Mumps
Mumps is a paramyxovirus infection that has re-emerged with declining vaccination rates and classically causes parotitis with fever, headache, and malaise, complicated by orchitis, aseptic meningitis, pancreatitis, or hearing loss. Diagnosis is confirmed by PCR or IgM serology and management is supportive, since prevention through the two-dose MMR vaccine is the only proven control measure.
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What this article covers
- Overview
Paramyxovirus glandular infection: mumps virus is a single-stranded RNA paramyxovirus that preferentially infects glandular and neural tissue, producing the classic triad of parotitis, orchitis, and aseptic meningitis.
- Epidemiology
Outbreak-driven pattern: outbreaks occur largely in unvaccinated children and in close-contact congregate settings such as college dormitories, sports teams, and military units, even among previously…
- Risk factors
Unvaccinated or incompletely vaccinated status: the single strongest risk factor; lack of any MMR dose confers the highest risk.
- Pathophysiology
Respiratory entry and viremia: the virus initially replicates in the nasopharyngeal and upper respiratory epithelium, then disseminates hematogenously (viremia) to glandular and neural tissues.
- Clinical features
Parotitis: the hallmark finding, presenting as unilateral or bilateral parotid gland swelling with earache and pain worsened by chewing or acidic foods; this is the dominant clinical clue and, in an…
- Differential diagnosis
Bacterial (suppurative) parotitis: unilateral, tender, warm gland with purulent drainage from Stensen duct on massage, high fever, and marked leukocytosis; typically caused by Staphylococcus aureus…
- Diagnosis
Clinical diagnosis in an epidemiologically linked case, confirmed virologically: an epidemiologically compatible presentation (parotitis plus fever, headache, and malaise in an unvaccinated or…
- Management
First, confirm there is no antiviral therapy for mumps and begin supportive, organ-directed care: management is symptomatic throughout the illness.
- Complications
Orchitis with testicular atrophy: the most feared reproductive complication in postpubertal men; while sterility is uncommon even after bilateral involvement, unilateral testicular atrophy can occur.
- Prognosis
Excellent in immunized or uncomplicated cases: most cases resolve fully within 1-2 weeks without sequelae.
- Prevention
Two-dose MMR vaccination is the primary prevention strategy: the first dose is given at age 12-15 months and the second at age 4-6 years; adults born in 1957 or later without documented immunity…
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