Epidemic mumps(piggy)- a widespread acute benign viral infectious disease that occurs with non-purulent lesions of the glandular organs (more often the salivary glands, especially the parotid glands, less often the pancreas, genital, mammary glands, etc.), as well as nervous system(meningitis, meningoencephalitis). Incidence: 13.97 per 100,000 population in 2001

Code according to the international classification of diseases ICD-10:

• B26- Parotitis

Parotitis epidemic: Causes

Etiology

The causative agent is an RNA-containing virus of the Paramyxoviridae family.

Epidemiology

Epidemic mumps- a typical anthroponosis. The source of infection is only a sick person, contagious for 9 days of illness. Patients with erased forms of the disease represent the greatest epidemic danger. The mechanism of transmission of infection is airborne. The most affected population is children school age. With age, the number of cases falls due to an increase in the number of immune individuals. Cases of the disease among children of 1 year of age are extremely rare. Rarely epidemic mumps seen in patients over 40 years of age.

Parotitis epidemic: Signs, Symptoms

Clinical picture

. periods of illness. Incubation period (11-21 days). prodromal period; optional for all cases of epidemic mumps flowing with general intoxication (fever, headache, malaise); no longer than a day. The period of detailed clinical manifestations (7-9 days). The period of convalescence (up to 2 weeks).
. Clinical symptoms. The defeat of the parotid salivary glands: swelling of the affected tissue (fullness of the mandibular fossa, swelling of the dense tissue of the gland upwards and forward on the face) and hyperemia of the buccal mucosa at the exit of the stenon duct. Damage to the submandibular salivary glands (submaxillitis) with severe edema and their moderate soreness in areas of typical location (proximal sections of the floor of the mouth). CNS damage: headache, sleep disturbance, vomiting, symptoms of meningitis (typical triad: headache, high body temperature, nausea and vomiting; positive meningeal signs confirm the diagnosis). Symptoms of meningoencephalitis (in addition to the symptoms of meningitis, cerebral disorders are added: depression of consciousness, mental disorders, convulsive seizures). Damage to the pancreas (pancreatitis): abdominal pain (usually in the upper half, possibly shingles), repeated vomiting. The defeat of the male genital glands (orchitis, orchiepididymitis) with one or two-sided lesions in the form of edema and tenderness of the testicle, edema and hyperemia of the scrotum. Damage to the sublingual salivary gland (sublinguitis): swelling and moderate soreness of the affected organ in the distal part of the floor of the mouth; rarely noted. Lesions of the lacrimal, thyroid, mammary and female gonads: symptoms of acute inflammation. All specific topical symptoms are necessarily accompanied by general toxic manifestations. Changes in the glandular organs and the central nervous system reach their maximum development within 2-4 days from the moment the first symptoms appear. The symptoms of the period of extended clinical manifestations are characterized by the sequence of the appearance of foci of a new topical lesion, which is usually accompanied by a rise in body temperature. There is no rigid dependence in the sequence of development of these foci, but, as a rule, typical inflammatory changes in the central nervous system and genital organs follow the defeat of the salivary glands.

Parotitis epidemic: Diagnosis

Research methods

Virus isolation: traditional isolation of viruses from nasopharyngeal mucus biomaterial by seeding on embryonic tissues. Detection of antibodies to Ag virus. RSK (an increase in the titer of antibodies in the dynamics of the disease by 4 times or more). RTNHA (diagnostic titer 1: 80 and above). When evaluating the results of the study, a possible post-vaccination reaction is taken into account. Allergological method: staging an intradermal allergic reaction with mumps diagnosticum; rarely used at present. The study of cerebrospinal fluid in meningitis: high lymphocytosis. Blood test: increase in the content of amylase in pancreatitis. Urinalysis: an increase in the content of diastase in the urine with pancreatitis.

Differential Diagnosis

Infectious mononucleosis. Diphtheria. Hemoblastosis. Sarcoidosis. Mikulich syndrome. Purulent, non-epidemic mumps. Sjögren's syndrome. Salivary disease. Tumors of the salivary gland.

Treatment

Diet with mechanical sparing (food in pureed and liquid form). Patients are treated on an outpatient basis. Indication for hospitalization - development severe form(with damage to the central nervous system and genital organs) or the inability to isolate the patient at home. Symptomatic therapy. With meningitis - dehydrating agents (for example, furosemide) for the period of pronounced manifestations of the syndrome. With orchitis - bed rest, wearing a suspensory; appoint prednisolone 1-3 mg/kg for 3-5 days.

Complications

In foreign literature, the phenomena of meningitis, orchitis, pancreatitis are regarded as complications of epidemic mumps. In domestic medicine, these inflammatory processes are considered as manifestations or independent clinical variants of the course of the underlying disease. Testicular atrophy is a residual phenomenon of previously transferred orchitis.

Prevention

Vaccination with parenteral live mumps vaccine at 12 months of age. Revaccination at 6 years of age: use domestic or foreign drugs (including combined ones). There are observations of cases of epidemic mumps among previously vaccinated children. The disease in these cases proceeds relatively easily with the involvement of only the salivary glands in the pathological process. Children of the first 10 years who had contact with the patient are separated for 21 days from the moment the patient is isolated.

ICD-10. B26 Mumps

Inflammation of the gland with saliva is caused by infections of a bacterial, viral, fungal nature.

According to the clinical picture, there are:

• specific mumps - viral ( parotitis), tuberculosis, actinomycotic;
• non-epidemic or purulent mumps.

Acute parotitis

There are also parotitis acute and chronic. Acute inflammation corresponds to the primary infection, is caused, as a rule, by one causative agent of the disease.

Acute mumps of viral origin is most often caused by the infectious mumps virus - mumps. Bacterial acute parotitis develops as a result of activation bacterial microflora in oral cavity in the ducts of the salivary gland.

The cause of acute bacterial parotitis can be a violation of the secretion of saliva in the parotid gland.

According to the forms of leakage, serous acute parotitis, purulent, gangrenous are distinguished. With serous parotitis, the tissues of the salivary gland swell, and a secret accumulates in the excretory ducts.

Stagnation of saliva contributes to the activation of microflora. Little saliva is secreted, the skin over the gland is not changed, the patient's condition is usually satisfactory.

Next stage inflammatory process- purulent parotitis. At this stage, areas of purulent fusion of the gland tissue appear.

The skin over the gland becomes inflamed, reddens, glossy. It hurts the patient to open his mouth, on palpation the gland is dense, sharply painful.

With the spread of the purulent process, acute otitis media turns into a gangrenous form, in which purulent fusion of tissues covers the entire gland. After the breakthrough of purulent foci, fistulas form, through which necrotic tissues are removed.

Perhaps you were looking for information on acute otitis media? Read more in our next article. Acute otitis media middle ear in a child: causes, symptoms, treatment.

Chronic parotitis

It usually occurs as a primary disease, rarely a complication of acute parotitis. Chronic parotitis is a manifestation of Sjögren's syndrome or Mikulich's syndrome.

Sjögren's syndrome is an inflammation that affects the mucous membranes, characterized by a decrease in the secretion of the mucous glands. With Sjögren's syndrome, dry eyes and oral cavity are observed due to a lack of saliva, lacrimal fluid.

Mikulich's syndrome is manifested in an increase in the volume of the salivary glands, an increase in the secretion of saliva. The swelling of the glands can reach such proportions that it interferes with talking and eating.

Swelling of the salivary gland and arching pain are observed in chronic sialodochitis. Changes are also noted in the ducts of the gland, accompanied by secretion with lumps of mucus.

Chronic parotitis is manifested in the proliferation of connective tissue, the replacement of glandular tissue, and a decrease in salivation. Symptoms in chronic parotitis are mild, often the disease is asymptomatic.

With exacerbations, dry mouth, swelling of the gland, salivation with pus during massaging are noted.

The occurrence of chronic parotitis is associated with metabolic disorders, the disease occurs with periodic exacerbations, does not cause serious complications.

mumps - mumps

The disease is caused by the paramyxovirus Mamps virus. The infection affects mainly children from 3 years to 16. Boys get sick twice as often as girls.

You can get mumps at any age, but much less frequently. Men get sick more often than women; in adults, mumps is especially severe, with serious complications.

You can get infected only from a person, animals are not carriers of the virus. Infection occurs by airborne droplets when sneezing, talking.

