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