Mumps

Most children are asymptomatic or demonstrate mild respiratory symptoms similar to a cold. Symptoms typically appear 7 to 21 days after contracting the infection. The early symptoms of mumps that can be observed in both adults and children include:

• Low to moderate grade fever
• Malaise or generalized feeling of discomfort/uneasiness
• Myalgia or muscle pain
• Headache
• Anorexia or loss of appetite

These symptoms are followed by:

• A high grade fever of 103°F or 104°F (about 39.5°C or 40°C)
• Parotitis (swelling and discomfort in the salivary or parotid glands)
• Swollen and tender jaw
• Pain in the ears
• Difficulty in eating, chewing, swallowing (particularly acidic drinks like citrus fruit juices), or talking

Note: Parotitis is a condition characterized by swelling and discomfort in the salivary glands (in the front of the neck) or the parotid glands (in front of the ears). Swelling of these glands usually occurs within 24 hours after the first symptoms appear, but in some cases, it may take as long as 1 week. Either of these glands may be involved on one or both sides of the face. The glands are tender when touched, and swelling causes the cheeks to puff out.

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Mumps is caused by a virus known as paramyxovirus, which is a member of the rubulavirus family.

The virus spreads easily through infected saliva and can be contracted by:

• Inhaling infected air droplets released through coughing or sneezing.
• Using utensils or cups with someone who has already had the infection.
• Engaging in close contact activities with an infected person, such as dancing, kissing, or playing sports.

If one contracts mumps, the virus moves from the respiratory tract (the nose, mouth, and throat) into the parotid or other glands, where it begins to reproduce. This leads to inflammation, swelling, and tenderness of the glands. Patients are most contagious 1-2 days before the onset of symptoms, but they can even spread the disease at least five days before their salivary glands begin to swell and one week after the appearance of symptoms.

• School-going children
• College students
• Living or traveling to areas with a high prevalence of mumps
• Being exposed to someone recently infected with mumps
• Not being immunized against mumps
• Being in a crowded setting
• Having a weakened immune system

Most cases of mumps are observed during late winter or early spring.

Call your healthcare provider if your child is showing any symptoms of mumps or has come in contact with someone who has been infected with mumps. Your doctor will provide you with specific instructions before you visit their clinic to protect other patients from acquiring the infection. Your doctor will perform a routine examination and record the present symptoms to confirm if your child has mumps. No tests are needed in most cases. The doctor can usually diagnose mumps by looking at the symptoms. However, the following tests might help in confirming the diagnosis of mumps, especially in cases of viral mumps infection in the absence of any parotid swelling and/or salivary gland involvement.

• RT-PCR test: In RT-PCR based testing, viral RNA can be extracted directly from buccal (inner cheek) swabs, throat swabs, and saliva for virus detection, particularly when obtained within 2 days of the appearance of symptoms. The ability to detect viral RNA rapidly reduces beyond the first week after the onset of symptoms. Virus detection has also been found to be substantially lower in people who have received two doses of the mumps vaccine in the past than in unvaccinated individuals.
• IgM test: The mumps virus antibody IgM test is used for the laboratory diagnosis of mumps virus infection. Detection of IgM antibodies supports a clinical diagnosis of recent infection with the virus. However, since most people are vaccinated, test results may not mount a detectable IgM response upon reinfection. Thus, a negative IgM result does not necessarily rule out mumps. Moreover, IgM may not be detectable if the test is done prior to day 3 of symptom onset or beyond 6 weeks after symptom onset.
• IgG test: The presence of detectable quantities of IgG antibodies could indicate a previous exposure to the mumps virus either through an infection or immunization. Individuals testing positive are considered immune to the mumps virus.
• CSF analysis: In cases of complications involving the central nervous system (CNS), a lumbar puncture (spinal tap) may be used to rule out other potential causes.

The best way to protect your child from acquiring the infection is to get them vaccinated with the MMR vaccine. The MMR vaccine protects people against three diseases: measles, mumps, and rubella. This vaccine is safe and serves as an extremely effective prevention strategy. Children usually do not show any side effects after receiving the vaccination. If side effects do occur, they are typically mild, presenting signs such as rash or low-grade fever.

Two shots of the vaccine are given to a child:

• The first shot is given between the ages of 12 to 15 months.
• The second shot is required for school-going children between the ages of 4 to 6 years old.

The vaccine is effective only after both shots have been administered. A single dose cannot provide complete protection against the infection. The following individuals are also advised to receive timely vaccination:

• Women who are not pregnant but are of childbearing age.
• Students attending postsecondary school or college.
• People working in healthcare facilities, such as hospitals, schools, or childcare centers.
• Individuals born before 1957.
• People planning to travel by cruise or overseas.

Note: Individuals who are currently ill need to wait until they recover to receive the vaccine. Additionally, pregnant women can wait until they deliver to get the vaccine.

You may not need the MMR vaccination if you:

• Have had two doses of MMR vaccination after 12 months of age.
• Are receiving chemotherapy.
• Are on long-term immunosuppressive therapy.
• Have had blood tests indicating immunity against measles, mumps, and rubella due to a previous infection.