Enhances the contagiousness of mumps colds, flu, so there is a seasonality of the disease. Outbreaks of mumps are observed in the cold season.

According to the ICD 10 classification of diseases, mumps is an acutely contagious disease. A sick mumps is dangerous to others on the second day after infection, during illness and another two weeks after recovery.

With mumps, there is no purulent inflammation of the tissues. The virus that causes mumps is unstable, loses activity when exposed to ultraviolet radiation, heating, treatment with lysol, formalin.

After transferred mumps immunity is developed. The incubation period is from 13 to 19 days, deviations are days.

Symptoms

The first symptom of mumps is stomatitis - inflammation of the oral mucosa. Harbingers of mumps are muscle pain, chills, feeling of weakness, headache.

Inflammation of the parotid saliva gland, caused by trauma, blockage of the salivary duct, is accompanied by salivary colic - paroxysmal pain in the region of the gland.

Signs of infection of the salivary glands are pain when chewing, pain behind the earlobe.

Almost immediately, swelling appears on one side of the face, the temperature rises above 38 degrees, the earlobe protrudes.

On palpation, there is pain in front of the ear tragus, in the behind-the-ear region, at the edge mandible. Characteristic symptoms with mumps - pain when chewing, dry mouth.

There are changes on the part gastrointestinal tract, heart, nervous system, eyes.

Depending on the degree of damage to the target organ, the following are noted:

• loss of appetite, negative attitude to hot spices in food, vomiting, nausea, constipation or diarrhea (in children);
• shortness of breath, palpitations, chest pain;
• meningitis, asthenia, mental disorder;
• inflammation of the optic nerve, inflammation of the lacrimal gland, otitis.

Diagnostics

Parotitis is diagnosed according to radiosialography, a method that allows you to evaluate the features of the functioning of the salivary gland. In the diagnosis of mumps, an ultrasound examination of the parotid gland, a cytological analysis of the composition of saliva are used.

To confirm mumps, testing is carried out in specialized laboratories in vitro - from lat. names in vitro, which means "outside the living".

A specific analysis for mumps consists in determining the presence of IgM and IgG. IgM is detected already on the third day after infection, sometimes before the onset of symptoms of mumps.

IgG is found in the blood after the onset of symptoms of mumps. Sufficient to maintain lifelong immunity, the level of IgG is maintained throughout life.

Epidemic parotitis is differentiated from false parotitis - Herzenberg's pseudomumps. With this disease, the lymph nodes inside the salivary gland are affected. The ducts of the salivary gland, its tissues are not involved in inflammation.

Treatment

Parotitis is treated at home. The patient must be isolated for the duration of treatment, quarantine in children's institutions upon detection of mumps is three weeks.

Disinfection for infectious parotitis is not carried out; to prevent complications, the patient must observe bed rest for at least 10 days. Mild dehydration therapy, dairy cuisine, sparing diet are shown.

Non-epidemic and mumps are treated conservatively and surgically. To conservative treatment include frequent rinsing of the mouth with water acidified with lemon juice, a diet that includes foods that cause active salivation.

Read more about the procedure for rinsing your mouth using the example of our article Rinse your mouth with chlorhexidine.

At the same time, the patient receives drops of a 1% solution of pilocarpine - 8 drops per meal for breakfast, lunch and dinner. Prescribe sulfonamides, antibiotics penicillin series. The gland ducts are washed with chymotrypsin.

Warming compresses are applied to the gland, irradiated with ultraviolet light, UHF therapy, sollux are used.

Interferon is used to treat mumps. It is administered intramuscularly once a day for 10 days. The oral cavity is irrigated with interferon several times a day, general strengthening therapy is carried out.

With purulent parotitis in the absence positive result treatment with drugs resort to surgery.

The patient is made two incisions to cleanse the tissues of pus:

The evacuation of pus improves the patient's condition, the inflammation stops. In debilitated patients, it is not always possible to stop the process even after surgery.

With the spread of inflammation to the tissues of the neck, the temperature continues to be high, the patient is threatened with sepsis.

Complications

In children, a complication of parotitis can be inflammation of the testicles in boys with possible atrophy and infertility later.

In girls, inflammation of the ovaries, mastitis are possible. Parotitis during pregnancy can cause the death of a child, its infection.

Mumps is severe in adults, complicated by meningitis, diabetes, infertility, and deafness.

In acute purulent parotitis, there is a danger of purulent fusion of large blood vessels, inflammation of the facial nerve and partial paresis of the muscles of the face. Pus can break into the ear canal, cause jugular vein thrombosis.

Prevention

Prevention of mumps is vaccination with the associated measles, mumps and rubella vaccine - MMR. Vaccination is done at 1 year and at 6 years.

Stimulation of salivation by rinsing the mouth with a weak solution drinking soda or citric acid during seasonal outbreaks infectious diseases serves as a prophylaxis of acute parotitis.

Forecast

With serous acute parotitis, the prognosis is favorable. Purulent and gangrenous parotitis cause a decrease in the function of the salivary gland. Epidemic parotitis, which occurs without complications, has a favorable prognosis.

A positive prognosis for chronic parotitis. Although a complete recovery does not occur, hygienic oral care has a positive effect on the patient's health.

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mumps (mumps)

Epidemic parotitis (parotitis epidemica; synonyms - mumps infection, mumps, mumps, "trench" disease, "soldier's" disease).

Mumps is an acute, contagious, systemic viral infection, usually causing an increase and soreness of the salivary glands, most often the parotid. Complications include orchitis, meningoencephalitis, and pancreatitis. Clinical diagnosis, symptomatic treatment. Vaccination is highly effective.

ICD-10 code

Epidemiology

Mumps (mumps) is traditionally classified as a childhood infection. At the same time, epidemic parotitis in infants and under the age of 2 years occurs rarely. From 2 to 25 years the disease is very common, it becomes rare again after 40 years. Many doctors attribute mumps to a disease of school age and military service. The incidence rate in US troops during World War II was 49.1 per 1,000 troops. 3 last years mumps in adults is more common in connection with the mass vaccination of children. In most of the vaccinated, after 5-7 years, the concentration of protective antibodies decreases significantly. This contributes to an increase in susceptibility to the disease in adolescents and adults.

The source of the causative agent of the disease is a person with mumps who begins to shed the virus 1-2 days before the appearance of the first clinical symptoms and up to 9 days of illness. In this case, the most active release of the virus into the environment occurs in the first 3-5 days of the disease. The virus is excreted from the patient's body with saliva and urine. It has been established that the virus can be detected in other biological fluids of the patient: blood, breast milk, cerebrospinal fluid and in the affected glandular tissue.

The virus is transmitted by airborne droplets. The intensity of the release of the virus into the environment is small due to the absence of catarrhal phenomena. One of the factors accelerating the spread of the mumps virus is the presence of concomitant acute respiratory infections, in which, due to coughing and sneezing, the release of the pathogen into the environment increases. The possibility of infection through household items (toys, towels) infected with the patient's saliva is not ruled out. A vertical route of transmission of mumps from a sick pregnant woman to the fetus is described. After the disappearance of the symptoms of the disease, the patient is not contagious. Susceptibility to infection is high (up to 100%). "sluggish" pathogen transmission mechanism, prolonged incubation, a large number of patients with erased forms of the disease, which makes it difficult to identify and isolate them, leads to the fact that outbreaks of mumps in children's and adolescent groups proceed for a long time, in waves for several months. Males suffer from this disease 1.5 times more often than women.

Seasonality is characteristic: the maximum incidence occurs in March-April, the minimum - in August-September. Among the adult population, epidemic outbreaks are recorded more often in closed and semi-closed groups - barracks, hostels. ship teams. Rise in incidence is noted with a frequency of 7-8 years. Mumps (mumps) is classified as a controlled infection. After the introduction of immunization into practice, the incidence has decreased significantly, but only in 42% of the countries of the world, vaccination against mumps is included in the national vaccination calendars. Due to the constant circulation of the virus, 80-90% of people over the age of 15 have anti-mumps antibodies. This indicates a wide spread of this infection, and it is believed that in 25% of cases mumps proceeds inapparently. After the disease, patients develop a stable lifelong immunity, and repeated diseases are extremely rare.

Causes of mumps

The cause of mumps (mumps) is the Pneumophila parotiditis virus, pathogenic for humans and monkeys.

