Mumps, mumps, mumps, mumps infection - these are all names for one acute infectious viral disease, which affects the central nervous system, salivary glands and glandular organs. The pathogen transmission mechanism is aspiration. This common disease is most often diagnosed in the pediatric population and in some cases has long-term adverse effects. The rise is recorded in the winter-spring period. The age category from three to six years is most susceptible to infection. Babies under one year of age who receive breast milk, thanks to passive immunity, are resistant to the pathogen. After an illness, immunity lasts for life, and after vaccination, stable immunity is formed for twenty years.
A bit of history. Etiology
This disease was first described by Hippocrates. Back in 1790, it was discovered that with parotitis, the genitals and the central nervous system are affected. A detailed study of this infection was carried out by a group of Russianscientists later. In 1934, the causative agent of mumps infection was isolated for the first time, which belongs to the paramyxovirus family and, accordingly, has the characteristics inherent in this family, including an irregular spherical shape and large size. According to the antigenic structure, it is close to the parainfluenza virus. Only one serotype of the virus is known. It retains its viability for up to four to six days at a temperature of 20 degrees. Instantly dies when boiled, dried, afraid of ultraviolet radiation and disinfectants with chlorine. It is very resistant to low temperatures and can exist in such conditions for up to six months.
Epidemiology of mumps infection
The only source of the virus are individuals with asymptomatic infection, as well as those with erased and typical forms of pathology. A day or two before onset and during the first six to nine days of illness, patients are considered contagious. A sick individual is especially dangerous from the third to the fifth day of illness. It is during these periods that the virus is found in the blood and saliva. Basically, the pathogen is transmitted by airborne droplets during conversation, as it is in the patient's saliva. However, there are isolated cases of infection through objects that had saliva.
The virus is not volatile, so transmission is only possible through close contact. In view of the absence of catarrhal phenomena (runny nose, cough), intensive spread of the pathogen is not observed. The focus of infection can exist for a long time, up to several months, as the virus is transmittedslowly. This is facilitated by a rather long incubation period, as well as an increase in the number of patients with an erased clinical picture. It is typical for the epidemiology of mumps infection that after the ninth day it is not possible to isolate the virus and the patient is no longer considered contagious. However, there is a reason that enhances the ability to infect others - these are concomitant acute respiratory viral infections in a patient with mumps. Thus, the virus spreads faster when coughing or sneezing. The susceptibility to the disease is high and is about 85 percent. Thanks to vaccination, the incidence in the age group from one to ten years has decreased. However, there has been an increase in ill adolescents and adults under 25 years of age. After 50 years, mumps is rarely diagnosed. After an illness, immunity is lifelong.
Pathogenesis
The mucous membranes of the upper respiratory tract and oropharynx are called the entry gates of infection. In the epithelial tissues of the mucosa, the virus reproduces offspring similar to itself and then spreads throughout the body. It is concentrated in the epithelial cells of the glandular organs, mainly in the salivary gland. Serous inflammation occurs in it and the death of secretory cells is observed. Isolation of the virus with saliva determines the airborne route of transmission. With the primary presence of the virus in the blood, there may be no clinical manifestations. A more massive release of the pathogen is carried out from the affected glands. As a result of the secondary form of mumps infection, the pancreas and thyroid gland, testicles, and mammary glands are affected. ATIn the central nervous system, the virus makes its way through the blood-brain barrier, provoking serous meningoencephalitis. Due to the rapid formation of specific immunity, the pathogen dies, and recovery occurs.
Diagnosis
Diagnosis is not difficult in a typical clinic. Diagnosis is based on the following features:
- fever;
- swelling and soreness of the parotid glands.
It is more difficult to identify it when there is an atypical variant of the disease or an isolated lesion of any organ without involvement of the salivary parotid glands in this process. In this case, a correctly collected epidemiological history helps (cases of illness in kindergarten, family). Confirm the diagnosis using the method of enzyme immunoassay, identifying specific immunoglobulin M (antibodies formed upon first contact with the infection), which confirms the presence of an active infection in the body. With mumps infection in children, antibodies are detected in all forms of pathology, including isolated localizations: meningitis, pancreatitis, orchitis. The virological method is not used in practical medicine, it is very long and laborious. Serological - used for retrospective diagnosis. In recent years, the polymerase chain reaction method has been widely used in medical institutions to diagnose the disease.
Classification
Forms of mumps infection are divided into typical and atypical. The first happens:
- Glandular - mumps, orchitis, pancreatitis, thyroiditis, sublinguitis, epididymitis, submaxillitis, oophoritis, dacryoadenitis.
- Nervous - neuritis, meningitis, cochlear neuritis with hearing loss, meningoencephalitis, Guillain-Barré polysciatica.
- Combined - these are various combinations of the above forms.
Atypical is subdivided into obliterated and subclinical form.
According to the severity of mumps infection is:
- Mild - signs of intoxication are mild, the glands are slightly enlarged.
