Mumps Clinical Presentation

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 6, 2012
 

History

Symptoms in the patient’s history consist mostly of fever, headache, and malaise. Within 24 hours, patients may report ear pain localized near the lobe of the ear and aggravated by a chewing movement of the jaw. Older children may describe a swelling sensation at the mandibular angle and an associated sour taste in the mouth. Fever usually subsides within 7 days, well before the parotid gland edema disappears. Sudden hearing loss may occur due to a vestibular reaction.

Thyroiditis, a diffuse, tender swelling of the thyroid gland, may occur about 1 week after parotitis. Antithyroid antibodies are detected in the serum.

Pancreatitis is a severe but, fortunately, rare manifestation. A sudden onset of epigastric pain and tenderness occurs, accompanied by fever, chills, nausea, and vomiting. The patient generally recovers completely within 1 week.

Orchitis can occur in up to 50% of postpubertal males, and as many as 30% have bilateral involvement.[16] Orchitis presents acutely with fever, chills, nausea, vomiting, and lower abdominal pain. After the fever, the testes begin to rapidly swell. The size increase can be minimal or as much as 4 times normal size. As the fever decreases, the pain and edema subside. Loss of turgor is noticed, with as many as 50% of cases demonstrating atrophy.

Oophoritis in postpubertal females is associated with abdominal and/or pelvic pain and tenderness.

Parotitis may appear simultaneously with the primary neuron infection, or it may appear 10 days after the parotitis in the postinfection type.

Mumps is a common cause of aseptic meningitis, which usually is indistinguishable from other causes, such as enteroviruses, herpesviruses, or poxviruses. (The CSF has less than 500 cells/µL, mostly lymphocytes). Encephalitis, a frequent complication in childhood, is due to a primary infection of the neurons and/or postinfection encephalitis with demyelination.

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Physical Examination

Ordinarily, the parotid gland is not palpable, but in patients with mumps, it rapidly progresses to maximum swelling over several days. The patient may have trismus.

Submaxillary gland edema, palpable underneath and anterior to the angle of the mandible, may be accompanied by edema spreading onto the cheek and downward onto the neck. If parotitis does not simultaneously occur, it can be difficult to differentiate from cervical adenitis. The Wharton duct opening may be erythematous and edematous.

Sublingual gland involvement, most commonly bilateral, is considered the least common manifestation of mumps. The sublingual gland is palpated on the floor of the mouth and submental area. In severe and extensive cases, the edema may extend to the presternal area due to an obstruction of the lymphatic vessels by the compression of the enlarged salivary glands. Submandibular glands may also be involved and swollen.

The opening of the Stensen duct can be enlarged, edematous, and erythematous.

In addition, a morbilliform rash may be present.

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Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP  Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Cem S Demirci, MD  Consulting Staff, Division of Endocrinology/Diabetes, Connecticut Children's Medical Center

Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP  Professor of Pediatrics, Michigan State University College of Medicine; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center

Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Eileen C Quintana MD, Assistant Professor, Departments of Pediatrics and Emergency Medicine, St Christopher's Hospital for Children; Adjunct Clinical Professor, Pediatrics and Emergency Medicine Departments, Temple University Hospital, Pediatric Emergency Dept, Philadelphia, PA

Eileen C Quintana is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Hosseinali Shahidi, MD, MPH Assistant Professor, Departments of Emergency Medicine and Pediatrics, State University of New York and Health Science Center at Brooklyn

Hosseinali Shahidi, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and American Public Health Association

Disclosure: Nothing to disclose.

Garry Wilkes MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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