Refers to paramyxoviruses (family Pammyxoviridae, genus Rubulavirus). antigenically close to the parainfluenza virus. The mumps virus genome is a single-stranded helical RNA surrounded by a nucleocapsid. The virus is characterized by pronounced polymorphism: in shape it represents rounded, spherical or irregular elements, and sizes can vary from 100 to 600 nm. Possesses hemolytic. neuraminidase and hemagglutination activity associated with glycoproteins HN and F. The virus is well cultivated in chicken embryos, kidney culture guinea pig, monkeys, Syrian hamster, as well as human amnion cells, unstable in the environment, inactivated when exposed to high temperature, ultraviolet irradiation, drying, quickly destroyed in disinfectant solutions (50% ethyl alcohol, 0.1% formalin solution, etc.) . At low temperatures (-20 °C), it can persist in the environment for up to several weeks. The antigenic structure of the virus is stable. Only one virus serotype is known to have two antigens: V (viral) and S (soluble). The optimal pH of the medium for the virus is 6.5-7.0. Of laboratory animals, monkeys are the most susceptible to the mumps virus. in which it is possible to reproduce the disease by introducing a virus-containing material into the duct of the salivary gland.

The virus enters the respiratory tract and in the mouth. It stays in saliva for up to 6 days, until the salivary gland swells. It is also found in the blood and urine, in the cerebrospinal fluid with CNS damage. Past illness leads to permanent immunity.

Mumps is less contagious than measles. The disease is endemic in densely populated areas, there may be an outbreak in organized communities. Epidemics occur more frequently in non-immunized populations, with a rise in incidence in early spring and late winter. mumps occurs at any age, but more often between 5 and 10 years of age; it is unusual in children younger than 2 years, especially younger than 1 year.% of cases are inapparent forms.

Other causes of enlarged salivary glands:

• Purulent mumps
• HIV mumps
• Other viral mumps
• Metabolic disorders (uremia, diabetes mellitus)
• Mikulicz syndrome (chronic, usually painless parotitis and swelling of the lacrimal glands of unknown nature, which develops in patients with tuberculosis, sarcoidosis, SLE, leukemia, lymphosarcoma)
• Malignant and benign tumor salivary gland
• Drug-mediated parotitis (eg, with iodides, phenylbutazone, or propylthiouracil)

Pathogenesis

The mumps virus (mumps) enters the body through the mucous membrane of the upper respiratory tract and conjunctiva. It has been experimentally shown that the application of the virus to the mucous membrane of the nose or cheek leads to the development of the disease. After entering the body, the virus multiplies in the epithelial cells of the respiratory tract and spreads with the bloodstream to all organs, of which the most sensitive to it are the salivary, genital and pancreas, as well as the central nervous system. Early viremia and damage to various organs and systems that are distant from each other testify to the hematogenous spread of infection. The phase of viremia does not exceed five days. Damage to the central nervous system and other glandular organs can occur not only after, but also simultaneously, earlier and even without damage to the salivary glands (the latter is observed very rarely).

The nature of morphological changes in the affected organs has not been studied enough. It has been established that the defeat of the connective tissue prevails, and not of the glandular cells. At the same time, the development of edema and lymphocytic infiltration of the interstitial space of the glandular tissue is typical for the acute period, however, the mumps virus (mumps) can simultaneously affect the glandular tissue itself. A number of studies have shown that with orchitis, in addition to edema, the parenchyma of the testicles is also affected. This causes a decrease in the production of androgens and leads to impaired spermatogenesis. A similar nature of the lesion is also described for the lesion of the pancreas, which may result in atrophy of the islet apparatus with the development diabetes.

Symptoms of mumps

Epidemic parotitis (mumps) does not have a generally accepted classification. This is explained by the different interpretation of the manifestations of the disease by specialists. A number of authors believe that the symptoms of mumps (mumps) are a consequence of damage to the salivary glands, and damage to the nervous system and other glandular organs is a complication or manifestation of an atypical course of the disease.

The position is pathogenetically substantiated, according to which lesions not only of the salivary glands, but also of other localizations caused by the mumps virus should be considered precisely as symptoms of mumps (mumps), and not as complications of the disease. Moreover, they can manifest in isolation without affecting the salivary glands. At the same time, lesions of various organs as isolated manifestations of mumps infection are rarely observed ( atypical form disease). On the other hand, an erased form of the disease, which was diagnosed before the start of routine vaccination during almost every outbreak of the disease in children and adolescents and during scheduled checkups cannot be considered atypical. An asymptomatic infection is not considered a disease. The classification should also reflect the frequent adverse long-term effects of mumps. The severity criteria are not included in this table, since they are completely different in different forms of the disease and do not have nosological specifics. Complications of mumps (mumps) are rare and have no characteristic features, so they are not considered in the classification.

The incubation period of mumps (mumps) is from 11 to 23 days (usually 18-20). Often a detailed picture of the disease is preceded by a prodromal period.

In some patients (more often in adults), 1-2 days before the development of a typical picture, prodromal symptoms of mumps (mumps) are observed in the form of weakness, malaise, oropharyngeal hyperemia, muscle pain, headache, sleep disturbance and appetite. Typically acute onset, chills and fever up to °C. Early symptoms mumps (mumps) - soreness behind the earlobe (Filatov's symptom). Swelling of the parotid gland often appears by the end of the day or on the second day of illness, first on the one hand, and after 1-2 days in 80-90% of patients on the other. In this case, tinnitus is usually noted, pain in the ear area, aggravated by chewing and talking, trismus is possible. The enlargement of the parotid gland is clearly visible. The gland fills the fossa between the mastoid process and the lower jaw. With a significant increase in the parotid gland Auricle protrudes and the earlobe rises upwards (hence the popular name "mumps"). Edema spreads in three directions: anteriorly - on the cheek, down and backwards - on the neck and upwards - on the area of ​​the mastoid process. Puffiness is especially noticeable when examining the patient from the back of the head. The skin over the affected gland is tense, of normal color, on palpation of the gland it has a test consistency, moderately painful. Puffiness reaches its maximum degree on the 3rd-5th day of the disease, then gradually decreases and disappears, as a rule, on the 6th-9th day (for adults, one day). During this period, salivation is reduced, the oral mucosa is dry, patients complain of thirst. Stenon's duct is clearly visible on the buccal mucosa in the form of a hyperemic edematous ringlet (Mursu's symptom). In most cases, not only the parotid, but also the submandibular salivary glands are involved in the process, which are determined as mildly painful fusiform swellings of the test consistency; if the sublingual gland is affected, the swelling is noted in the chin area and under the tongue. The defeat of only the submandibular (submaxillitis) or sublingual glands is extremely rare. Internal organs with isolated parotitis, as a rule, they are not changed. In some cases, patients have tachycardia, murmur at the apex and muffled heart sounds, hypotension. The defeat of the central nervous system is manifested by headache, insomnia, adynamia. The total duration of the febrile period is often 3-4 days. in severe cases - up to 6-9 days.

A common symptom of mumps (mumps) in adolescents and adults is damage to the testicles (orchitis). The frequency of mumps orchitis directly depends on the severity of the disease. In severe and moderate forms, it occurs in approximately 50% of cases. Orchitis is possible without damage to the salivary glands. Signs of orchitis are noted on the 5-8th day of illness against the background of a decrease and normalization of temperature. At the same time, the condition of the patients worsens again: the body temperature rises to ° C, chills, headache appear, nausea and vomiting are possible. Celebrate severe pain in the scrotum and testicles, sometimes radiating to the lower abdomen. The testicle increases 2-3 times (to the size of a goose egg), becomes painful and dense, the skin of the scrotum is hyperemic. often - with a bluish tint. More often one testicle is affected. Pronounced clinical manifestations of orchitis persist for 5-7 days. Then the pain disappears, the testicle gradually decreases in size. In the future, signs of its atrophy can be noted. In almost 20% of patients, orchitis is combined with epididymitis. The epididymis is palpated as an oblong painful swelling. This condition leads to impaired spermatogenesis. Obtained data on the erased form of orchitis, which can also be the cause male infertility. Pulmonary infarction due to thrombosis of the veins of the prostate and pelvic organs has been described in mumps orchitis. An even rarer complication of mumps orchitis is priapism. Women may develop oophoritis, bartholinitis, mastitis. Infrequently occurs in female patients in the post-pubertal period, oophoritis. does not affect fertility and does not lead to sterility. It should be noted that mastitis can also develop in men.

