MUMPS
Mumps is an acute infectious disease caused by a virus. It is characterized by the swelling and tenderness of one or more of
the salivary glands, typically both the parotid glands. The main symptom is swelling of the salivary
glands, giving the patient a “hamster-
like” face.
Epidemiology & Incidence
The data regarding epidemiology of mumps in India is not relevant
because majority of cases were unreported.
In hot climate the disease is endemic throughout the year in most
unvaccinated population
Incidence peak in winter and summer
Epidemics are associated with overcrowding
Mumps is a
disease of childhood, the highest incidence occurs in children between 5 - 9 years
of age.
Up to 90% of
infections at the age of 10 - 15 years
According to a
recent epidemiological survey in America, 10% of the population had mumps at
the first 5 years of life, 74% had it by age 10, and 95% by 20 years of age.
India outbreak
are reported throughout the year and from all regions of the country
Mumps
cases in India
Etiology and Pathophysiology
·
Agent- The
causative agent is a para-myxovirus (mumps virus/ MuV).
·
Sources of
infection- it is an air born infection transmitted by close contact with
patients suffering from mumps, through fomites and droplet (saliva and
respiratory droplet).
·
Incubation
period- 14-21 days
·
Communicability
period – 7 days before to 9 days after swelling appears. Numbers of viruses are
more just before and after parotitis appear.
·
Age and sex-
it is common in the age group of 5 to 15 years. Both sexes are affected.
·
Immunity -
usually life long after infection. But second attack may occur.
Clinical features
Ø The symptoms of mumps normally appear 2-3 weeks
after the patient has been infected. Initially the disease starts with fever, headache,
sore throat, ear ache and pain on chewing
Ø Tenderness beneath the angle of the jaw or
redness and oedema of the parotid gland may be noted.
Ø Over the next few days, the classic symptoms of
mumps will develop, i.e. painful and swollen parotid glands (unilateral or
bilateral).
Ø The gland gradually enlarges, displacing the
ear lobe outwards and upwards
Ø The enlarged gland is painful and tender.
Ø The swelling begins to subside in about 7-10
days.
Ø The sub-mandibular and sublingual glands may
occasionally be affected
Ø Adolescents and adult have more severe disease
than young children
Diagnosis
ü Normally, mumps can be diagnosed by its
symptoms alone by examining the facial swelling
ü Enzyme immune assay for mumps immunoglobulin-
Ig
ü IgG and IgM antibodies are most commonly used
for diagnosis
ü IgM antibodies are detectable in the first few
days of illness and are considered diagnostic
ü History of exposure
ü significant increase
in IgG antibody between acute and convalescent specimens
ü Mumps virus can be cultured from the saliva,
blood,CSF and urine
ü Elevated serum amylase - return to normal
within 2 weeks
Differential Diagnosis
·
Bacterial
parotitis
·
Parotid duct
stone
·
Recurrent
parotitis of childhood
·
Parotid tumour
Management
Mumps is a
viral disease and antibiotics are not used to treat it. So treatment is symptomatic.
·
Isolation and
bed rest till fever and swelling subsides
·
Nutrition- liquid
or soft diet are given because the patient is unable to swallow
·
Cold compress and
antipyretics (acetaminophen) to reduce fever
·
Local application of heat or cold to the
swollen part helps to reduce swelling and pain
·
Analgesics – NSAID
·
Warm saline
gargle
·
Avoid sour
food that stimulate saliva production
·
management of
complications
Complications
§ Complications maximum during adolescence and
must be prevented.
§ Meningoencephalitis - this is one of the rarest
of the common complications. It happens when the virus spreads through the
bloodstream and infects the body's central nervous system (brain, meninges and spinal cord).
§ Pancreatitis- About 1 in 20 cases of mumps lead
to short-term inflammation of the pancreas (acute pancreatitis)& pain will be experienced in the upper
abdomen
§ Orchitis - testicles swell and become painful.
This affects one in four males who get mumps after puberty. The swelling normally goes down within 1 week; tenderness can last
longer than that. This rarely results in infertility
§ Oophoritis - ovaries swell and are painful. One
in 20 females who get mumps after puberty experience swelling of the ovaries.
The swelling will subside as the immune system fights off the virus. This
rarely results in infertility.
§ Neuritis and hearing loss- About 1 in 20 people
with mumps experience some temporary hearing
loss
§ Hepatitis
§ Spontaneous abortion- among women who acquire
mumps during the first 12 weeks of pregnancy
Prophylaxis (prevention)
v Mumps is a vaccine preventable disease. The
vaccine is derived from Jerry-Lyne Strain of mumps virus
v Combined vaccine - Active immunization with
mumps measles and rubella (MMR-1) vaccine at the age of 15 months after birth. A
booster dozes at the age of 5 year – MMR-2 (IAP Schedule). MMR vaccine
–injection, 0.5 ml S/C on right upper arm. (active immunization)
v Live attenuated vaccine – Mumpsvax 0.5 ml S/C
(AAP schedule), - gives lifelong protection. (active immunization)
v Passive immunization with - Gamma globulin (immunoglobulin-
IgM), 2.5ml, I/M injection soon after exposure may reduce complications.
v Maternal antibody is protective in infants first
6 months of life (Placentally transferred passive immunity)
v
Nursing management
Assessment: subjective and
objective data
Nursing diagnosis:
(1) Imbalanced nutrition less than body
requirements related to inability to ingest adequate nutrients due to
infectious condition as evidenced by swelling, pain and difficulty in
swallowing
(2) Acute pain related to inflammatory process..
(3) Risk for deficient fluid volume related to disease
condition such as swelling and difficulty in swallowing(4) Anxiety related to
change in health status.
(5) Hyperthermia related to inflammatory process as evidenced
by rise in body temperature.
Interventions:
§ Provide analgesics
and apply warm or cool compresses to the neck area to relieve pain
§ Give antibiotics and
tapid sponge bath for fever
§ Increase fluid
intake to prevent dehydration
·
·
Provide a high calorie, nutritionally rich soft or liquid
food frequently
·
Avoid spicy, sour food that stimulate salivation or require
the act of chewing
·
Measure body weight daily
·
Closely observe for complications
