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. Parotitis may be unilateral or bilateral. Initial unilateral involvement is followed by contralateral involvement in 90% of cases. Parotid swelling can last up to 10 days. [21]
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. [17, 11, 13, 14]
Orchitis can occur in up to 50% of postpubertal males, and as many as 30% have bilateral involvement. Sterility is rare. [16, 12] 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. [17]
Other rare presenting symptoms can be due to arthralgias, arthritis, mastitis, thyroiditis, thrombocytopenic purpura, or nephritis.
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.
Complications
Potential complications of mumps are as follows:
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Meningoencephalitis: Although most patients recover without prolonged sequelaa, the mortality rate has been reported to be up to 1.4%. [14] Meningitis can occur before, during, or after mumps parotitis. In some cases, up to half of patients present with meningitis in the absence of parotitis. CSF samples show predominantly lymphocytes with normal or mildly increased protein levels and mildly depressed glucose levels.
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Orchitis: This is the most common complication in the pediatric population. Symptoms typically occur 5-10 days after parotitis onset and include high-grade fever and severe testicular pain. This does not usually result in sterility. Ultrasonography may be indicated when orchitis is clinically identified to rule out torsion.
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Oophoritis: This affects approximately 7% of postpubertal females with mumps and manifests as lower abdominal pain, fever, and vomiting. Whether mumps is related with female infertility is unknown. [15]
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Pancreatitis: Acute pancreatitis has been described in adults and children with mumps. It has a benign clinical course and is treated conservatively.
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Transverse myelitis
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Cerebellar ataxia
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Myocarditis
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Sensorineural hearing loss
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Additional rare complications include nephritis, arthritis, thrombocytopenic purpura, mastitis, thyroiditis, and keratouveitis.
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Child with mumps.