A common symptom of mumps (mumps) is acute pancreatitis, often asymptomatic and diagnosed only on the basis of increased activity of amylase and diastase in the blood and urine. The incidence of pancreatitis, according to various authors, varies widely - from 2 to 50%. It most often develops in children and adolescents. This scatter of data is associated with the use of different criteria for diagnosing pancreatitis. Pancreatitis usually develops on the 4-7th day of illness. Nausea, repeated vomiting, diarrhea, girdle pain in the middle part of the abdomen are observed. With a pronounced pain syndrome, tension in the abdominal muscles and symptoms of peritoneal irritation are sometimes noted. A significant increase in the activity of amylase (diastase) is characteristic. lasting up to one month, while other symptoms of the disease disappear after 5-10 days. Damage to the pancreas can lead to atrophy of the islet apparatus and the development of diabetes.

In rare cases, other glandular organs may also be affected, usually in combination with the salivary glands. Thyroiditis, parathyroiditis, dacryadenitis, thymoiditis are described.

The defeat of the nervous system is one of the frequent and significant manifestations of mumps infection. The most common is serous meningitis. Meningoencephalitis, cranial neuritis, polyradiculoneuritis are also possible. The symptoms of mumps meningitis are polymorphic, so the diagnostic criterion can only be the detection of inflammatory changes in the cerebrospinal fluid.

There may be cases of mumps occurring with meningism syndrome, with intact cerebrospinal fluid. On the contrary, often without the presence of meningeal symptoms, inflammatory changes in the cerebrospinal fluid are noted, therefore, data on the frequency of meningitis, according to various authors, vary from 2-3 to 30%. Meanwhile, timely diagnosis and treatment of meningitis and other lesions of the central nervous system significantly affects the long-term consequences of the disease.

Meningitis is more common in children aged 3-10 years. In most cases, it develops on the 4th-9th day of illness, i.e. in the midst of damage to the salivary glands or against the background of the subsidence of the disease. However, the appearance of symptoms of meningitis simultaneously with the defeat of the salivary glands and even earlier is possible. There may be cases of meningitis without damage to the salivary glands, in rare cases, in combination with pancreatitis. The onset of meningitis is characterized by a rapid increase in body temperature to 38-39.5 ° C, accompanied by an intense headache of a diffuse nature, nausea and frequent vomiting, skin hyperesthesia. Children become lethargic, adynamic. Already on the first day of the disease, meningeal symptoms of mumps (mumps) are noted, which are moderately expressed, often not in full, for example, only a symptom of landing ("tripod"). In children younger age convulsions, loss of consciousness are possible, in older children - psychomotor agitation, delirium, hallucinations. Cerebral symptoms usually regress within 1-2 days. Preservation for a longer time indicates the development of encephalitis. An essential role in the development of meningeal and cerebral symptoms is played by intracranial hypertension with an increase in LD domm of water. Careful dropwise evacuation of cerebrospinal fluid during lumbar puncture to a normal level of LD (200 mm of water column) is accompanied by a pronounced improvement in the patient's condition (cessation of vomiting, clarification of consciousness, decrease in headache intensity).

Cerebrospinal fluid in mumps meningitis is clear or opalescent, pleocytosis is 1 µl. The protein content is increased to 0.3-0.b/l, sometimes up to 1.0-1.5/l. rarely observed reduced or normal level squirrel. Cytosis, as a rule, is lymphocytic (90% and above), on the 1st-2nd days of illness it can be mixed. The concentration of glucose in the blood plasma - within normal values or raised. Sanitation of the liquor occurs later than the regression of the meningeal syndrome, by the 3rd week of the disease, but can be delayed, especially in older children, up to 1-1.5 months.

With meningoencephalitis, 2-4 days after the development of the picture of meningitis, against the background of a weakening of meningeal symptoms, cerebral symptoms increase, focal symptoms appear: smoothness of the nasolabial fold, deviation of the tongue, revival of tendon reflexes, anisoreflexia, muscle hypertonicity, pyramidal signs, symptoms of oral automatism, stop clonuses, ataxia, intentional tremor, nystagmus, transient hemiparesis. In young children, cerebellar disorders are possible. Mumps meningitis and meningoencephalitis are benign. As a rule, there is a complete restoration of the functions of the central nervous system. however, intracranial hypertension may occasionally persist. asthenia, decreased memory, attention, hearing.

Against the background of meningitis, meningoencephalitis, sometimes in isolation, it is possible to develop neuritis of the cranial nerves, most often the VIII pair. At the same time, dizziness, vomiting, aggravated by a change in body position, nystagmus are noted. Patients try to lie still with their eyes closed. These symptoms are associated with damage to the vestibular apparatus, but cochlear neuritis is also possible, which is characterized by the appearance of noise in the ear, hearing loss, mainly in the high-frequency zone. The process is usually unilateral, but often complete recovery of hearing does not occur. It should be borne in mind that with a pronounced parotitis, a short-term hearing loss is possible due to edema of the external auditory canal.

Polyradiculoneuritis develops against the background of meningitis or meningoencephalitis. it is always preceded by a lesion of the salivary glands. In this case, the appearance of radicular pain and symmetrical paresis of predominantly distal extremities is characteristic, the process is usually reversible, and damage to the respiratory muscles is also possible.

Sometimes, usually find the day of the disease, more often in men, polyarthritis develops. Large joints (shoulder, knee) are mainly affected. Symptoms of mumps (mumps), as a rule, are reversible, ending in complete recovery within 1-2 weeks.

Complications (tonsillitis, otitis media, laryngitis, nephritis, myocarditis) are extremely rare. Blood changes in mumps are insignificant and are characterized by leukopenia, relative lymphocytosis, monocytosis. an increase in ESR, in adults leukocytosis is sometimes noted.

Forms

The clinical classification of mumps includes the following clinical forms.

• Typical.
  • With isolated lesions of the salivary glands:
    • clinically pronounced:
    • erased.
  • Combined:
    • with damage to the salivary glands and other glandular organs;
    • with damage to the salivary glands and nervous system.
• Atypical (without damage to the salivary glands).
  • With damage to the glandular organs.
  • with damage to the nervous system.
• Disease outcomes.
  • Full recovery.
  • Recovery with residual pathology:
    • diabetes;
    • infertility:
    • CNS damage.

Diagnosis of mumps

Diagnosis of mumps (mumps) is based mainly on the characteristic clinical picture and epidemiological history, and in typical cases does not cause difficulties. From laboratory methods To confirm the diagnosis, the most convincing is the isolation of the mumps virus from the blood, parotid gland secretion, urine, cerebrospinal fluid and pharyngeal swabs, but in practice this is not used.

In recent years, serological diagnosis of mumps (mumps) is more often used; ELISA, RSK and RTGA are most often used. high titer IgM and low IgG titer during the acute period of infection may be a sign of mumps. The diagnosis can be finally confirmed in 3-4 weeks by re-examination of the antibody titer, while an increase in the IgG titer by 4 times or more has a diagnostic value. When using RSK and RTGA, cross-reactions with the parainfluenza virus are possible.

Recently, the diagnosis of mumps (mumps) has been developed using PCR of the mumps virus. For diagnosis, the activity of amylase and diastase in the blood and urine is often determined, the content of which increases in most patients. This is especially important not only for the diagnosis of pancreatitis, but also for indirect confirmation of the mumps etiology of serous meningitis.

What needs to be examined?

Differential Diagnosis

Differential Diagnosis epidemic parotitis is primarily carried out with bacterial parotitis, salivary stone disease. Enlargement of the salivary glands is also noted in sarcoidosis and tumors. Mumps meningitis is differentiated from serous meningitis of enteroviral etiology, lymphocytic choriomeningitis, and sometimes tuberculous meningitis. At the same time, an increase in the activity of pancreatic enzymes in the blood and urine in mumps meningitis is of particular importance. The greatest danger is when the swelling of the subcutaneous tissue of the neck and lymphadenitis, which occurs in toxic forms of oropharyngeal diphtheria (sometimes with infectious mononucleosis and herpesvirus infections). The doctor takes it for parotitis. Acute pancreatitis should be differentiated from acute surgical diseases. abdominal cavity(appendicitis, acute cholecystitis).

Mumps orchitis is differentiated from tuberculous, gonorrheal, traumatic and brucellosis orchitis.

