin has normal color stretch, burns, not hot red, elastic.

There is usually swelling on both sides of the parotid glands, one after the other for several hours to several days. The ratio of bilateral to unilateral swelling cases is 6/1.

Examination revealed an edematous, reddened stenotic hole but never a blinding discharge when pressed.

Orchitis

Common in puberty, accounting for 20% - 30% of cases of mumps in adults. Very rare in children under 2 years old and people over 50 years old. This manifestation sometimes occurs alone without parotid gland inflammation.

The disease appears after 5 to 10 days of swelling of the parotid gland. The patient has a high fever again, chills, headache, vomiting, pain in the testicle that is about to be swollen, then the testicle is 3-4 times bigger than normal, pain, red scrotum, sometimes the epididymis is also swollen. Usually, patients only have to swell in one testicle, but it can also be bilateral.

The disease progressed about 4-5 days, the patient had no fever, but the testicles were swollen for a longer time and did not turn pus.

After about 2 weeks, the testicles will not swell and it will take 2 months to evaluate whether the testicles have atrophied or not. Some authors found the rate of testicular atrophy due to mumps is 30%-40% after 2-4 months of infection.

If the patient has atrophy of one testicle, there is no effect, but if the patient is atrophy on both sides, there is a possibility of infertility.

Meningitis

Found in 10%-35% of cases, especially in young children, can occur alone or 3-10 days after parotid gland inflammation.

Clinical symptoms: high fever, headache, vomiting, confusion, convulsions, stiff neck, Kernig's sign (+). If the condition occurs after parotid gland inflammation, it is easily related to the cause of the mumps virus.

A lumbar puncture presents as hydrocephalus in lymphocytosis. Cerebrospinal fluid protein is moderately increased (50-100mg%), glucose is normal.

Encephalitis

Less common than meningitis (0.5%), it can also occur at the same time as or 2 to 3 weeks after parotid gland inflammation.

Clinical manifestations: same symptoms as other viral encephalitides with high fever, headache, convulsions, increased muscle tone, behavioral disorders, speech restriction, possibly focal paralysis.

On examination of the clear cerebrospinal fluid, the pressure increased but the composition did not change.

Consciousness and motor disturbances in nerve damage caused by mumps virus usually resolve spontaneously, very rarely, with permanent sequelae.

Acute pancreatitis

Usually uncommon, according to each author, usually 3 - 7% in adults, most of them are hidden, only showing biochemical changes through tests.

The disease occurs in the second week (4-10 days) when the parotid gland inflammation has improved.

The patient returned with fever, acute epigastric pain at the midpoint of the line connecting the nasopharynx to the navel. Vomiting, bloating, diarrhea, and loss of appetite are common signs.

Serum and urine amylase tests were elevated from day 3 of illness and returned to normal after 15 days.

The disease is benign, cured after 1-2 weeks, rarely leaving sequelae.

Ovitis: 7% after puberty, fever, and hypogastric pain (rarely infertility).

Epidemiology

Spring winter.

Live in a place where there is a mumps patient, or a classroom, construction site, or office where someone has mumps.

Test

Complete blood count: white blood cell normal or slightly decreased, lymphocyte increased.

Biochemistry: blood and urine amylase increased.

Isolation of mumps virus in salivary glands and cerebrospinal fluid.

Do diagnostic serological reactions: complement-conjugation or erythrocyte agglutination inhibitory reactions. ELISA reaction or immunofluorescence method detects specific IgM, IgG antibodies.

Differential diagnosis

Parotid salivary gland inflammation

Bacteria:

There is an infection of the parotid gland, which is swollen, hot, red, painful, and when pressed, there is pus flowing through the hole of the stent.

Blood tests increased white blood cell count and increased neutrophil count.

Obstruction of ducts due to stones:

Diagnosis: Contrast-enhanced stent.

Other diseases:

Other viruses: Influenza virus, Parainfluenza (based on testing for diagnosis).

Lymphosarcoma, Hodgkin's disease, lupus erythematosus: physical examination, lymph node biopsy, a blood test to confirm the diagnosis.

Tuberculosis: lymphadenectomy for cytology, chest x-ray, and blood test.

Orchitis

Tuberculosis of the testis and epididymis:

On physical examination, the course of the disease was less acute, fever in the afternoon, combined with chest x-ray, ultrasound with testicular fluid and blood tests, sputum for alcohol-resistant bacilli, acid-fast (AFB: acid-fast bacilli), and TB PCR in the testicular fluid.

Prostatitis and epididymitis in gonorrhea:

Appears after unprotected sex, with hematuria, pyuria.

Test urine culture for gonorrhea bacteria.

Meningitis

Bacterial meningitis:

The sea is acute, the state of infection - severe intoxication, clear meningeal syndrome.

A lumbar puncture for diagnosis.

Tuberculous meningitis: gradual onset, comprehensive examination, chest x-ray, lumbar puncture for diagnostic analysis.

Treatment

Currently, there is no specific treatment. Antibiotics have no effect. Only treat according to mechanism and symptoms.

Inflammation of the salivary glands

Patients must be isolated for a minimum of 2 weeks. Patients with limited movement, especially young people, are still feverish + swollen salivary glands (first 6-8 days).

Apply heat to the jaw area, if necessary, use mild sedatives and pain relievers (aspirin, paracetamol). Regularly rinse your mouth with 0.9% saline or 5% boric acid after eating. Eat light and loose food for the first few days.

Reduce fever if fever is too high with paracetamol 10mg/kg/every 8 hours.

Orchitis

You must stay in bed until the testicle swelling is gone. Limit heavy activities for 3 to 6 months.

Wear tight underwear to hang the testicles, apply heat.

Take pain relievers such as paracetamol 10mg/kg/every 8 hours.

Use corticosteroids (prednisolone, dexamethasone) 25-30mg/day.

Corticosteroids used for 5-7 days, stop, only have anti-inflammatory and pain-relieving effects, but do not limit the possibility of testicular atrophy. When giving these drugs, attention must be paid to cases where the drug cannot be used, such as patients with a history of stomach problems, and must be combined with drugs that coat the stomach lining.

Meningitis

If the patient shows signs of increased intracranial pressure (headache, vomiting); It is possible to have a lumbar puncture to remove CSF to relieve pressure, but each time should not exceed 15ml.

30% glucose solution or other hypertonic solutions at a dose of 250ml/day.

Mannitol 20% 300ml/day.

Use intravenous corticosteroids (prednisolone, dexamethasone) 25-30mg/day.

Cardiovascular support, water, and electrolyte balance.

Pay attention to the nursing regimen and nursing care for the patient.

Use appropriate antibiotics when superinfection is present.

Pancreatitis

Apply heat to the epigastrium, eat light and liquid, use pain relievers if necessary, pay attention to exclude conditions requiring surgical intervention.

Prevention

No contact with sick people for 14-21 days.

Active immunity

Vaccination:

Unit price.

Polyvalent: three in one (mumps, mumps, rubella).

Point:

People > 1 year old (any time), especially puberty, adulthood, teenagers, individuals living in crowded groups.

People with HIV have no symptoms (even those with symptoms).

Revaccination in previously vaccinated mumps with a dead virus (no risk of adverse reactions).

Create passive immunity

Specific prophylaxis with 7 immunoglobulins against mumps, used early in pregnant women in contact with mumps patients, 3-4 ml intramuscularly, but no protection.