- Medium - there is multiple lesions of the glandular organs and the central nervous system, hyperthermia.
- Severe - convulsive syndrome, toxicosis phenomena.
Downstream:
- Sharp or smooth.
- Not smooth. Such a course is observed in the case of complications, when secondary forms of mumps infection are superimposed or existing chronic pathologies are exacerbated. Residual phenomena appear: infertility, testicular atrophy, psychosensory disorders, asthenic syndrome, hydrocephalus, hypertensive syndrome within three to four months.
Clinical manifestations of mumps infection in children
Signs begin 11-21 days after infection. The first symptom is fever. The temperature is usually high and rises to 39 degrees. In addition to it, intoxication is observed, which is expressed by weakness, lack or poor appetite, headache. The disease can take a long time, as different glands are involved in the pathological process in turn.
Each new inflammatory process provokes a jump in temperature. The glandular organs that are affected by mumps infection are as follows:
- Salivary gland. One of the most common symptoms is an inflammatory process in the parotid salivary glands. In the behind-the-ear region and the fossa, a pain syndrome appears, which intensifies when chewing. Feels dry in the mouth. A swelling forms in front of the auricle due to an increase in the parotid salivary gland. The swelling spreads to the cheeks, neck and rises to the mastoid process of the temporal bone, as a result, the baby hardly opens his mouth. The dermis over the inflamed gland does not change color, but becomes tense and shiny. After a short period of time (one or two days), another salivary gland located on the opposite side also undergoes a pathological process. As a result of a bilateral lesion, the lower part of the face increases significantly in size compared to the upper. The child's face becomes like the head of a pig, which is why this disease is often called mumps. The greatest increase in the salivary glands occurs on the third - fifth day of illness. In addition to the existing symptoms, they are accompanied by hearing loss, tinnitus. Palpation of the gland does not cause unpleasant or painful sensations. Pits when pressing on it is not formed. On the sixth - ninth day, the swelling gradually decreases. With mumps infection in children, other glands are also involved in the pathological process.
- Testicular lesion. Inflammatory process - orchitis is observed in children andteenagers. Most often, one testicle is affected. Orchitis is characterized by a feeling of chills, headache, fever, severe pain in the scrotum, which radiate to the groin and intensify with movement. The testicle doubles or triples in size. The scrotum reddens, swells, stretches. On palpation, the testicle is dense, the child feels severe pain.
- Pancreatic lesion does not occur in all cases, but it occurs quite often. Develops before or after inflammation of the salivary glands. Symptoms, which are manifested by girdle pain in the abdomen, impaired stool, fever, headache, loss of appetite, disappear after five to ten days and recovery occurs.
Nervous system lesions can be combined with inflammation of the glands or be independent. In the first case, the symptoms are observed on the third or sixth day of the disease and result in serous meningitis, which begins acutely. The child is worried about vomiting, headache, fever. He becomes lethargic and drowsy, convulsions, loss of consciousness, hallucinations are possible. If this disease is suspected, cerebrospinal fluid is taken for examination. Meningitis lasts about eight days. After suffering inflammation that accompanied parotitis, children recover. However, for several months they will be disturbed by residual effects - mood swings, lethargy, low concentration.
Symptoms of mumps in adults
The incubation period for mumps infection can last 15–19 days in adults. Between this period and the disease itselfmalaise appears, appetite decreases, the head hurts, weakness is felt. These phenomena precede the clinical picture. The onset of the disease is acute and is accompanied by an increase in temperature up to 40 degrees. Some individuals do not have a fever. Further, there are unpleasant sensations in the area of the salivary glands and swelling. The inflammatory process affects both salivary glands, their swelling in adults lasts up to 16 days. At night, the patient is very worried about pain and tension in the region of the gland. In case of compression of the Eustachian tube, noise and pain appear in the ears. The most important sign of parotitis is pain behind the earlobe when pressing on this area. Catarrhal symptoms are not characteristic of mumps infection.
Orchitis in men is common. The defeat of the testicles occurs without inflammation of the salivary glands. Mainly one testicle is affected. The transferred inflammation can cause infertility, impaired potency and some other disorders. Women sometimes develop inflammation in the ovaries. Due to the fact that the clinical picture is poorly expressed, this phenomenon remains without the attention of the doctor. As in children, it is possible that the pancreas and nervous system are affected. People after 50 years of age rarely get sick with mumps, they have reduced susceptibility to this disease. However, they can get it from sick grandchildren. The disease in this category is both asymptomatic and severe. Exacerbation of existing chronic pathologies aggravates the course of the disease.
Treatment of mumps in children
Patients receive symptomatic and pathogenetictherapy on an outpatient basis in accordance with clinical guidelines. Mumps infection in children does not require specific treatment aimed at destroying the virus. To reduce some symptoms, the doctor prescribes medications:
- "Paracetamol", "Ibuprofen" - to reduce the temperature.
