Mumps

Mumps is an extremely contagious viral infection of the salivary glands, this gives the patient a hamster-like face.  Mumps is a disease caused by the mumps virus which is a member of the paramyxoviridae family. This is actually a large family of viruses which includes measles virus and parainfluenza viruses, all of these tend to affect the children the most. Mumps affects the humans and is spread in the form of a tiny respiratory droplet that is very small enough to be carried by air for short distances, hence mumps virus is said to be extremely contagious and anyone near a person having mumps is at the risk of getting the disease as well. The mumps virus is said to have a single strand of RNA and there is a viral polymerase enzyme surrounded by a phospholipid bilayer envelope studded with the viral proteins Hemagglutinin-neuraminidase or HN protein and fusion or F protein. The HN protein allows the virus to stick to a potential host cell and cut itself loose if necessary and the F protein that fuses the virus and the cell membranes together thereby allowing this mumps virus to enter the cell. The time when mumps enters the cell, the single-stranded RNA which is a negative sense the gets transcribed by the viral polymerase enzyme into the complementary positive sense strands of mRNA which later can then be translated by the host cells ribosomes into new copies of envelope proteins and the viral polymerase which gets assembled into new viruses. What also ends up happening with these is that HN and the F proteins on the cell surface now bind other cells so they actually end up binding epithelial cells to one another which forms a clump of connected cells called the multinucleated giant cell or a Syncytium. 

Mumps enter the body and first infect the epithelial cells of nasopharynx where it starts replicating and causing local damage to the tissue. From there it tends to cause viremia that is a virus in the blood and will reach various other organs and tissues  The mumps virus has tropism or preference for the parotid salivary glands and the most classic finding in the mumps is swelling of the parotid either on one side or on both the sides sometimes with an associated earache. The swollen parotid lifts the earlobe up and out thereby obscuring the angle of the jaw and can sometimes cause trismus which is a spasm of the muscles of mastication or chewing. Mumps also has an affinity for the central nervous system and can cause meningitis, which is an infection of the lining of the brain as well as encephalitis which is an infection of the brain tissue itself. These type infections can cause symptoms that can range from those that will feel like a headache, common cold, and neck stiffness. When we take a look at more severe symptoms it will cause difficulty with balance and hearing loss. In a general sense, the infection is that which is self-limited and symptoms will eventually go away as the body recovers. In the case of boys usually, with adolescents and the young men, mumps can infect the epididymis and testicles, also cause epididymitis and orchitis respectively most often seen in just one side. This can end up causing testicular atrophy in some men as well as a decrease in sperm count and sperm motility, but rarely this causes infertility. Less commonly mumps can infect the kidneys and can cause glomerulonephritis which eventually leads to hematuria and proteinuria which is the blood and protein in the urine. It can also affect the joints causing arthritis usually in the larger joints such as hips, knees, ankles, and shoulders. And it can affect the heart causing myocarditis as well as the pancreas causing pancreatitis. 

Pregnant women with mumps are not at an increased risk of having a baby with congenital defects. Like all the other viruses, diagnosis is done looking at the antibody titers, though for treatment there is not any effective antiviral for mumps. For prevention individuals with mumps, particularly young children are usually kept isolated for 5 days after the onset of the symptoms to prevent it from spreading. The best way to treat the mumps is with the mumps vaccine wish is 90% effective at preventing the disease in the first place. The vaccine is a live attenuated vaccine which means that it is a weekend mumps virus that is not infectious but still stimulates the immune system to generate a strong response to prevent the future infection from the actual wild type of mumps virus. Mumps vaccine has reduced the effects of the occurrence of mumps dramatically, with outbreaks happening most often in the areas where the children are not vaccinated. 