MMR vaccination is contraindicated in:

• People with a life-threatening allergy to gelatin, neomycin, or any other constituents of the vaccine.
• Pregnant women or women planning to become pregnant soon.
• Individuals with a compromised immune system.

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Mumps is mostly a self-resolving illness. It does not require any specific treatment and cannot be treated using antibiotics as it is a viral infection. Treatment consists of supportive care for each presenting symptom.

Over-the-counter, non-aspirin pain relief medications such as acetaminophen or ibuprofen can help alleviate symptoms. Aspirin should not be given to children, as its use during viral illness has been linked to Reye syndrome, a life-threatening condition that can cause liver failure and swelling of the brain.

Application of warm and cold compresses to the painful parotid or other salivary gland areas may be helpful in relieving tenderness.

The following treatment protocols are considered for the management of complications of mumps:

• Boys or men with inflammation of the testes require bed rest. The scrotum can be supported with an athletic supporter or by using adhesive tape to connect the thighs. Elevation along with cold compression may also provide relief from pain in tender testicles.
• Studies have shown that treatment with interferon-α2B seems effective in preventing sterility and testicular atrophy after bilateral mumps orchitis. However, large-scale studies are needed to establish these promising results.
• Lumbar injection can be considered to relieve headaches associated with meningitis due to mumps viral infection.

Mumps is a self-limiting disease, and its management primarily involves care at home. This includes making yourself comfortable and resting until your symptoms subside. To care for yourself or your child at home, follow these tips:

• The most important step is to isolate yourself or your child to prevent spreading mumps to others. The CDC recommends isolation for 5 days after the onset of parotid or other salivary gland swelling.
• Practice good hygiene by thoroughly and frequently washing hands, covering the mouth when sneezing or coughing, and sanitizing regularly touched surfaces to prevent the spread of the disease.
• Rest whenever you feel tired. It is common to experience fatigue and muscle aches, so it is important to rest during these times.
• Apply warm and cold compresses regularly to soothe inflamed salivary glands.
• Drink plenty of fluids such as filtered water, coconut water, and soups to avoid dehydration due to fever.
• Avoid acidic foods or sour foods, such as citrus fruits or juices, during this time. Acidic foods can increase salivation, which may heighten pain in your salivary glands.
• Consume a soft, bland diet including mashed potatoes, oatmeal, yogurt, broth-based soups, or other soft foods that are easy to swallow and do not require much chewing.

Mumps can lead to several complications, which include the following:

• Orchitis: This condition is seen in 15-30% of cases in post-pubertal men. It is characterized by inflammation of the tube that carries and stores sperm and/or the testicles. The inflammation of one or both testicles is accompanied by fever, which typically occurs during the first week of parotitis but can develop after 6 weeks of parotitis. The testis becomes painful and enlarges to several times its normal size. This condition usually resolves within a week. Testicular atrophy develops in 50% of affected men, but sterility is rare.
• Oophoritis: This condition involves inflammation of one or both ovaries and occurs in 5% of women with mumps. It may be associated with lower abdominal pain and vomiting. It has rarely been associated with sterility or premature menopause.
• Mastitis: Inflammation of breast tissue can be seen in some cases of mumps.
• Pancreatitis: This condition involves inflammation of the pancreas, which is located in the abdomen. Pancreatitis is a temporary condition that resolves when mumps resolves. Common symptoms include nausea, vomiting, and abdominal pain.
• Meningitis: Meningitis is the swelling of the membranes surrounding the brain and spinal cord. It is a serious condition that requires immediate medical treatment.
• Encephalitis: Encephalitis is the inflammation of the brain itself. Symptoms associated with this condition include seizures, severe headaches, and loss of consciousness.
• Hearing loss: Mumps, when left untreated, can lead to hearing loss in rare cases. Approximately 5 out of 10,000 cases are associated with hearing loss. The paramyxovirus can damage the cochlea of the ear, a structure in the inner ear that aids in hearing.
• Heart problems: Rarely, mumps has been associated with abnormal heartbeat and diseases of the heart muscle.

It is advisable to consult a doctor if you have any symptoms or if you plan to get a second opinion from a doctor.

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Herbal Remedies

• You can make a paste out of ginger powder and apply it to the swollen area for pain relief.
• Aloe vera has soothing properties that can alleviate swelling and pain.
• Neem leaves have been used since ancient times to treat mumps. They reduce itching and swelling and can be mixed with turmeric powder to form a paste that can be applied to the affected area.

Homoeopathy

• Homoeopathic medications may be beneficial in managing mumps. Aconitum and Belladonna are two homoeopathic medicines that may help alleviate the symptoms of mumps.
• Pilocarpine can assist in controlling salivation and perspiration, serving as an effective remedy for mumps.

Being diagnosed with mumps can cause stress and anxiety in parents. This medical condition can be painful for both children and adults. However, the disease is mostly self-resolving and tends to resolve within 10 to 12 days. It is important to let it run its course, but timely diagnosis and treatment can help alleviate symptoms and prevent more severe complications.

Mumps can cause muscle tiredness and fatigue. To manage this, consider the following:

• Take sufficient rest.
• Drink plenty of fluids to avoid dehydration due to fever.
• Use warm and cold compresses to relieve pain and swelling.
• Use non-aspirin medications like acetaminophen or ibuprofen to manage pain associated with mumps.