- "Papaverine", "Drotaverine" - with severe pain in the abdomen.
- "Kontrykal" - to reduce the activity of digestive enzymes.
- "Pancreatin" - to improve digestion, it is recommended during the recovery period for inflammation of the pancreas.
It is especially important for a child to observe:
- bed rest until body temperature returns to normal;
- oral hygiene. Irrigate the oral mucosa with a solution of furacilin or sodium bicarbonate.
Dry heat shown on the swollen area of the salivary glands.
Children with severe mumps infection are being treated in the hospital. The clinical recommendations on which the doctor is based in the management of such patients help to make the choice of therapy, taking into account the course of the disease and the individual characteristics of the child:
- Orchitis. In this case, bed rest is required. A special supporting bandage is applied to the child's scrotum, which is removed only after the symptoms of testicular inflammation disappear. Usually this manipulation is done in the acute period of the disease. The patient is consulted by a surgeon. If necessary, corticosteroids are prescribed.
- Serous meningitis. Strict bed restshown for two weeks. The patient takes diuretics until the symptoms of the disease disappear under constant medical supervision.
- Polyneuritis, meningoencephalitis. In these cases, bed rest is also recommended. Dehydration and detoxification therapy is carried out. The child is prescribed hormonal, antiallergic and vitamin drugs.
Treatment of mumps in adults
Adults should call their doctor at home if they suspect a mumps infection. Clinical guidelines for the management of such patients do not establish uniform patterns; they contain an algorithm for the doctor's actions using effective methods of treatment. The therapy of any patient is individual, and the attending physician determines the specific treatment tactics.
With a mild and uncomplicated form of mumps, the patient is treated at home. Diet and regimen are the main components of a successful cure. With severe intoxication, drinking plenty of water is indicated. Treatment is primarily aimed at relieving and relieving symptoms. With inflammation of the central nervous system and orchitis, hormonal agents are used. To increase immunity, vitamin preparations and immunostimulants are prescribed. In case of severe illness and complications, the patient is hospitalized.
Diet for mumps
Treatment of mumps infection also involves following a special diet. To reduce the burden on the digestive system, fractional meals in puree or liquid form and in small volumes are recommended. The advantage is given to dairy and vegetable food. Products with a salivary effect are excluded only in the first days of the disease. In the future, their use helps to improve the discharge of glandular secretions. In the presence of pancreatitis, a strict diet is indicated. To unload the digestive tract, in the first two days, fasting is recommended. Further, food is introduced gradually. After twelve days, patients are transferred to a special diet.
Consequences
Complications of mumps infection manifest as the following conditions:
- encephalitis;
- after suffering orchitis, testicular atrophy is possible. With bilateral lesions, infertility develops;
- cerebral edema;
- pancreatitis, which provokes the development of diabetes;
- unilateral hearing loss without the possibility of its recovery;
- female infertility is associated with inflammation of the gonads at an early age;
- increased intracerebral pressure (hypertensive syndrome).
Complications do not occur in all patients, weakened children suffer the most. The consequences of the disease in adults are more common and are mainly due to secondary infection.
Prevention
Preventive measures boil down to:
- Isolation of the patient for at least ten days, i.e. until the disappearance of clinical signs.
- Children under the age of ten in contact with the sick are separated from the eleventh to the twenty-first day from the moment of the last contact. In the children's institution where the patient was identified, quarantine is introduced for a period of 21 days, countdownconducted from the ninth day of the disease.
- Immunizations.
Vaccination against mumps
The incidence of mumps infection has decreased significantly due to routine vaccination. For the purpose of prevention, children are vaccinated from the age of 12 months with the “Cultural Mumps Vaccine”. Vaccination for children who have not had mumps is carried out twice - a year and at six years. Emergency prophylaxis is possible for babies from 12 months old, adolescents and adults who have been in contact with a sick individual, have not had mumps and have not been previously vaccinated. It is recommended that the vaccine be administered no later than 72 hours after contact with an infected person. In addition, vaccination with a complex vaccination against three infections is possible: mumps, rubella and measles. It is also carried out in accordance with the vaccination calendar. This vaccine is administered three times. The first is at 12 months. The timing of revaccination against mumps, measles and rubella is as follows:
- first - at 6-7 years old;
- second - at 15-17 years old.
Revaccination is necessary, since not all children develop immunity to the above infections after the first injection. In addition, artificially acquired immunity weakens over time. On average, the vaccine is valid for about ten years. Revaccination during adolescence is warranted for the following reasons:
- For young girls, this is an extension of protection against the rubella and mumps virus, since the development of these infections during pregnancy is very dangerous. Mumps in a pregnant woman can cause a miscarriage.
- For boys diseaseparotitis at this age is undesirable due to the fact that one of the complications of the infection is male infertility.
Vaccination is 96 percent effective. The attending physician will recommend which medical immunobiological preparation to give preference to before immunization. Both vaccines are well tolerated. Complications and adverse reactions are rare.
