Mumps Workup

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

Approach Considerations

Mumps is a clinical diagnosis. A study investigated the difficulty of medical professionals in diagnosing mumps, noting that only 14% of 2082 cases occurring during an outbreak were laboratory confirmed.[18] The conclusion was that the ability to diagnosis mumps based solely on clinical presentation is low.

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Laboratory Studies

Serum amylase is elevated in mumps parotitis (amylase-S) and pancreatitis (amylase-P). Serum lipase is elevated in pancreatitis.

A complete blood cell (CBC) count reveals a normal, decreased, or elevated white blood cell (WBC) count, with the differential reflecting a relative lymphocytosis.

Viruria is present, even in uncomplicated mumps, with the virus detected during the first 2 weeks of illness.[19]

Mumps virus can be isolated from nasopharyngeal swabs, blood, and fluid from buccal cavity typically from 7 days before up until 9 days after the onset of parotitis. Mumps virus can be isolated in a cell culture inoculated with throat washings, urine, or spinal fluid. Spinal fluid as part of CNS infections usually exhibits a lymphocytic pleocytosis. Polymerase chain reaction (PCR) assay of the CSF can be used to detect viral mumps RNA and fosters a rapid confirmation for the diagnosis.

Mumps infection can be confirmed by demonstrating a significant rise in mumps-specific immunoglobulin G (IgG) antibody titers between acute and convalescent sera specimens or a positive mumps immunoglobulin M (IgM) titer. IgG titer can be detected by complement fixation, hemaglutination inhibition, or enzyme immunoassay. Interpretation of titer rise may have limitations because of mumps cross-reaction with parainfluenza viruses.

In mumps orchitis, an elevated serum C-reactive protein (an inflammatory marker) may be found.[20]

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Imaging Studies

No specific imaging studies are diagnostic.

Imaging studies may be needed as a further workup with certain complications of mumps. If there is concern for meningitis or encephalitis, prior to lumbar puncture, head computed tomography (CT) scanning without contrast should be considered. Testicular ultrasonography must be performed when acute orchitis is found clinically, with specific indication to rule out torsion.

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Other Tests

Complicated cases may need further testing, if determining organ system involvement is necessary.

Given the associated concern for sensorineural hearing loss, auditory testing is indicated in young children.

If considering meningitis or encephalitis, perform a lumbar puncture to eliminate causes other than mumps.

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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.

References

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