Pain when chewing and opening the mouth in the region of the salivary glands

Enlargement of one or more salivary glands (parotid, submandibular)

Simultaneous damage to the salivary glands and pancreas, testicles, mammary glands, the development of serous meningitis

Research completed. Diagnosis: epidemic parotitis.

In the presence of neurological symptoms, a consultation with a neurologist is indicated, with the development of pancreatitis (abdominal pain, vomiting) - a surgeon, with the development of orchitis - a urologist.

Precedes local changes

Appears simultaneously or later than local changes

Bilateral possible damage to other salivary glands

Usually unilateral

Dense in the future - fluctuation

Hyperemia, purulent discharge

Leukopenia lymphocytosis ESR - no change

Neutrophilic leukocytosis with a shift to the left. increase in ESR

No characteristic changes

skin over gland

Normal color, tense

Who to contact?

Treatment of mumps

Hospitalize patients from closed children's groups (orphanages, boarding schools, military units). As a rule, the treatment of mumps (mumps) takes place at home. Hospitalization is indicated for severe disease (hyperthermia over 39.5 ° C, signs of CNS damage, pancreatitis, orchitis). In order to reduce the risk of developing complications, regardless of the severity of the course of the disease, patients should remain in bed for the entire period of fever. It was shown that in men who did not comply with bed rest in the first 10 days of illness, orchitis developed 3 times more often. In the acute period of the disease (up to the 3-4th day of illness), patients should receive only liquid and semi-liquid food. Given salivation disorders, great attention should be paid to oral care, and during the period of convalescence it is necessary to stimulate saliva secretion, using, in particular, lemon juice. For the prevention of pancreatitis, a milk-vegetable diet is advisable (table No. 5). Plentiful drinking is shown (fruit drinks, juices, tea, mineral water.) For headaches, metamizole sodium, acetylsalicylic acid, paracetamol are prescribed. Desensitizing treatment of mumps (mumps) is advisable. To reduce local manifestations of the disease, light and heat therapy (sollux lamp) is prescribed for the area of ​​​​the salivary glands. For orchitis, prednisolone is used for 3-4 days at a dose of 2-3 mg / kg per day, followed by a dose reduction of 5 mg daily. Be sure to wear a suspension for 2-3 weeks to ensure an elevated position of the testicles. In acute pancreatitis, a sparing diet is prescribed (on the first day - a starvation diet). Shows cold on the stomach. To reduce the pain syndrome, analgesics are administered, aprotinin is used. If meningitis is suspected lumbar puncture which has not only diagnostic but also therapeutic value. At the same time, analgesics, dehydration therapy using furosemide (lasix) at a dose of 1 mg / kg per day, acetazolamide are also prescribed. With a pronounced cerebral syndrome, dexamethasone is prescribed at 0.25-0.5 mg / kg per day for 3-4 days with meningoencephalitis - nootropic drugs in courses of 2-3 weeks.

Approximate periods of incapacity for work

The duration of disability is determined by clinical course epidemic parotitis, the presence of meningitis and meningoencephalitis, pancreatitis. orchitis and other specific lesions.

Clinical examination

Epidemic parotitis (mumps) does not require clinical examination. It is carried out by an infectious disease specialist, depending on clinical picture and presence of complications. If necessary, specialists of other specialties (endocrinologists, neurologists, etc.) are involved.

Prevention

Patients with mumps are isolated from children's groups for 9 days. Contact persons (children under 10 years of age who did not have mumps and were not vaccinated) are subject to separation for a period of 21 days, and in cases of an exact establishment of the date of contact - from the 11th to the 21st day. Carry out wet cleaning of the premises using disinfectants and airing the premises. For children who had contact with the patient, for the period of isolation, medical supervision.

The basis of prevention is vaccination within the framework of national calendar preventive vaccinations. Vaccination is carried out with a mumps cultural live dry vaccine, taking into account contraindications at 12 months and revaccination at 6 years. The vaccine is injected subcutaneously in a volume of 0.5 ml under the shoulder blade or into the outer surface of the shoulder. After the introduction of the vaccine, a short fever, catarrhal phenomena for 4-12 days are possible, very rarely - an increase in the salivary glands and serous meningitis. For emergency prevention of unvaccinated against mumps and not ill, the vaccine is administered no later than 72 hours after contact with the patient. The mumps-measles cultural live dry vaccine and the vaccine against measles, mumps and rubella live attenuated lyophilized (manufactured in India) are also certified.

Mumps immunoglobulin and serum immunoglobulin are ineffective. Vaccination with a live mumps vaccine is effective, which do not cause local systemic reactions and require only one injection, vaccination against measles, mumps and rubella is carried out. Post-exposure vaccination does not protect against mumps.

Forecast

In uncomplicated mumps, recovery usually occurs, although a relapse may occur after 2 weeks. Mumps usually has a favorable prognosis, although sequelae such as unilateral (rarely bilateral) hearing loss or facial paralysis may remain. Rarely, post-infectious encephalitis, acute cerebellar ataxia, transverse myelitis, and polyneuritis occur.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University them. A.A. Bogomolets, specialty - "Medicine"

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Disease code - B26 (ICD 10)

Syn: mumps, mumps
Epidemic parotitis (parotitis epidemica) - acute viral disease, characterized by fever, general intoxication, an increase in one or more salivary glands, often damage to other glandular organs and the nervous system.

Historical information

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Mumps was described by Hippocrates in the 5th century BC. BC. Hamilton (1790) singled out CNS symptoms and orchitis as frequent manifestations of the disease. At the end of the XIX century. data on the epidemiology, pathogenesis and clinical picture of mumps were summarized. A great contribution to the study of this problem was made by domestic scientists I.V. Troitsky, A.D. Romanov, N.F. Filatov.

In 1934, the viral etiology of the disease was proven.

Etiology

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Pathogen mumps infection belongs to the family Paramyxoviridae, genus Paramyxovirus, has a size of 120 x 300 nm. The virus contains RNA, has hemagglutinating, neuraminidase and hemolytic activity.

Antigenic structure the virus is stable.

Under laboratory conditions, the virus is cultivated on 7–8‑day chicken embryos and cell cultures. Laboratory animals are insensitive to the causative agent of mumps. In the experiment, only monkeys manage to reproduce a disease similar to human mumps.

Sustainability. The virus is unstable, inactivated by heating (at a temperature of 70 ° C for 10 minutes), ultraviolet irradiation, exposure to low concentration formalin and lysol solutions. It is well preserved at low temperatures (–10–70 °С).

Epidemiology

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source of infection is a sick person, including an erased and asymptomatic form of parotitis. The patient is contagious in the last days incubation period, in the prodromal period and in the first 5 days of the height of the disease. Convalescents are not sources of infection.

mechanism of infection. Infection occurs by airborne droplets, the virus is shed in saliva. Transmission of infection through infected household items, toys is allowed. In some cases, intrauterine infection with the mumps virus is described - a vertical route of transmission.

Children are predominantly affected at the age of 1 year - 15 years, boys are 1.5 times more likely than girls. Persons who have not suffered from mumps remain susceptible to it throughout their lives, which leads to the development of the disease in different age groups.

Typical seasonal rise in incidence at the end of winter - in the spring (March - April). The disease occurs both in the form of sporadic cases and epidemic outbreaks.

Mumps infection is one of the most common viral diseases that occurs in all countries of the world.

After the illness, a strong specific immunity remains.

Pathogenesis and pathological anatomical picture

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entrance gate infections are the mucous membranes of the upper respiratory tract and possibly the oral cavity. After accumulation in epithelial cells, the virus enters the blood (primary viremia) and spreads with its current to various organs and tissues. The virus, hematogenously introduced into the salivary glands, finds here the optimal conditions for reproduction and causes a local inflammatory reaction. In other organs, the reproduction of the virus also occurs, but much less intense. As a rule, damage to other glandular organs (testicles, pancreas) and the nervous system does not develop from the first days of the disease, which is associated with slow replication of the virus in them, as well as secondary viremia, which is the result of intensive reproduction of the virus and its release into the blood from inflamed parotid salivary glands. In the development of complications, the functional state of organs (for example, weakening of the blood-brain barrier), as well as immune mechanisms (circulating immune complexes, autoimmune reactions) are important.

Pathological picture uncomplicated mumps has not been studied enough due to the benign course of the disease. The parotid tissue retains an acinar structure, but edema and lymphocyte infiltration are noted around the salivary ducts. The main changes are localized in the ducts of the salivary glands - from a slight edema of the epithelium to its complete desquamation and obstruction of the duct with cellular detritus. Suppurative processes are extremely rare.

