Acute Mumps Clinical Presentation

Updated: Nov 06, 2015
  • Author: Yonatan Yohannes, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Presentation

History

After the incubation period, mumps usually has a prodromal phase, which consists of nonspecific viral symptoms: low-grade fever, malaise, myalgias, and headache.

The prodromal phase is usually followed by unilateral or bilateral parotid gland swelling. This usually occurs within the first 2 days of infection.

Infections can be asymptomatic in up to 20% of persons and may be nonspecific or have predominantly respiratory symptoms in up to 50%.

Patients typically complain of worsening pain when eating or drinking acidic foods.

Persons can present with other symptoms without a preceding parotitis. CNS presentations can include headache, neck pain, and fever. Preceding parotitis can be absent in up to 50% of these persons. [13, 8, 10, 11]

Orchitis can occur in up to 50% of postpubertal males, and as many as 30% have bilateral involvement. Sterility is rare. [12, 9] Patients can present with abdominal pain due to oophoritis or pancreatitis. Oophoritis occurs in up to 5% of postpubertal females.

Sudden hearing loss results from a vestibular reaction. [13]

Other rare presenting symptoms can be due to arthralgias, arthritis, mastitis, thyroiditis, thrombocytopenic purpura, or nephritis.

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Physical Examination

Low-grade fever is common with mumps.

Classic parotid gland swelling typically manifests without warmth or erythema and rapidly progresses over several days. Swelling may be preceded by parotid tenderness and/or earache. Enlargement of the contralateral parotid gland is not uncommon.

The swollen parotid gland may lift the earlobe upward and outward.

The patient may have tenderness over the angle of the mandible, which itself may be obscured by parotid swelling.

Opening of the Stensen duct can be edematous and erythematous.

Trismus may or may not be present.

Submandibular and sublingual glands may also be involved and swollen.

A morbilliform rash may be present.

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Complications

Potential complications of mumps are as follows:

  • Meningoencephalitis: Although most patients recover without prolonged sequela, the mortality rate has been reported to be up to 1.4%. [11]
  • Orchitis: This is the most common complication in the pediatric population. This does not usually result in sterility. Ultrasonography may be indicated when orchitis is clinically identified to rule out torsion.
  • Oophoritis
  • Pancreatitis
  • Transverse myelitis
  • Cerebellar ataxia
  • Myocarditis
  • Sensorineural hearing loss
  • Additional rare complications include nephritis, arthritis, thrombocytopenic purpura, mastitis, thyroiditis, and keratouveitis.
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