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Overview |
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Definition |
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Mumps, also called infectious or epidemic parotitis (or parotiditis), is a
contagious viral disease. It usually causes painful enlargement of the salivary
glands, particularly the parotids. The disease is generally self-limiting.
Infection with the virus, including the approximately 30% of infections that are
subclinical, results in lifelong immunity.
Mumps is most commonly a disease of childhood and adolescence. Although
overall mortality is low, complications and fatalities occur more frequently in
patients older than 20. Painful orchitis, sometimes resulting in testicular
atrophy and, rarely, in sterility, is a particular concern when mumps occurs in
postpubertal males.
The incidence of mumps has decreased approximately 99% in the U.S. since the
introduction of the live virus vaccine in 1967. Prior to the vaccine, about half
of all children contracted the disease. Now only about 1,500 cases are reported
in the U.S. each year. |
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Etiology |
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Mumps is caused by a paramyxovirus, spread through infected saliva and
probably entering via the mouth. The incubation period is 14 to 24 days. Humans
are the only reservoir of the mumps virus.
Most symptoms of mumps result from direct infection of the parotid glands,
testes, pancreas, eyes, ovaries, or kidneys. The virus is also frequently
neurotropic, resulting in central nervous system
involvement. |
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Risk Factors |
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- Lack of immunization
- Age: Peak incidence occurs between 5 and 9 years of age, followed by 1
to 4 and 10 to 14.
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Signs and Symptoms |
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- Febrile illness: fever, chills, headache, anorexia, malaise
- Pain on chewing or swallowing
- Glandular swelling: in front of and below the ear, usually bilateral
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Differential
Diagnosis |
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- Acute suppurative parotitis (often due to Staphylococcus
aureus)
- Mastoiditis
- Cervical lymphadenitis
- Salivary calculus
- Other viruses may cause parotid swelling including parainfluenza,
Coxsackie, and influenza A
- Mikulicz's syndrome (chronic painless parotid and lachrymal gland
edema of unknown etiology)
- Salivary gland tumors (benign or malignant)
- Drug-related parotid enlargement
- In the case of testicular involvement, must consider orchitis,
epidydimitis, and testicular torsion
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Diagnosis |
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Physical Examination |
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Parotid glands are extremely tender and feel jelly-like, with swelling
anterior to the ear and above the angle of the jaw. Submaxillary and sublingual
glands may also be involved. Skin over swollen glands may be tense and shiny,
but not usually warm or erythematous. Stensen's duct may show signs of
inflammation including edema and erythema. |
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Laboratory Tests |
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- WBC: May show leukocytosis with predominance of lymphocytes,
leukopenia, or normal count; most commonly shows slight reduction
- Serum amylase: May be
elevated.
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Imaging |
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Not generally necessary, although studies, such as ultrasound, may be
required to distinguish mumps orchitis from testicular
torsion. |
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Other Diagnostic
Procedures |
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Complement fixation, hemagglutination inhibition, and enzyme-linked
immunosorbent assay tests may be performed with paired samples from the acute
and convalescent phases; antibodies tend to peak in the first week and drop off
rapidly. The virus may be isolated from the throat, cerebrospinal fluid, blood,
and possibly the urine. |
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Treatment Options |
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Treatment Strategy |
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The patient should be isolated until glandular swelling subsides. Treatment
is symptomatic and should include a soft diet, avoidance of acidic food and
beverages, and administration of analgesics. Orchitis requires bed rest. Pain
may be relieved by means of ice packs. Relief may also be provided by supporting
the scrotum with cotton or gauze (or an athletic supporter when ambulatory).
If patient develops pancreatitis (see section entitled
Complications/Sequelae) with nausea and vomiting, administer IV fluids
and treat appropriately. Please see monograph on Pancreatitis for
detailed information.