Testicular biopsy in mumps orchitis revealed lymphocytic infiltration of interstitial tissue and foci of hemorrhage. Often there are foci of necrosis of the glandular epithelium with blockage of the tubules by cellular detritus, fibrin and leukocytes. In severe cases, after inflammation, ovarian atrophy may occur. Inflammatory-degenerative processes are described in the ovaries.

Changes in the pancreas are not well understood. There is evidence of the possibility of developing necrotizing pancreatitis with damage to both the endocrine and exocrine tissue of the gland, in severe cases with its subsequent atrophy. CNS lesions are nonspecific.

Clinical picture (Symptoms) of mumps

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The duration of the incubation period ranges from 11 to 23 days (usually 15–19 days).

The prodrome is rare.

Within 1-2 days, patients complain of malaise, general weakness, weakness, chilling, headache, pain in muscles and joints, loss of appetite.

In typical cases, there is an acute onset of the disease with an increase in body temperature to 38-40 ° C and the development of signs of general intoxication. Fever often reaches its maximum severity on the 1st–2nd day of illness and lasts 4–7 days, followed by a lytic decrease.

The defeat of the parotid salivary glands is the first and feature disease . Swelling and soreness appear in the area of ​​the parotid glands, first on one side, then on the other side. Other salivary glands, submaxillary and sublingual, may also be involved in the process. The area of ​​the enlarged gland is painful on palpation, soft-testy consistency. The pain is especially pronounced at some points: in front of and behind the earlobe (Filatov's symptom) and in the area of ​​the mastoid process.

The symptom of Mursu (Murson) is of diagnostic value - hyperemia, an inflammatory reaction of the mucous membrane in the area of ​​the excretory duct of the affected parotid gland. Hyperemia and swelling of the tonsils are possible. Swelling can spread to the neck, the skin becomes tense, shiny, there is no hyperemia. Patients are concerned about pain when chewing. In some cases, reflex trismus sets in, which interferes with talking and eating. With a unilateral lesion of the salivary glands, the patient often tilts his head towards the affected gland. Enlargement of the salivary gland progresses rapidly and reaches a maximum within 3 days. The swelling lasts 2-3 days and then gradually (within 7-10 days) decreases. Against this background, various, often severe, complications can develop. There is no single idea of ​​how to consider lesions of various organs in mumps - as manifestations or complications of the disease - no. There is no generally accepted classification of mumps. A.P. Kazantsev (1988) proposes to single out complicated and uncomplicated forms of the disease. According to the severity of the course - light (including erased and atypical), moderate and severe form. The inapparent (asymptomatic) form of the disease is of great importance in the epidemiology of the disease. There are residual phenomena of mumps, which include such consequences as deafness, testicular atrophy, infertility, diabetes mellitus, dysfunction of the central nervous system.

The form of severity of the disease is determined on the basis of the severity of the intoxication syndrome. In severe form, along with signs of intoxication, hyperthermia, patients develop nausea, vomiting, diarrhea as a result of damage to the pancreas; enlargement of the liver and spleen is less common. The more severe the course of the disease, the more often it is accompanied by various complications.

Complications

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Perhaps the development of meningitis, meningoencephalitis, orchitis, acute pancreatitis, arthritis, myocarditis, etc.

Serous meningitis

Serous meningitis - the most common and characteristic complication of mumps, which occurs after inflammation of the salivary glands or, less often, simultaneously with it, at different times from the onset of the disease, but more often after 4–10 days. Meningitis begins acutely, with the appearance of chills, a repeated increase in body temperature (up to 39 ° C and above). Patients are concerned about a severe headache, vomiting, a pronounced meningeal syndrome develops (stiff neck, positive symptom of Kernig, Brudzinsky). Cerebrospinal fluid is clear, colorless, flows under high blood pressure. In the liquorogram, typical signs of serous meningitis are found: lymphocytic pleocytosis up to 500 and less often 1000 in 1 μl, a slight increase in protein content at normal levels of glucose and chlorides. After the symptoms of meningitis and intoxication subside, sanitation of the cerebrospinal fluid occurs relatively slowly (1.5–2 months or more).

Some patients develop clinical signs meningoencephalitis: impaired consciousness, lethargy, drowsiness, uneven tendon reflexes, paresis of the facial nerve, lethargy of pupillary reflexes, pyramidal signs, hemiparesis, etc. The course of meningoencephalitis of mumps etiology is predominantly favorable.

Orchitis and epididymitis

Orchitis and epididymitis most common in adolescents and adults. They can develop both in isolation and together. Orchitis is observed, as a rule, after 5-8 days from the onset of the disease and is characterized by a new rise in body temperature, the appearance of severe pain in the scrotum and testicles, sometimes with irradiation to the lower abdomen. Involvement of the right testicle sometimes stimulates acute appendicitis. The affected testicle is significantly enlarged, becomes dense, the skin over it swells and turns red. The enlargement of the testicle persists for 5-8 days, then its size decreases, the pain disappears. In the future (after 1–2 months), some patients may develop signs of testicular atrophy.

Oophoritis

Oophoritis rarely complicates mumps, accompanied by pain in the lower abdomen and signs of adnexitis.

Acute pancreatitis

Acute pancreatitis develop on the 4-7th day of illness. Main symptoms: sharp pains in the abdomen with localization in the mesogastrium, often of a cramping or shingles character, fever, nausea, repeated vomiting, constipation or diarrhea. In the blood and urine increases the content of amylase.

Hearing loss

Hearing loss rare, but can lead to deafness. There is a predominantly unilateral lesion of the auditory nerve. The first signs are tinnitus, then manifestations of labyrinthitis join: dizziness, impaired coordination of movement, vomiting. Hearing usually does not recover.

Rare complications include myocarditis, arthritis, mastitis, thyroiditis, bartholinitis, nephritis, etc.

Forecast

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Usually favorable.

Synonyms - mumps infection, parotitis epidemica, mumps, mumps, "trench" disease, "soldier's" disease.

Epidemic parotitis - acute anthroponous airborne infectious disease, characterized by a predominant lesion of the salivary glands and other glandular organs (pancreas, sex glands, more often testicles, etc.), as well as the central nervous system.

ICD-10 codes

B26. Parotitis.
B26.0†. Mumps orchitis.
B26.1†. Mumps meningitis.
B26.2†. Mumps encephalitis.
B26.3†. Mumps pancreatitis.
B26.8. Epidemic parotitis with other complications.
B26.9. Epidemic parotitis is uncomplicated.

Causes and etiology of parotitis

The causative agent of mumps- Pneumophila parotiditis virus, pathogenic for humans and monkeys. Refers to paramyxoviruses (family Paramyxoviridae, genus Rubulavirus), antigenically close to the parainfluenza virus. The mumps virus genome is a single-stranded helical RNA surrounded by a nucleocapsid. The virus is characterized by pronounced polymorphism: in shape it represents rounded, spherical or irregular elements, and sizes can vary from 100 to 600 nm. It has hemolytic, neuraminidase and hemagglutination activity associated with HN and F glycoproteins. The virus is well cultivated on chicken embryos, guinea pig, monkey, Syrian hamster kidney cultures, as well as human amnion cells, is not stable in the environment, is inactivated when exposed to high temperature, ultraviolet irradiation, drying, quickly destroyed in disinfectant solutions (50% ethyl alcohol, 0.1% formalin solution, etc.). At low temperatures (-20 °C), it can persist in the environment for up to several weeks. The antigenic structure of the virus is stable.

Only one virus serotype is known to have two antigens: V (viral) and S (soluble). The optimal pH of the medium for the virus is 6.5–7.0. Of the laboratory animals, monkeys are most sensitive to the mumps virus, in which the disease can be reproduced by introducing a virus-containing material into the duct of the salivary gland.

Epidemiology of mumps

Mumps is traditionally classified as a childhood infection. At the same time, mumps in infants and under the age of 2 years is rare. From 2 to 25 years the disease is very common, it becomes rare again after 40 years. Many doctors attribute mumps to a disease of school age and military service. The incidence rate in US troops during World War II was 49.1 per 1,000 troops.

In recent years, mumps in adults is more common due to mass vaccination of children. In most of the vaccinated, after 5–7 years, the concentration of protective antibodies decreases significantly. This contributes to an increase in susceptibility to the disease in adolescents and adults.

The source of the pathogen- a person with mumps who begins to shed the virus 1–2 days before the onset of the first clinical symptoms and before the 9th day of illness. In this case, the most active release of the virus into the environment occurs in the first 3-5 days of the disease.

The virus is excreted from the patient's body with saliva and urine. It has been established that the virus can be detected in other biological fluids of the patient: blood, breast milk, cerebrospinal fluid and in the affected glandular tissue.

The virus is transmitted by airborne droplets. The intensity of the release of the virus into the environment is small due to the absence of catarrhal phenomena. One of the factors accelerating the spread of the mumps virus is the presence of concomitant acute respiratory infections, in which, due to coughing and sneezing, the release of the pathogen into the environment increases. The possibility of infection through household items (toys, towels) infected with the patient's saliva is not ruled out.

A vertical route of transmission of mumps from a sick pregnant woman to the fetus is described. After the disappearance of the symptoms of the disease, the patient is not contagious.

Susceptibility to infection is high (up to 100%). The "sluggish" mechanism of transmission of the pathogen, prolonged incubation, a large number of patients with erased forms of the disease, which makes it difficult to identify and isolate them, leads to the fact that outbreaks of mumps in children's and adolescent groups proceed for a long time, in waves for several months. Boys and adult men suffer from this disease 1.5 times more often than women. Seasonality is characteristic: the maximum incidence occurs in March-April, the minimum - in August-September. Among the adult population, epidemic outbreaks are recorded more often in closed and semi-closed groups - barracks, hostels, ship crews. Rise in incidence is noted with a frequency of 7–8 years.

Mumps is classified as a controlled infection. After the introduction of immunization into practice, the incidence has decreased significantly, but only in 42% of the countries of the world, vaccination against mumps is included in the national vaccination calendars. Due to the constant circulation of the virus, 80-90% of people over the age of 15 have anti-mumps antibodies. This indicates a wide spread of this infection, and it is believed that in 25% of cases mumps proceeds inapparently.

After the disease, patients develop stable lifelong immunity. relapses are extremely rare.

The pathogenesis of mumps

The mumps virus enters the body through the mucous membrane of the upper respiratory tract and conjunctiva. It has been experimentally shown that the application of the virus to the mucous membrane of the nose or cheek leads to the development of the disease. After entering the body, the virus multiplies in the epithelial cells of the respiratory tract and spreads with the bloodstream to all organs, of which the most sensitive to it are the salivary, genital and pancreas, as well as the central nervous system. Early viremia and damage to various organs and systems that are distant from each other testify to the hematogenous spread of infection.

The phase of viremia does not exceed five days. Damage to the central nervous system and other glandular organs can occur not only after, but also simultaneously, earlier and even without damage to the salivary glands (the latter is observed very rarely). The nature of morphological changes in the affected organs has not been studied enough. It has been established that the defeat of the connective tissue prevails, and not of the glandular cells. At the same time, the development of edema and lymphocytic infiltration of the interstitial space of the glandular tissue is typical for the acute period, however, the mumps virus can simultaneously affect the glandular tissue itself. A number of studies have shown that with orchitis, in addition to edema, the parenchyma of the testicles is also affected. This causes a decrease in the production of androgens and leads to impaired spermatogenesis. A similar nature of the lesion has been described for lesions of the pancreas, which may result in atrophy of the islet apparatus with the development of diabetes mellitus.

Symptoms and clinical picture of parotitis

There is no generally accepted classification of mumps. This is explained by the different interpretation of the manifestations of the disease by specialists. A number of authors consider characteristic manifestation diseases are only damage to the salivary glands, and damage to the nervous system and other glandular organs - as complications or manifestations of an atypical course of the disease.

The position is pathogenetically substantiated, according to which lesions not only of the salivary glands, but also of other localization, caused by the mumps virus, should be considered precisely as manifestations, and not complications of the disease. Moreover, they can manifest in isolation without affecting the salivary glands. At the same time, lesions of various organs as isolated manifestations of mumps infection are rarely observed (an atypical form of the disease).

On the other hand, the erased form of the disease, which was diagnosed before the start of routine vaccination during almost every outbreak of the disease in children and adolescents and during routine examinations, cannot be considered atypical. An asymptomatic infection is not considered a disease. The classification should also reflect the frequent adverse long-term effects of mumps. The severity criteria are not included in this table, since they are completely different in different forms of the disease and do not have nosological specifics. Complications are rare and have no characteristic features, so they are not considered in the classification. The clinical classification of mumps includes the following clinical forms.

Typical.
- With an isolated lesion of the salivary glands:
- clinically expressed;
- erased.
- Combined:
- with damage to the salivary glands and other glandular organs;
- with damage to the salivary glands and nervous system.
Atypical (without damage to the salivary glands).
- With the defeat of the glandular organs.
- With damage to the nervous system.

Disease outcomes.
Full recovery.
Recovery with residual pathology:
- diabetes;
- infertility;
- damage to the CNS.

Incubation period ranges from 11 to 23 days (usually 18–20). Often a detailed picture of the disease is preceded by a prodromal period.

In some patients (more often in adults), 1-2 days before the development of a typical picture, prodromal phenomena are observed in the form of weakness, malaise, oropharyngeal hyperemia, muscle pain, headache, sleep disturbance and appetite.

Typically acute onset, chills and fever up to 39–40 °C.

One of the early signs of the disease is soreness behind the earlobe (Filatov's symptom).

Swelling of the parotid gland more often appears by the end of the day or on the second day of illness, first on the one hand, and after 1–2 days in 80–90% of patients on the other. In this case, tinnitus is usually noted, pain in the ear area, aggravated by chewing and talking, trismus is possible. The enlargement of the parotid gland is clearly visible. The gland fills the fossa between the mastoid process and the lower jaw. With a significant increase in the parotid gland, the auricle protrudes and the earlobe rises upwards (hence the popular name "mumps"). Edema spreads in three directions: anteriorly - on the cheek, down and backwards - on the neck and upwards - on the area of ​​the mastoid process. Puffiness is especially noticeable when examining the patient from the back of the head. The skin over the affected gland is tense, of normal color, on palpation of the gland it has a test consistency, moderately painful. Puffiness reaches its maximum degree on the 3-5th day of the disease, then gradually decreases and disappears, as a rule, on the 6-9th day (in adults on the 10-16th day). During this period, salivation is reduced, the oral mucosa is dry, patients complain of thirst. Stenon's duct is clearly visible on the buccal mucosa in the form of a hyperemic edematous ringlet (Mursu's symptom). In most cases, not only the parotid, but also the submandibular salivary glands are involved in the process, which are determined as mildly painful fusiform swellings of the test consistency; if the sublingual gland is affected, the swelling is noted in the chin area and under the tongue. The defeat of only the submandibular (submaxillitis) or sublingual glands is extremely rare. Internal organs with isolated mumps, as a rule, are not changed. In some cases, patients have tachycardia, murmur at the apex and muffled heart sounds, hypotension.

Symptoms of mumps in children and adults

The defeat of the central nervous system is manifested by headache, insomnia, adynamia. The total duration of the febrile period is often 3-4 days, in severe cases - up to 6-9 days.

A common symptom of mumps in adolescents and adults is testicular disease (orchitis). The frequency of mumps orchitis directly depends on the severity of the disease. In severe and moderate forms, it occurs in approximately 50% of cases. Orchitis is possible without damage to the salivary glands. Signs of orchitis are noted on the 5-8th day of illness against the background of a decrease and normalization of temperature.

At the same time, the condition of the patients worsens again: the body temperature rises to 38-39 ° C, chills, headache appear, nausea and vomiting are possible. Severe pain in the scrotum and testicles is noted, sometimes radiating to the lower abdomen. The testicle increases 2–3 times (to the size of a goose egg), becomes painful and dense, the skin of the scrotum is hyperemic, often with a bluish tint. More often one testicle is affected. Pronounced clinical manifestations of orchitis persist for 5-7 days. Then the pain disappears, the testicle gradually decreases in size. In the future, signs of its atrophy can be noted.

