pediatrics
Mumps
Symptoms and Signs of Mumps
After a 12- to 24-day incubation period, most people develop headache, anorexia, malaise, and a low- to moderate-grade fever. The salivary glands become involved 12 to 24 hours later, with fever up to 39.5 to 40°C. Fever persists for 24 to 72 hours. Glandular swelling peaks on about the 2nd day and lasts 5 to 7 days. Involved glands are extremely tender during the febrile period. Parotitis is usually bilateral but may be unilateral, especially at the onset. Pain while chewing or swallowing, especially while swallowing acidic liquids such as vinegar or citrus juice, is its earliest symptom. It later causes swelling beyond the parotid in front of and below the ear. Occasionally, the submandibular and sublingual glands also swell and, more rarely, are the only glands affected. Submandibular gland involvement causes neck swelling beneath the jaw, and suprasternal edema may develop, perhaps because of lymphatic obstruction by enlarged salivary glands. When sublingual glands are involved, the tongue may swell. The oral duct openings of the affected glands are edematous and slightly inflamed. The skin over the glands may become tense and shiny. Mumps may involve organs other than the salivary glands, particularly in postpubertal patients. Such complications include Orchitis or oophoritis Meningitis or encephalitis Pancreatitis Approximately 30% of unvaccinated and 6% of vaccinated infected postpubertal males develop Orchitis (testicular inflammation), usually unilateral, with pain, tenderness, edema, erythema, and warmth of the scrotum. Some testicular atrophy may ensue, but In females, oophoritis (gonadal involvement) is less commonly recognized, is less painful, and does not impair fertility. Overview of Meningitis , typically with headache, vomiting, stiff neck, and CSF pleocytosis, occurs in 1 to 10% of patients with parotitis. Overview of Pancreatitis , typically with sudden severe nausea, vomiting, and epigastric pain, may occur toward the end of the first week. These symptoms disappear in about 1 week, leading to complete recovery. Prostatitis, nephritis, myocarditis, hepatitis, mastitis, polyarthritis, deafness, and lacrimal gland involvement occur extremely rarely. Inflammation of the thyroid and thymus glands may cause edema and swelling over the sternum, but sternal swelling more often results from submandibular gland involvement with obstruction of lymphatic drainage. 