Routine hearing tests should be performed on young children to detect any
loss, as this is a common complication (see section entitled
Complications/Sequelae). |
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Drug Therapies |
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In the case of mumps, medicines are intended for symptomatic relief and/or
treatment of complications; generally, no medications other than analgesics are
indicated for uncomplicated mumps. |
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Complementary and Alternative
Therapies |
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As mentioned earlier, mumps is generally a self-limiting disease, the
treatment of which typically entails providing symptomatic relief. Acupuncture
has been reported to be effective in shortening the duration of mumps. Other CAM
therapies may play a supportive role. |
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Nutrition |
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As stated earlier, acidic foods should be avoided; they can stimulate the
secretion of enzymes from the parotid glands. Liberal fluid intake in frequent
small sips should be recommended. Nutrients used to support the immune system in
general include vitamin A, vitamin C, and zinc. |
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Herbs |
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Herbal therapies utilized in clinical practice for the treatment of mumps
include immune stimulating herbs, antipyretics, and antimicrobials, such as
echinacea (Echinacea spp.), peppermint (Mentha piperita), onion
(Allium cepa), yarrow (Achillea millefolium), elder (Sambucus
nigra), and mullein (Verbascum thapsus). While the general
immunomodulatory effects of echinacea and the antipyretic, antimicrobial, and
antiviral actions of the other herbs listed have been reported (Blumenthal et
al. 2000), their efficacy in the treatment of mumps specifically has yet to be
explored in scientific studies. |
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Homeopathy |
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Although they have not yet received scientific validation, acute homeopathic
remedies may provide symptomatic relief and shorten the severity and duration of
disease course. Morrison lists Abrotanum, Belladonna,
Phytolacca, and Pulsatilla as possible remedies for mumps
(Morrison 1993). Although not proven or accepted as an appropriate measure, some
advocate homeopathic treatment for mumps and other childhood illnesses in lieu
of vaccination (Maceoin and Cope 1988). |
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Acupuncture |
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Acupuncture is thought to possibly reduce the severity and duration of the
clinical course of mumps; however, the claims are difficult to assess given the
self-limited nature of the disease. With that said, the following case reports
from Chinese journals describe the clinical practice of using acupuncture for
mumps.
One thousand cases of mumps in children aged 5 to 10 years treated with ear
needling of the pingjian point (MA-T2) were reviewed. All patients suffered from
common symptoms of mumps. When there was pain and swelling on a single parotid
gland, the needle was inserted on the affected side; otherwise, if involvement
was on both sides, needles were placed bilaterally with depth of insertion
limited appropriately. All cases achieved improvement and/or resolution of
symptoms, some after only one treatment and all within five treatments. The
sooner the child was seen following onset of symptoms, the fewer the number of
acupuncture treatments were needed (Song 1989). Again, for a variety of reasons
(including lack of certainty about whether the diagnosis of mumps was
definitively established), it is difficult to draw conclusions from these
results. However, they raise the possibility that acupuncture may be used as an
adjunct for supportive care in the case of mumps.
A clinical report of 108 cases of acute mumps in patients aged 3 months to 24
years treated with acupuncture yielded similar results. Duration of disease at
time of presentation ranged from one to four days. There was unilateral
involvement in 37 cases and bilateral involvement in 71. Eighty-nine patients
had fever; 19 patients had tonsillar swelling and pain. Bilateral taichong (LR
3) and hegu (LI 4) points were selected. The reinforcing method was used for the
taichong points and the reducing method used for hegu points. In cases of high
fever, dazhui (DU 14) and waiguan (SJ 5) were added. With cough and tonsillar
swelling, shaoshang (LU 11) and shangyang (LI 1) were also used. Of the 108
cases, 32 experienced resolution of symptoms after only one treatment, 33 after
2 treatments, 29 after 3, 4 after 4, and 5 after 5 treatments. Five cases were
improved and none failed to improve, for a reported success rate of 95.4% and an
overall effective rate of 100% (Dong et al. 1995). As with the previous report
of case histories, it is difficult to draw definitive conclusions about the
efficacy of acupuncture in this condition.