When you get mumps the virus moves from your respiratory tract as in your nose, mouth, and throat into your parotid glands which are the saliva producing glands found on either side of your face where it begins to reproduce, this causes the glands to swell. The virus can also enter the cerebrospinal fluid (CSF), which is the fluid that surrounds and protects your brain and spine. Once the virus has entered the CSF, it can spread to other parts of your body such as brain, pancreas, testicles (in boys and men), ovaries (in girls and women)

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Signs and Symptoms 

The symptom of mumps usually appears within 2 weeks of exposure to the virus. Flu like symptoms may be the first to appear including 

1. Fatigue 

2. Body ache

3. Headaches  

4. Loss of appetite 

5. Low-grade fever

A high-grade fever 39 degrees celsius and swelling of the salivary glands follow over the next few days. The glands in the case will not all swell at once, more commonly they tend to swell and become more and more painful periodically. When a person with the

mumps virus comes in contact with another he is more likely to pass on the mumps virus to your parotid glands swell.

Diagnosis 

Normally the mumps can be diagnosed by its symptoms alone, especially by examining the facial swelling. 

1. The doctors might also check inside the mouth to see the position of the tonsils.

2. When a person is infected with mumps, his tonsils can get pushed to the side of the face. 

3. Take the patient’s temperature, take a sample of blood, urine, or saliva to confirm the diagnosis. 

4. Take a sample of CSF from the spine for testing this is usually in severe cases.

5. Positive IGM antibody test for mumps, which appears 4 days after onset of symptoms and peeks by 1 week. 

Transmission 

The mumps can be easily transmitted to another person via the following

1. Mumps is spread by coughing and sneezing.

2. Touching something that is infected with the mumps virus.

3. It can occur at any time from a few days prior to the onset of swelling of the salivary glands to 9 days after the onset of the symptom.

4. Once the virus enters the body it travels to the back of the throat, nose, and lymph glands in the neck where it multiplies.

Treatment 

By drinking plenty of fluids we may be able to help relieve the symptoms of mumps. Because mumps is viral, antibiotics cannot be used to treat it and at present, there are no anti-viral medications that can treat mumps and at present, there are no antiviral medicines that can treat mumps. Current treatment can only help to relieve the symptoms until the infection has run its course. We can say that the body has built up an

immunity, much like a cold. In most of the cases, people recover from mumps within 2 weeks. There are some steps that can be taken to help relieve the symptoms of the mumps. Consuming plenty of fluids ideally water avoids fruit juices as they stimulate the production of saliva which can be painful. The pain can be alleviated by keeping something cold in the swollen area. Eat mushy or liquid food as chewing food might be painful. Get sufficient rest and sleep, gargle warm salt water, take pain killers.              

Clinical Manifestations

1. Periodic swelling, which is usually unilateral at the onset of illness which later becomes bilateral in 70 % of cases.

2. Other salivary glands such as the submandibular and sublingual glands may also be involved.

3. Systemic symptoms include fever, usually resolved within 3 to 5 days and the parotid swelling subsides within 7 to 10 days.  

Complications

1. Mumps encephalitis 3 to 10 days after the onset of parotitis which is usually self-limited.

2.  Orchitis which happens in 14 % to 35 % of males, comes 4 to 8 days after the parotid swelling. Testicular involvement is mostly unilateral and epididymitis is associated with orchitis. 

3. Mumps pancreatitis

4. During the time of pregnancy development of endocardial fibroelastosis (EFE) in offsprings.      

5. Deafness

6. Meningitis, which is an infection of the fluid and the lining covering the brain and the spinal cord 

7. Myocarditis

8. Arthritis 

9. Infertility, as the infection, can spread to the ovaries.

Kids usually get 2 doses of the measles-mumps-rubella (MMR) vaccine. The 1st one is at the time when they are between the age of 12 to 15 months and the 2nd when they are 4 to 6 years old. If you get mumps chances are there that you will make a total recovery in a few weeks. The main thing to do at this time is to stay at home from work and school and get plenty of rest in the meantime. Other ways to avoid spreading it is 

1. By washing the hands often 

2. Covering the mouth when you cough or sneeze 

3. Disinfect the things that you touch a lot. 

4. Avoid close contact with others in your home 

5. Sleep in a separate bedroom if possible 

6. Don’t share things like utensils and towels