Parotitis epidemic (mumps) is an infectious disease characterized by the defeat of glandular organs and the central nervous system (CNS). Already 400 years before BC. e. Hippocrates first described the epidemic parotitis. Indications for this disease occurs in the works of Celsus and Galen. Since the end of the XVIII century, information about the epidemiology and the clinic of this infection has been accumulating.
The causative agent of mumps is a virus of the genus Paramyxovirus. It is completely inactivated at a temperature of 55-60 ° C (for 20 min), with UV irradiation; sensitive to the action of 0.1% formalin solution, 1% lysol, 50% alcohol. At 4 ° C, the infectivity of the virus changes for a few days, at -20 ° C it persists for several weeks, and at -50 ° C it lasts several months.
The source of the disease is a sick child in the last days of the incubation period (one or two days before the appearance of the clinical picture) and up to the 9th day of the disease. During this period, the virus is isolated from the patient's body with saliva. The most severe infectiousness is observed in the first three to five days from the onset of the disease. Infection is transmitted by airborne droplets during conversation, coughing, sneezing. There is a possibility of infection through household items, toys, etc. Because of the absence of catarrhal phenomena in patients with mumps infection, as well as uninvolved saliva in them, infection occurs only in close intercourse.
The greatest danger as a source of infection is patients with erased or asymptomatic forms of the disease, which are difficult to identify and therefore isolated from children's groups. There are data on the possibility of transplacental transmission of infection and intrauterine infection of the fetus. Susceptibility to mumps is quite high. Children who are between 2 and 10 years old are particularly ill. Children under one year are resistant to this infection, since they have transplacental immunity to it.
Parotitis is recorded as isolated cases, as well as epidemic outbreaks. The most frequent increases in morbidity occur in the winter and in the spring. The incidence is higher among children who are in groups. After this infection, usually, a lasting immunity is produced. Recurrent disease with mumps is rare
The entrance gate of the infection is the mucous membrane of the respiratory tract in the oral cavity, as well as the mucous membrane of the eye.
Symptoms .
Parotitis infection most often affects the parotid glands (parotitis), possibly involving submandibular (submaxillitis) and sublingual salivary glands (sublinguitis), pancreas (pancreatitis). Serious meningitis is very common. A rare and severe manifestation of infection is meningoencephalitis. It should be emphasized that, according to modern ideas, lesions of glandular organs (orchitis or pancreatitis) or CNS (meningitis) in case of parotitis infection should be considered its manifestation, but not a complication.
According to modern classification, the forms of this infection vary in type and severity. Typical forms include: lesion of glandular organs - isolated or combined (glandular form); defeat of the central nervous system (nervous form); lesion of various glandular organs and CNS (combined form). Atypical include an erased and asymptomatic form. By severity, the lungs, medium severity and severe forms of the disease are distinguished, the severity being the number of affected glands (one or more), the intensity of the inflammation, the degree of CNS damage (the severity of meningeal and encephalitic symptoms), the degree of intoxication.
The incubation period for epidemic parotitis lasts from 11 to 23 days (an average of 18-20). The disease begins after a 1-2 day prodromal period or without a prodrome. Usually the temperature rises to 38 - 39 ° С. Patients often complain of headaches, pain in front of the external auditory canal and in the region of the parotid salivary gland, pain when chewing and swallowing. There is a swelling of the parotid salivary gland on one side, and 1-2 days later the gland will swell from the opposite side. The auricle with a significant increase in the gland protrudes, and the lobe of the ear rises to the top
Submaxillite almost always occurs in combination with mumps, very rarely - isolated. Two-sided lesions are characterized by a symmetrical change in the contours of the submaxillary regions (swelling), swelling of the subcutaneous tissue. With unilateral lesion, asymmetry of the face and swelling on one side are revealed. At palpation, compression along the course of the lower jaw and soreness is noted. The increase in the affected salivary glands persists until the 3rd-5th day of the disease, edema, and tenderness usually disappear by the 6th to 9th day of the disease.
Almost a constant symptom of parotitis in boys is orchitis. One testicle is involved in the process, but a bilateral defeat is also possible. Orchitis develops on the 5th-7th day of the disease. In the testicle and in the groin, there are pains that increase with movement. The temperature rises, chills and headache. The testicle is enlarged 2-3 times, compacted, there is a sharp soreness in palpation, the skin over it is reddened. These symptoms persist for 6-7 days and gradually disappear.
In parotitis, older girls sometimes experience ovary involvement (oophoritis), bartholinitis (bartholinitis) and mammary glands (mastitis)
Pancreatitis develops after the defeat of the salivary glands, but sometimes precedes it or is the only manifestation of the disease. Patients with nausea, repeated vomiting, marked cramping, sometimes surrounding belly pains, localized in the epigastric region, the left hypochondrium or in the navel. There is bloating, constipation, and rarely a loose stool. These phenomena are accompanied by headache, chills, fever. When palpating the abdomen, the tension of the muscles of the abdominal wall is revealed. If these symptoms are combined with a lesion of the salivary glands or the patient is taken from a hotbed of mumps, then the diagnosis is made easier. The course of pancreatitis in case of mumps infection is favorable. Signs of pancreatic lesions disappear after 5-10 days
Serous meningitis is a frequent manifestation of parotitis infection in children. Usually it is combined with lesions of glandular organs and begins 3 to 6 days after the onset of mumps. In this case, there is hyperthermia, headache, vomiting. There may be seizures, loss of consciousness. The course of serous meningitis in mumps is in most cases favorable. Clinical symptoms of meningitis usually last no longer than 5-8 days
A rare manifestation of mumps infection is meningoencephalitis, the symptoms of which usually appear after the 5th day of the disease. At the same time, adynamia, inhibition, drowsiness, convulsions, loss of consciousness are noted. Then there are focal cerebral symptoms, possibly the development of paresis of the cranial nerves, hemiparesis. In most cases, meningoencephalitis ends favorably.
The prognosis for parotitis is almost always favorable.
Complications are rare. With bilateral damage to the testicles, testicular atrophy and the cessation of spermatogenesis are possible. Meningitis and meningoencephalitis can lead to paresis or paralysis of the cranial nerves, damage to the auditory nerve.
Treatment for parotitis is symptomatic. In the acute period of the disease, bed rest is shown. To maintain heat on the affected area, dry heat is recommended. Liquid food, frequent rinsing of the mouth. With fever and headaches recommend paracetamol, nurofen, etc. With orchitis is shown the application of suspensions, topically apply cold. If suspected of pancreatitis, the patient must be hospitalized. Restrict the diet of proteins and fats until the complete exclusion of food for 1-2 days.
Prevention. Patients with mumps are isolated at home or in the hospital (in severe forms). At the moment, there is a specific prevention of mumps. Immunization with live attenuated vaccine is performed once at the age of 15-18 months of age, simultaneously with vaccination against rubella and measles.