MUMPS

Mumps is caused by a virus which spreads by droplet infection and affects mainly children of school age and young adults. The virus has a predilection for certain gland tissues. The common site of infection is one or both parotid glands, but sometimes there is involvement of the submandibular or sublingual salivary glands, the testicle, the pancreas or ovary alone or in combination. Encephalomyelitis is rare, but examination of the cerebrospinal fluid early in the course of mumps frequently shows an increase in lymphocytes. The infectivity rate is not very high. Most cases occur in the spring. The disease is not notifiable. The incubation period is 18 days. A quarantine period is not necessary: contacts should be watched for the first sign of disease from the 12^th to the 28^th day after exposure.

Clinical features:

Constitutional disturbance is slight or moderate, and may be present for several days before any specific symptom is present. During this time it may be possible to suspect mumps by observing inflammatory swelling round the orifice of the parotid duct. More often the diagnosis is not evident until there is painful spasm of the jaw muscles on attempting to open the mouth and tender swelling of one or both parotid glands appears.

Indeed, parotid swelling alone is often the first feature. Mumps should also be considered when patient suffers from acute inflammation of a submandibular gland or of a testicle for which there is no local cause. Obscure abdominal pain may also rarely be due to pancreatitis or oophoritis. Acute lymphocytic meningitis is another mode of presentation. If such conditions are due to mumps, they are accompanied by a lymphocytosis. It is also of great diagnostic value in such obscure cases to know that mumps is epidemic in the district at the time.

The swollen glands subside in a few days, and may be succeeded by swelling of a previously unaffected gland. Orchitis occurs at puberty or in early manhood and is usually on one side only, but if it is bilateral, sterility may be a sequel.

Diagnosis:

Most cases of mumps can be diagnosed on clinical grounds alone. A compliment fixation test can establish the diagnosis as early as the sixth day from the onset of symptoms, and is of value in atypical cases.

Treatment:

Oral hygiene is important when the mouth is very dry due to lack of saliva. Difficulty in opening the mouth may necessitate feeding through straw. Apart from the relief of symptoms as they appear, no other treatment is necessary. Orchitis can be relieved by the administration of prednisolone for a few days without apparent danger of dissemination of infection. Cases of mumps should be isolated until gland last affected has subsided. 

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