[Note: Reinforcing (or tonifying) in acupuncture refers to the
building up of deficient yin, yang, or qi in an organ by a needling technique
that stimulates energy flow in the corresponding meridian. Reducing (or
dispersing) refers to the opposite, i.e., the draining away of excessive
or stagnant energy that has accumulated because of blocked circulation in the
affected area (Kaplan 2000).] |
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Massage |
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N/A |
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Other
Considerations |
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Prevention |
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Live mumps virus vaccine is approximately 95% effective in preventing the
disease. It is available alone or combined with vaccines for measles and
rubella. The vaccine produces a subclinical, noncommunicable infection; immunity
seems to last at least 20 years. Very few side effects have been reported.
Administration of the vaccine is routinely recommended at any time on or after
the first birthday, generally at 15 months, but may be administered to
adolescents and adults as well. Contraindications include: (1) pregnancy, (2)
severe febrile illness, (3) anaphylactic allergy to eggs or neomycin (history of
contact dermatitis from neomycin is not a contraindication to the vaccine), (4)
recent immunoglobulin injection, or (5) immunodeficiency (however, asymptomatic
HIV-positive children should be vaccinated). |
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Complications/Sequelae |
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- Meningoencephalitis: Meningeal signs manifest in up to 15% of cases;
usually not severe. Encephalitis reports range up to 5 in 1,000 mumps cases,
with fatalities from mumps encephalitis of about 1.4%. About 30% of mumps
infections with central nervous system involvement occur without associated
parotitis.
- Deafness: Sensorineural, about 0.5 to 5.0 per 100,000 reported mumps
cases; one of the most frequent common causes of unilateral hearing loss. Onset
occurs four to five days after infection; often transient.
- Orchitis: Occurs in 20% to 35% of postpubertal male patients,
generally 7 to 10 days after onset of parotitis. Manifests with edema and acute
pain. Usually unilateral.
- Testicular atrophy: In about 35% of patients following mumps orchitis;
rarely, in bilateral cases, sterility.
- Pancreatitis: Rare, generally resolves in about one week with full
recovery.
- Other possible CNS manifestations include cerebellar ataxia,
transverse myelitis, hydrocephalus, facial palsy, and Guillain-Barré
syndrome.
- Myocarditis, mastitis, thyroiditis, nephritis, arthritis, and
thrombocytopenic purpura are all rare possible
complications.
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Prognosis |
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For uncomplicated mumps, the prognosis is excellent. Complications are more
likely in postpubertal patients. |
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Pregnancy |
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Spontaneous abortion occurs in as many as 27% of cases of mumps in first
trimester of pregnancy. Vaccinated women should avoid pregnancy for three months
after vaccination. Avoid giving live virus vaccine to pregnant
women. |
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References |
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Advisory Committee on Immunization Practices (ACIP). Mumps Prevention.
MMWR Morb Mortal Wkly Rep. 1989;38(22):388-392, 397-400.
Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy.
Whitehouse Station, NJ: Merck & Co.; 1999:2325-2327.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
2000:458-459.
Dong GR, Zhang Y, Yan YX. Bilateral Taichong and Hegu in treatment of mumps:
an observation of 108 cases. Int J Clin Acupunct. 1995;6(1):65-66.
Felter R. Mumps. In: Adler J, Brenner B, Dronen S, et al., eds. Emergency
Medicine: An On-line Medical Reference. Accessed at www.emedicine.com on
September 18,2000.
Kaplan MS. The abbreviated history and development of acupuncture and
moxibustion. North American Society of Acupuncture and Alternative Medicine.
Accessed at www.nasa-altmed.com/alterna3.htm on September 18, 2000.
Maceoin D, Cope E. A hearing for an alternative approach to vaccine.
Guardian. October 19,1988.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:3-7, 58-62, 297-299,
310-315.
Song GY. 1000 cases of mumps treated with ear needling on Pingjian point
(MA-T2). J Tradit Chin Med.
1989;9(1):14. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
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including any injury and/or damage to any person or property as a matter of
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The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |