11/14/24, 10\:54 AM Mumps

Mumps

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Mumps\: acute, generalised viral infection characterised by bilateral parotid swelling. More common in young adults at
university post-MMR vaccine introduction.
Aetiology\: caused by a paramyxovirus, a
pancreas, and brain. Highly infectious, spread by respiratory droplets and saliva, incubation period of 16-18 days, leading to
life-long immunity post-infection.
Clinical features\:
15-20% asymptomatic
Prodrome of
Parotitis in 95% of symptomatic cases\: bilateral swelling, face/neck distortion, pain near the jaw, dry mouth, reduced mouth
opening
Associated with orchitis and meningitis/encephalitis
Parotitis\: bilateral, causing 'hamster face' appearance, hot/
reduced mouth opening.
Di
orchitis, meningitis/encephalitis from other causes.
Investigations\: Clinical diagnosis; con
investigations for meningitis/encephalitis or orchitis to rule out other causes.
Management\:
Self-limiting condition, most recover in 1-2 weeks
Supportive care\: analgesia,
Hospital admission for complications (e.g., meningitis, encephalitis)
Children should not attend school for
Vaccination\:
MMR vaccine part of national immunisation programme, 88% e
Unimmunised individuals exposed to mumps should receive MMR
Complications\:
Orchitis\: severe testicular pain/tenderness, scrotal oedema, potential subfertility (25% of post-pubertal males)
Meningitis/encephalitis\: meningitis in 15% (usually mild, self-limiting), encephalitis (1.5% mortality, rare, can present early or
late in disease course)
Other\: oophoritis, unilateral/transient deafness, pancreatitis
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Introduction

Mumps is an acute, generalised viral infection characterised by bilateral parotid swelling.
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Prior to the introduction of the measles, mumps, and rubella (MMR) vaccine in 1987, it was common in children, but
outbreaks are now more common among young adults at university, especially those who did not receive the MMR
vaccine.
1
There were over 5000 cases of mumps in England in 2019, more than in any year since 2009.
2

Aetiology

Mumps is a viral infection caused by a paramyxovirus, usually a
1
Although it can infect any organ, the salivary glands are most commonly a
ovaries, pancreas, and brain.
1
Mumps virus is highly infectious and is spread by respiratory droplets and saliva.
3
It has an incubation period of 16 to 18 days, and transmission rates are highest one to two days prior to the onset of
symptoms. Almost all of those infected subsequently develop life-long immunity.
3

Clinical features

15-20% of those infected with the mumps virus are asymptomatic.
3
There is usually a prodrome of non-speci
anorexia.
3
Parotitis (swelling of the parotid glands) then develops in 95% of symptomatic cases and usually lasts three to four days,
although can last up to ten.
3,1
Mumps is also associated with orchitis and meningitis/encephalitis (see complications section).
Mumps parotitis
Mumps parotitis is generally bilateral. It causes distortion of the face and neck, giving the distinctive ‘hamster face’
appearance (Figure 2).
2
The skin can be hot and
of the jaw, dry mouth, and reduced opening of the mouth.
Figure 1. The parotid gland.
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Figure 2. Parotitis.
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Di

High fever with associated neck pain and swelling can be caused by other infections including pharyngitis, tonsillitis,
infectious mononucleosis and HIV.
1
Parotid stones can also cause pain and swelling but are usually unilateral and occur in older patients. In this case,
chewing causes pain as saliva is produced.
1
Unilateral testicular swelling and pain can be caused by testicular torsion (although here there are no preceding systemic
1
symptoms, and the testicle has a horizontal lie). Bilateral testicular swelling should prompt consideration of epididymo-
orchitis caused by sexually transmitted infections.
Meningitis and encephalitis can be caused by other infectious (viral, bacterial, fungal) and non-infectious (neoplastic)
agents. 6
For more information, see the Geeky Medics guide to meningitis.

Investigations

Mumps is usually a clinical diagnosis, but con
1
Further investigations are also required if patients present with meningitis/encephalitis or orchitis to look for other causes.

Management

Mumps is a self-limiting condition, and most children recover within one to two weeks.
1,3
Supportive management may include simple analgesia (paracetamol and ibuprofen), advice regarding
rest.
Admission to hospital is required if there are concerns about complications (e.g. meningitis or encephalitis).
3
Children should not attend school for
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Vaccination

The MMR (measles, mumps and rubella) vaccination is part of the national immunisation programme. The e
MMR vaccine (both doses) against mumps is 88%.
7
If a person is exposed to mumps and has not been fully immunised, MMR should be o
contraindications).
3
For more information, see the Geeky Medics guides to childhood immunisations and childhood immunisation counselling.

Complications

Orchitis (or epididymo-orchitis)

Mumps orchitis often occurs without parotitis, but if both are present, orchitis generally develops four or
parotitis onset.
1
Orchitis is found in 25% of post-pubertal males with mumps and is bilateral in 15-30% of cases.
1,3
It is associated with severe testicular pain and tenderness. Signi
Bilateral orchitis may lead to subfertility.
1

Meningitis and encephalitis

Mumps meningitis and encephalitis also usually occur without parotitis.
1
In patients infected with the mumps virus, 15% develop meningism. 8
limiting, mumps encephalitis has a mortality rate of 1.5%.
1,9
Although mumps meningitis is usually mild and self-
Mumps encephalitis is rare, and may present as part of the initial infection, or later in the disease course.
1

Other complications

Other complications include oophoritis, deafness (usually unilateral and transient) and pancreatitis.
1

References

Patient.info. M u m p s . Last edited September 2020. Available from\: [LINK]
GOV.UK. M u m p s o u t b r e a k s a c r o s s E n g l a n d . Published February 2020. Available from\: [LINK]
NICE CKS. M u m p s . Last revised December 2018. Available from\: [LINK]
Memorial University Newfoundland. P a r o t i d g l a n d . License\: [CC BY-SA]
Afrodriguezg. P a r o t i d i t i s ( P a r o t i t i s ; M u m p s ) . License\: [CC BY-SA]
Geeky Medics. M e n i n g i t i s . Last updated October 2020. Available from\: [LINK]
Harling et al. T h e e
Available from\: [LINK]
Balbi et al. M u m p s \: R e s u r g e n c e o f a o n c e-d o r m a n t d i s e a s e . Published May 2018. Available from\: [LINK]
Orlíková et al. P r o t e c t i v e e LINK]
Published April

Reviewer

Dr Jennifer Mackintosh
Paediatric registrar
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Contents

Introduction
Aetiology
Clinical features
Di
Investigations
Management
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