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Mumps

Definition, Description, Causes and symptoms, Diagnosis, Treatment, Alternative treatment, Prognosis, Prevention

Mumps is a relatively mild, short-term viral infection of the salivary glands that usually occurs during childhood. Typically, mumps is characterized by a painful swelling of both cheek areas, although the person could have swelling on one side or no perceivable swelling at all. The salivary glands are also called the parotid glands, therefore, mumps is sometimes referred to as an inflammation of the parotid glands (epidemic parotitis). The word mumps comes from an old English dialect, meaning lumps or bumps within the cheeks.

Description

Mumps is a very contagious infection that spreads easily in highly populated areas, such as schools. Although not as contagious as measles or chickenpox, mumps was once quite common. Prior to the release of a mumps vaccine in the United States in 1967, approximately 92% of all children had been exposed to mumps by the age of 15. In these pre-vaccine years, most children contracted mumps between the ages of four and seven. Mumps epidemics came in two to five year cycles. The greatest mumps epidemic was in 1941 when approximately 250 cases were reported for every 100,000 people. In 1968, the year after the live mumps vaccine was released, only 76 cases were reported for every 100,000 people. By 1985, less than 3,000 cases of mumps were reported throughout the entire United States, which works out to about 1 case per 100,000 people. The reason for the decline in mumps was the increased usage of the mumps vaccine. However, 1987 noted a five-fold increase in the incidence of the disease because of the reluctance of some states to adopt comprehensive school immunization laws. Since then, state-enforced school entry requirements have achieved student immunization rates of nearly 100% in kindergarten and first grade. In 1996, the Centers for Disease Control and Prevention (CDC) reported only 751 cases of mumps nationwide, or, in other words, about one case for every five million people.

Causes and symptoms

The virus that causes mumps is harbored in the saliva and is spread by sneezing, coughing, and other direct contact with another person's infected saliva. Once the person is exposed to the virus, symptoms generally occur in 14-24 days. Initial symptoms include chills, headache, loss of appetite, and a lack of energy. However, an infected person may not experience these initial symptoms. Swelling of the salivary glands in the face

A young child with mumps. Photo Researchers. Reproduced by permission.) A young child with mumps. Photo Researchers. Reproduced by permission.)

(parotitis) generally occurs within 12-24 hours of the above symptoms. Accompanying the swollen glands is pain on chewing or swallowing, especially with acidic beverages, such as lemonade. A fever as high as 104°F (40°C) is also common. Swelling of the glands reaches a maximum on about the second day and usually disappears by the seventh day. Once a person has contracted mumps, they become immune to the disease, despite how mild or severe their symptoms may have been.

While the majority of cases of mumps are uncomplicated and pass without incident, some complications can occur. Complications are, however, more noticeable in adults who get the infection. In 15% of cases, the covering of the brain and spinal cord becomes inflamed (meningitis). Symptoms of meningitis usually develop within four or five days after the first signs of mumps. These symptoms include a stiff neck, headache, vomiting, and a lack of energy. Mumps meningitis is usually resolved within seven days, and damage to the brain is exceedingly rare.

The mumps infection can spread into the brain causing inflammation of the brain (encephalitis). Symptoms of mumps encephalitis include the inability to feel pain, seizures, and high fever. Encephalitis can occur during the parotitis stage or one to two weeks later. Recovery from mumps encephalitis is usually complete, although complications, such as seizure disorders, have been noted. Only about 1 in 100 with mumps encephalitis dies from the complication.

About one-quarter of all post-pubertal males who contract mumps can develop a swelling of the scrotum (orchitis) about seven days after the parotitis stage. Symptoms include marked swelling of one or both testicles, severe pain, fever, nausea, and headache. Pain and swelling usually subside after five to seven days, although the testicles can remain tender for weeks.

Diagnosis

When mumps reaches epidemic proportions, diagnosis is relatively easy, because swollen salivary glands are so characteristic of the infection. With so many people vaccinated today, a case of mumps must be properly diagnosed in the event the salivary glands are swollen for reasons other than viral infection. For example, in persons with poor oral hygiene, the salivary glands can be infected with bacteria. In these cases, antibiotics are necessary. Also in rare cases, the salivary glands can become blocked, develop tumors, or swell due to the use of certain drugs, such as iodine. A test can be performed to determine whether the person with swelling of the salivary glands actually has the mumps virus.

