pediatrics
Mumps
Diagnosis of Mumps
History and physical examination Viral detection via reverse transcription–polymerase chain reaction (RT-PCR) Serologic testing Mumps is suspected in patients with evidence of salivary gland inflammation and typical systemic symptoms, particularly if there is parotitis or a known mumps outbreak. Laboratory testing is usually not needed to make a diagnosis in typical cases but is strongly recommended for public health purposes. Mumps is also suspected in patients with unexplained aseptic meningitis or encephalitis during mumps outbreaks. Lumbar puncture is necessary for patients with meningeal signs. Differential diagnosisincludes other conditions can cause similar glandular involvement (see table). Suppurative bacterial parotitis HIV parotitis Other viral parotitis Metabolic disorders (eg, uremia, diabetes mellitus) Mikulicz syndrome (a chronic, usually painless parotid and lacrimal gland swelling of unknown etiology that occurs with tuberculosis, sarcoidosis, systemic lupus erythematosus, leukemia, and lymphosarcoma) Malignant and benign Salivary Gland Tumors None Drug-related parotid enlargement (eg, due to iodides, phenylbutazone, orpropylthiouracil) Laboratory diagnosis of mumps is necessary if disease has features atypical for mumps such as the following: Unilateral Recurrent Occurs in previously immunized patients Causes prominent involvement of tissues other than the salivary glands Parotitis lasting≥2 days without an identified cause RT-PCR is the preferred method of diagnosis; however, serologic testing of acute and convalescent sera by complement fixation or enzyme-linked immunosorbent assays (ELISA) and viral culture of the throat, CSF, and occasionally the urine can be done. In previously immunized populations, IgM testing may be falsely negative; therefore, RT-PCR assays should be done on samples of saliva or throat washings as early in the course of the disease as possible. Other laboratory tests are generally unnecessary. In undifferentiated aseptic meningitis, an elevated serum amylase level can be a helpful clue in the diagnosis of mumps despite the absence of parotitis. White blood cell count is nonspecific; it may be normal but usually shows slight leukopenia and neutropenia. In meningitis, CSF glucose is usually normal but is occasionally between 20 and 40 mg/dL (1.1 and 2.2 mmol/L), as in bacterial meningitis. CSF protein is only mildly elevated. 