Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

1018 Mumps

➣Swelling salivary gland; can be uni-or bilateral, sometimes sub-

lingual or submandibular swelling

➣Fever – if present only moderately elevated for 3–4 days

➣Variably present: respiratory symptoms, especially <5 years

➣Headache, photophobia, anorexia, abdominal pain (due to pan-

creatic involvement)

tests

Nonspecific:

■Amylase often elevated

■CSF pleocytosis –∼50% of cases will have CSF pleocytosis

Specific:

Serology is diagnostic test of choice

■enzyme immunoassay (EIA or ELISA) methods widely available

■Complement fixation (CF), neutralization or hemagglutination

(HAI) can also be used

■4 fold change indicative of acute infection

■mumps-specific IgM is available and can be used to detect acute

infection (note false positive can occur due to interference with

rheumatoid factors/false negative can occur in mumps-infected

individuals previously immunized but not fully protected)

■IgG antibody is an indication of previous infection/immunization

and is predictive of immunity

■Skin test – not reliable

■Isolation saliva/urine; acute stages illness,

➣virus can be isolated from respiratory specimens (48 hrs. before

and up to 7 days following onset parotid swelling) urine (up to

14 days after onset) and CSF (up to 9 days after onset)

➣these methods are expensive, slow and not uniformly available

and should be used only in special circumstances

differential diagnosis

■Parotid swelling – other viruses such as influenza, parainfluenza

types 1and 2/CMV-viral isolation/detection can help distinguish

■Bacterial infection parotid gland – exquisite tenderness/leukocytosis

and pus from Wharton duct

■Stone/parotid gland

management

■No specific antiviral

■Hydration/Analgesics