Treatment

When mumps does occur, the illness is usually allowed to run its course. The symptoms, however, are treatable. Because of difficulty swallowing, the most important challenge is to keep the patient fed and hydrated. The individual should be provided a soft diet, consisting of cooked cereals, mashed potatoes, broth-based soups, prepared baby foods, or foods put through a home food processor. Aspirin, acetaminophen, or ibuprofen can relieve some of the pain due to swelling, headache, and fever. Avoid fruit juices and other acidic foods or beverages that can irritate the salivary glands. Avoid dairy products that can be hard to digest. In the event of complications, a physician should be contacted at once. For example, if orchitis occurs, a physician should be called. Also, supporting the scrotum in a cotton bed on an adhesive-tape bridge between the thighs can minimize tension. Ice packs are also helpful.

Alternative treatment

Acupressure can be used effectively to relieve pain caused by swollen glands. The patient can, by using the middle fingers, gently press the area between the jawbone and the ear for two minutes while breathing deeply.

A number of homeopathic remedies can be differentiated for the treatment of mumps. For example, belladonna may be useful for flushing, redness, and swelling. Bryonia (wild hops) may be useful for irritability, lack of energy, or thirst. Phytolacca (poke root) may be prescribed for extremely swollen glands. A homeopathic physician should always be consulted for appropriate doses for children, and remedies that do not work within one day should be stopped. A homeopathic preparation of the mumps virus can also be used prophylactically or as a treatment for the disease.

Several herbal remedies may be useful in helping the body recover from the infection or may help alleviate the discomfort associated with the disease. Echinacea (Echinacea spp.) can be used to boost the immune system and help the body fight the infection. Other herbs taken internally, such as cleavers (Galium aparine), calendula (Calendula officinalis), and phytolacca (poke root), target the lymphatic system and may help to enhance the activity of the body's internal filtration system. Since phytolacca can be toxic, it should only be used by patients under the care of a skilled practitioner. Topical applications are also useful in relieving the discomfort of mumps. A cloth dipped in a heated mixture of vinegar and cayenne (Capsicum frutescens) can be wrapped around the neck several times a day. Cleavers or calendula can also be combined with vinegar, heated, and applied in a similar manner.

Prognosis

When mumps is uncomplicated, prognosis is excellent. However, in rare cases, a relapse occurs after about two weeks. Complications can also delay complete recovery.

Prevention

A vaccine exists to protect against mumps. The vaccine preparation (MMR) is usually given as part of a combination injection that helps protect against measles, mumps, and rubella. MMR is a live vaccine administered in one dose between the ages of 12-15 months, four to six years, or 11-12 years. Persons who are unsure of their mumps history and/or mumps vaccination history should be vaccinated. Susceptible health care workers, especially those who work in hospitals, should be vaccinated. Because mumps is still prevalent throughout the world, susceptible persons over age one who are traveling abroad would benefit from receiving the mumps vaccine.

The mumps vaccine is extremely effective, and virtually everyone should be vaccinated against this disease. There are, however, a few reasons why people should NOT be vaccinated against mumps:

  • Pregnant women who contract mumps during pregnancy have an increased rate of miscarriage, but not birth defects. As a result, pregnant women should not receive the mumps vaccine because of the possibility of damage to the fetus. Women who have had the vaccine should postpone pregnancy for three months after vaccination.
  • Unvaccinated persons who have been exposed to mumps should not get the vaccine, as it may not provide protection. The person should, however, be vaccinated if no symptoms result from the exposure to mumps.
  • Persons with minor fever-producing illnesses, such as an upper respiratory infection, should not get the vaccine until the illness has subsided.
  • Because mumps vaccine is produced using eggs, individuals who develop hives, swelling of the mouth or throat, dizziness, or breathing difficulties after eating eggs should not receive the mumps vaccine.
  • Persons with immune deficiency diseases and/or those whose immunity has been suppressed with anti-cancer drugs, corticosteroids, or radiation should not receive the vaccine. Family members of immunocompromised people, however, should get vaccinated to reduce the risk of mumps.
  • The CDC recommends that all children infected with human immunodeficiency disease (HIV) who are asymptomatic should receive the MMR vaccine at 15 months of age.

Ron Gasbarro, PharmD

KEY TERMS


Asymptomatic—Persons who carry a disease and may be capable of transmitting the disease but who do not exhibit symptoms of the disease are said to be asymptomatic.

Encephalitis—Inflammation of the brain.

Meningitis—Inflammation of the membranes covering the brain and spinal cord.

Orchitis—Inflammation or swelling of the scrotal sac containing the testicles.

Parotitis—Inflammation and swelling of the salivary glands.

Post-pubertal—After puberty, in males approximately after the age of 14 years.

Additional topics

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