This article is mainly intedend for use by medical professionals.
Parotitis is a clinical condition marked by the swelling and inflammation of the parotid glands. It can arise from various causes, including obstruction of the parotid duct (such as sialolithiasis), infectious agents (viruses or bacteria), or inflammatory conditions (like Sjogren’s syndrome, rheumatoid arthritis, systemic lupus erythematosus, and sarcoidosis). This chapter focuses on epidemic parotitis, commonly known as mumps, which is caused by a viral infection.
Epidemiology
- Mumps classically affects children aged between 4-5years
- 85% of cases occur below age of 15 years.
- It is the most common cause of non-suppurative sialadenitis.
Etiology
- Mumps is caused by a paramyxovirus infection
- Mode of transmission via droplet route from an infected person’s respiratory tract.
- There is an incubation period of 2-3 weeks.
- Patient is infective even before clinical manifestations.
- Patient will remains infective (contagious disease) for 7-10 days even after parotid swelling subsides.
Clinical features of mumps
- Patients present with initial pyrexia (fever), chills, facial pain lasting 5 to 9 days.
- Salivary glands
- Typically affects major salivary glands.
- Parotids are typically bilaterally enlarged (may be unilateral initially)
- There may be often swelling of submandibular glands together with lymphadenopathy, giving rise to profound facial and neck swelling.
- Rarely sublingual swelling to cause elevation of tongue, dysphagia and dysarthria.
- The salivary swelling tends to diminish after approximately 4-5 days and may precede more complicated aspects of illness.
- Involvement of other structures like pancreas, testes, ovaries, brain, breasts, lover, joints and heart are reported.
- Orchitis may develop approximately 4-5 days after onset of parotitis, usually unilateral but bilateral involvement can also happen. The incidence is highest in post-pubertal boys but rarely gives rise to serious longstanding disease.
- Oophritis causes lower abdominal pain.
- Mumps can cause lymphocytic or viral meningitis a few days after the development of parotitis.
- Pancreatic infection may lead to mild upper abdominal pain, but acute and long-term complications are rare.
- Other neurological manifestations include retrobulbar neuritis and encephalitis.
- Sudden SNHL is possible, but rare.
Diagnosis
- Diagnosis of mumps parotitis is typically based on clinical picture.
- Imaging is rarely necessary for the evaluation of parotitis.
- Serum and urinary amylase are raised during first week.
- Confirmed by detection of viral specific IgA and IgG (S and V antigen)
- S antigen is positive at presentation and persists for 12 months.
- V antigen appears at one month, but persists for upto 24 months.
Treatment of mumps
- No specific treatment required for mumps.
- Bedrest, Analgesics, appropriate fluid intake is the main stay.
- Food which encourages salivary flow should be avoided as they cause pain.
- Corticosteroids may be effective for severe parotitis, but generally not needed unless other system involvements are there.
- Universal immunization program has made mumps an uncommon disease in developed countries. All children must receive their first measles, mumps, and rubella (MMR) vaccine at one year and a second shot at the age of 4 to 6 years.