Parotitis epidemical

2021-03-23 12:00 AM

An RNA group virus of the Paramyxovirus family. There is pathogenicity to the glands (exocrine) and nerve

Define

Mumps (also known as parotid gland or parotid gland inflammation due to mumps virus) is an acute infectious disease that spreads directly through the respiratory tract, or causes fluid in children. Mumps is caused by the mumps virus. The most common clinical presentation is inflammation of the parotid gland without pus. Other salivary glands, testicles, pancreas, and central nervous system can also be damaged.

Disease history

From the time of Hippocrates people have known about mumps and its transmission. In 1700 Hamilton described a testicular inflammation caused by mumps. In 1934 Johnson and Goodpasture found the mumps virus in the salivary glands of mumps patients. In 1950 Ender and his colleagues successfully invented a dead vaccine. In 1966 Buynak and Halleman successfully developed a live-attenuated vaccine.

Epidemiology

Pathogens

An RNA group virus of the Paramyxovirus family. There is a pathogenicity to the glands (exocrine) and nerve. Poor resistance, quickly inactivated in the sun and in hot dry conditions. Lasts long at low temperatures

Inoculum

People with acute mumps of all types.

Infection

Direct inhalation through contact between sick and healthy people.

Duration of infection: From 7 days before to 7 days after the first symptoms of the disease.

Epidemiological characteristics

The disease occurs all over the world and can occur all year round but often becomes epidemic in winter - spring.

The disease usually occurs in teenagers in groups: Kindergarten, school, rookie unit.

Sensation and immunity

Sensory: All people who do not have mumps are usually in their teens. Children under 2 years old and the elderly are very rarely sick.

Immunity: After being infected, there is a stable immunity that lasts for many years. There is a relapse, but very rarely. Maternal immunity to the baby lasts for about 1 year.

Mechanism of pathogenesis and pathology

Mechanism of pathogenesis

From the mucous membrane of the mouth, nose, throat, conjunctiva, the virus enters the bloodstream, causing viral infection and early symptoms of infection. Then from the blood, the virus enters the salivary glands (most commonly the parotid glands), gonads, pancreas, nerves, etc. and develops, causing symptoms of local inflammation in the organs. this. The virus is then excreted through saliva. Sometimes it is possible that from the salivary gland penetrates the bloodstream, causing damage in another.

Pathology

Salivary glands: Mainly inflammation of the interstitial tissue while lymphatic tissue is less susceptible to damage.

Pancreatitis: Necrotic inflammation of the endocrine system.

Testicular: Damage to both the interstitial and glandular epithelium leads to necrosis of the epithelial cells. Then the glands shrink and clogged. Severe injury can cause hypogonadism, lack of spermatozoa.

Central Nervous: Meninges are inflamed, infiltrating secretions. Inflammation of the brain causes edema, congestion.

clinical

Classify

Sort by symptoms         

Typical body.

Hidden form (accounting for 20% - 90% of the service).

Sorted by degree

There are levels: light, medium, heavy.

Sort by lesion location

Or used in clinical practice.

Inflammatory form of salivary glands: glands of the parotid, under the jaw, under the tongue.

Testicular inflammation.

Pancreatitis form.

Neurological form: Meningitis, encephalitis.

Combination: Inflammation of the parotid gland, testicular inflammation, inflammation of the parotid gland + meningitis.

Symptoms study according to each clinical form

Clinical, typical, moderate

It is inflammation of the parotid gland (the most common form, accounting for 70% of the clearly localized forms).

Incubation: Average from 18 to 21 days.

Onset: Fever 38-39 ° C. Headache, general aches and pains, poor appetite and sleep.

Full play:

After 24-28 hours of fever, parotid gland inflammation appears. Swelling on one side at first, after 1-2 days swelling on the other side (usually swelling on both sides, less swelling on only one side). The swelling on the two sides is often asymmetric (the side is swollen, the side is slightly swollen).

The skin of the parotid gland is swollen, shiny, not red, the pressure is not concave, is hot, painful.

Less saliva, thick.

Stenon ductus red inflammation (Mourson sign). When the parotid gland is not clearly swollen or at the beginning of the disease, it is necessary to find 3 pain points of Rillet and Barthez: the temporal joint point - jaw, the tip of the mastoid bone, the point behind the lower jaw.

Other symptoms:       

Jaw pain when opening, chewing, swallowing. Pain spread to the ear.

Red inflammation of the throat.

Swollen lymph nodes in the jaw.

Still fever, headache, possibly slow heartbeat.

There may be inflammation of the sublingual or sublingual gland.

Blood tests: Leukocytes decreased, polymorphonuclear leukocytes decreased, lymphocyte relative increase, blood amylase and urine increased.

Recovery:

The disease resolves on its own within 10 days. The fever usually clears after 3-4 days, the swelling disappears within 8-10 days, the swollen glands last a little longer. The salivary glands never purulent (unless superinfected) and never atrophy.

Other clinical forms

Inflammation of the salivary glands under the tongue, under the jaw:

Often accompanied by inflammation of the parotid gland, rarely separately.

When the inflammation of the lower jaw gland causes the chin to sag, it is difficult to swallow and swallow pain. Inflammation of the sublingual gland causes the tongue to stick out.

Laboratory tests: Both blood and urine amylases increased.

Species that are localized outside the salivary glands:

May occur before, with or after salivary gland inflammation. Sometimes salivary gland inflammation is not accompanied.

Testicular inflammation (orchitis):

Common in men who are puberty or mature.

The prevalence depends on the epidemic, depending on the author (from 10% to 30% of the cases of mumps), but it is the second most common localized place after parotid salivary gland inflammation.

Usually one-sided, less common both sides. When there are both sides, the swelling also occurs 2-3 days apart.

Usually occurs after salivary gland inflammation and when symptoms of salivary gland inflammation have subsided. Usually on days 5 to 10 of the illness the fever reappears or the fever increases. There may be nausea and vomiting. Testicular pain, especially when walking and 2-3 times larger than normal. In severe cases, there may be additional fibrosis, epididymitis and hydroceles.

Progression: The fever usually clears up after 3-5 days. Testicular swelling gradually reduces, may take 3 to 4 weeks before the swelling and pain (with severe form) and never pus.

Whether the testicles are atrophy or not have to wait about two months to know for sure (the rate of testicular atrophy is about 5/1000). Apermia is very rare. Endocrine function is usually not affected. Classically, atrophy of the testicles can cause conditions such as: No sperm, infertility, slow growth, loss of masculinity and impotence. Over the years today, most authors find that:

If one testicle atrophy will have no effect, the healthy side will work to compensate.

When both sides atrophy or in people with only 1 testicle, the rate of affected sexual activity and infertility is also low.

Ovarian inflammation (Oophoritis):

In contrast to testicular inflammation, mumps ovarian inflammation is very rare.

Pancreatitis:      

Uncommon, the rate depends on the author.

Nervous areas in the nervous system:

Mumps meningitis: Approximately 16% of mumps cases occur. Usually appears a few days after the inflammation of the salivary glands (sometimes comes first).

Encephalitis: Can occur with or after an inflammation of the parotid gland 2-3 weeks. Sometimes alone. Meningitis is often associated. Has a better prognosis than Japanese viral encephalitis. Rarely have death.

Other neurological manifestations:

 Spinal inflammation, inflammation of the multiple roots and nerves, inflammation of the cranial nerves (II, VII, VIII).

Other areas of mumps (very rare):

 Myocarditis, atypical pneumonia, pleural effusion, nephritis.

Prognosis - Complications and sequelae

Prognosis

Generally benign. Rarely can be fatal due to encephalitis, myocarditis, pancreatitis.

Complications and sequelae

Pregnant women with mumps can have miscarriages and premature births.

Men : Severe inflammation of the testicles on both sides can leave the testicles atrophy and infertility.

Diabetes due to pancreatitis, deafness due to nerve damage VIII.

Implementing the quadrants

Based on epidemiology, clinical, testing.

Epidemiology

There is an epidemic of mumps where the patient lives.

Winter - Spring.

clinical

Acute parotid gland inflammation does not tend to pus, often bilateral, not at the same time.

Test

The number of white blood cells in the blood decreases, lymphocytes increase.

Blood and urine amylases are elevated.

In pancreatitis may accompany high blood lipase.

Mumps virus isolation in saliva and cerebrospinal fluid.

Diagnostic serum: As a complement combination or erythrocyte agglutination inhibition reaction, the highly sensitive ELISA reaction is now widely used.

Differential diagnosis

When unilateral parotid gland inflammation should be distinguished from:

Purulent inflammation of the parotid gland

Due to bacteria typhoid, staphylococci, streptococcus ... Inflammation of the parotid gland is swollen, hot, red, and painful. Tend to pus so the seal should be concave. Swipe along the Stenon tube with pus coming out. Leukocytes increased, polymorphonuclear leukocytes increased. 

Salivary gland stones

Frequent frequent bumps, swelling increased with meals. Salivary gland to see stones.

Lymphadenitis of the lower jaw

Due to inflammation in the surrounding area (teeth, jaw, throat, pharynx, lymph nodes): Nodules have clear boundaries, mobility, pain. Leukocytes in peripheral blood increased, neutrophils increased. There is an inflammatory foci in the vicinity.

When swelling on both sides should distinguish from:

Abnormal bilateral parotid gland enlargement

There are no signs of pathology such as fever, pain in the parotid glands.

There was no swelling or reduction in the follow-up of some days. The disease has existed for a long time.

Treatment

There is no specific medicine, mainly symptomatic treatment.

Inflammation of the parotid gland

Mouthwash: 0.9% salt water, 5% Boric Acid solution.

Reduce fever if the fever is too high, relieve pain (Paracetamol), mild sedation (seduxen, rotunda), use vitaminsB, C to drink lemon juice, orange, and drink.

Bed rest, limit movement, while fever still swollen glands (usually the first 7-8 days). Quarantine for at least 10 days.

Testicular inflammation

Bed rest while still painful swelling. Wear lipsticks to hang the testicles.

Pain relief: Ice, paracetamol 0.5 ´ 1 tablet / time, take 2 to 3 times / day (drink when full, drink once every 6 hours) for 3-4 days.

If the testicular pain is severe, using paracetamol does not help, you can add codeine with a dose of 30 mg-60mg / day for adults (only use 2-3 days) or efferalgan-codeine 1 tablet / time x 2-3 times / day.

Reducing inflammation: Cortanxyl 20mg-30mg / day in 2 divided doses, take 3-4 days.

After the swelling and pain of the testicles can be used vitamin E 400mg 1 tablet / day for 1-2 months to increase sperm production.

Treatment of other forms

Pancreatitis, meningitis, encephalitis.

Preventive

Isolate 10-21 days if needed (usually 10 days).

Wearing a network when in contact with a patient.

Pregnant women are ill if conditions for specific immunoglobulin injection, dose of 0.3 mg/kg, a single intramuscular dose.

Live vaccines inactivated (often combined with other vaccines such as measles ...).

A single dose of 0.5 ml / subcutaneous injection once prevents the disease for adolescents and adolescents without immunity (especially for those with only one testicle, hearing loss). Vaccine for good immunity, without complications. Protection for 3 years to 5 years.