In almost 20% of patients, orchitis is combined with epididymitis. The epididymis is palpated as an oblong painful swelling. This condition leads to impaired spermatogenesis. Data have been obtained on the erased form of orchitis, which can also be the cause of male infertility. Pulmonary infarction due to thrombosis of the veins of the prostate and pelvic organs has been described in mumps orchitis. An even rarer complication of mumps orchitis is priapism. Women may develop oophoritis, bartholinitis, mastitis. Uncommon in female patients in the post-pubertal period, oophoritis does not affect fertility and does not lead to sterility. It should be noted that mastitis can also develop in men.

Frequent manifestation of mumps - acute pancreatitis, often asymptomatic and diagnosed only on the basis of an increase in the activity of amylase and diastase in the blood and urine. The incidence of pancreatitis, according to various authors, varies widely - from 2 to 50%. It most often develops in children and adolescents. This scatter of data is associated with the use of different criteria for diagnosing pancreatitis. Pancreatitis usually develops on the 4-7th day of illness. Nausea, repeated vomiting, diarrhea, girdle pain in the middle part of the abdomen are observed. With a pronounced pain syndrome, tension in the abdominal muscles and symptoms of peritoneal irritation are sometimes noted. A significant increase in amylase (diastase) activity is characteristic, which lasts up to one month, while other symptoms of the disease disappear after 5-10 days. Damage to the pancreas can lead to atrophy of the islet apparatus and the development of diabetes.

In rare cases, other glandular organs may also be affected, usually in combination with the salivary glands. Thyroiditis, parathyroiditis, dacryadenitis, thymoiditis are described.

Damage to the nervous system- one of the frequent and significant manifestations of mumps infection. The most common is serous meningitis. Meningoencephalitis, cranial neuritis, polyradiculoneuritis are also possible.

The clinical picture of mumps meningitis is polymorphic, so the only diagnostic criterion can be the detection of inflammatory changes in the CSF.

There may be cases of mumps occurring with meningism syndrome, with intact CSF. On the contrary, often without the presence of meningeal symptoms, inflammatory changes in the CSF are noted, therefore, data on the frequency of meningitis, according to various authors, vary from 2–3 to 30%. Meanwhile, timely diagnosis and treatment of meningitis and other lesions of the central nervous system significantly affects the long-term consequences of the disease.

Meningitis is more common in children aged 3–10 years. In most cases, it develops on the 4th–9th day of illness, i.e. in the midst of damage to the salivary glands or against the background of the subsidence of the disease. However, the appearance of symptoms of meningitis simultaneously with the defeat of the salivary glands and even earlier is possible.

There may be cases of meningitis without damage to the salivary glands, in rare cases - in combination with pancreatitis. The onset of meningitis is characterized by a rapid increase in body temperature to 38-39.5 ° C, accompanied by intense diffuse headache, nausea and frequent vomiting, skin hyperesthesia. Children become lethargic, adynamic. Already on the first day of the disease, meningeal symptoms are noted, which are moderately expressed, often not in full, for example, only a symptom of landing (“tripod”).

In young children, convulsions, loss of consciousness are possible, in older children - psychomotor agitation, delirium, hallucinations. Cerebral symptoms usually regress within 1-2 days. Preservation for a longer time indicates the development of encephalitis. An essential role in the development of meningeal and cerebral symptoms is played by intracranial hypertension with an increase in LD to 300–600 mm of water. Careful dropwise evacuation of CSF during lumbar puncture to a normal level of LD (200 mm of water column) is accompanied by a pronounced improvement in the patient's condition (cessation of vomiting, clarification of consciousness, decrease in headache intensity).

CSF with mumps meningitis is clear or opalescent, pleocytosis is 200-400 in 1 µl. The protein content is increased to 0.3-0.6 / l, sometimes up to 1.0-1.5 / l, rarely a reduced or normal protein level is observed. Cytosis, as a rule, is lymphocytic (90% and above), on the 1st–2nd days of illness it can be mixed. The concentration of glucose in the blood plasma is within normal limits or increased. Sanitation of the liquor occurs later than the regression of the meningeal syndrome, by the 3rd week of the disease, but can be delayed, especially in older children, up to 1–1.5 months.

With meningoencephalitis, 2–4 days after the development of the picture of meningitis, against the background of a weakening of meningeal symptoms, cerebral symptoms increase, focal symptoms appear: smoothness of the nasolabial fold, deviation of the tongue, revival of tendon reflexes, anisoreflexia, muscle hypertonicity, pyramidal signs, symptoms of oral automatism, clonuses of the feet, ataxia, intentional tremor, nystagmus, transient hemiparesis. In young children, cerebellar disorders are possible. Mumps meningitis and meningoencephalitis are benign. As a rule, there is a complete restoration of the functions of the central nervous system, but sometimes intracranial hypertension, asthenia, memory loss, attention, and hearing may persist.

Against the background of meningitis, meningoencephalitis, sometimes in isolation, it is possible to develop neuritis of the cranial nerves, most often the VIII pair. At the same time, dizziness, vomiting, aggravated by a change in body position, nystagmus are noted.

Patients try to lie still with their eyes closed. These symptoms are associated with damage to the vestibular apparatus, but cochlear neuritis is also possible, which is characterized by the appearance of noise in the ear, hearing loss, mainly in the high-frequency zone. The process is usually unilateral, but often complete recovery of hearing does not occur. It should be borne in mind that with a pronounced parotitis, a short-term hearing loss is possible due to edema of the external auditory canal.

Polyradiculoneuritis develops against the background of meningitis or meningoencephalitis, it is always preceded by damage to the salivary glands. In this case, the appearance of radicular pain and symmetrical paresis of predominantly distal extremities is characteristic, the process is usually reversible, and damage to the respiratory muscles is also possible.

Sometimes, usually on the 10-14th day of the disease, more often in men, polyarthritis develops. Large joints (shoulder, knee) are mainly affected. The process, as a rule, is reversible, ending in complete recovery within 1-2 weeks.

Complications (tonsillitis, otitis media, laryngitis, nephritis, myocarditis) are extremely rare. Blood changes in mumps are insignificant and are characterized by leukopenia, relative lymphocytosis, monocytosis, increased ESR, and leukocytosis is sometimes noted in adults.

Diagnosis of mumps

Diagnosis is based mainly on the characteristic clinical picture and epidemiological history, and in typical cases does not cause difficulties. Of the laboratory methods for confirming the diagnosis, the isolation of the mumps virus from the blood, parotid secretions, urine, CSF and pharyngeal lavages is the most convincing, but this is not used in practice.

In recent years, serological diagnostic methods have been more often used, the most commonly used are ELISA, RSK and RTGA. A high IgM titer and a low IgG titer during the acute period of infection may be a sign of mumps. The final confirmation of the diagnosis can be made in 3–4 weeks with a repeated study of the antibody titer, while an increase in the IgG titer by 4 times or more has a diagnostic value. When using RSK and RTGA, cross-reactions with the parainfluenza virus are possible.

Recently, diagnostic methods have been developed using PCR of the mumps virus. For diagnosis, the activity of amylase and diastase in the blood and urine is often determined, the content of which increases in most patients. This is especially important not only for the diagnosis of pancreatitis, but also for indirect confirmation of the mumps etiology of serous meningitis.

Differential Diagnosis

Differential diagnosis of mumps should primarily be carried out with bacterial parotitis, salivary stone disease. Enlargement of the salivary glands is also noted in sarcoidosis and tumors. Mumps meningitis is differentiated from serous meningitis of enteroviral etiology, lymphocytic choriomeningitis, and sometimes tuberculous meningitis. At the same time, an increase in the activity of pancreatic enzymes in the blood and urine in mumps meningitis is of particular importance.

The greatest danger is when the swelling of the subcutaneous tissue of the neck and lymphadenitis, which occurs in toxic forms of diphtheria of the oropharynx (sometimes with infectious mononucleosis and herpesvirus infections), the doctor takes for mumps. Acute pancreatitis should be differentiated from acute surgical diseases of the abdominal cavity (appendicitis, acute cholecystitis).

Mumps orchitis is differentiated from tuberculous, gonorrheal, traumatic and brucellosis orchitis.

Algorithm for diagnosing mumps infection in adults.

Symptoms of intoxication - Yes - Pain when chewing and opening the mouth in the area of ​​the salivary glands - Yes - Enlargement of one or more salivary glands (parotid, submandibular) - Yes - Simultaneous damage to the salivary glands and pancreas, testicles, mammary glands, development of serous meningitis - Yes - Examination completed, diagnosis: mumps

Table Differential diagnosis of mumps

signs	Nosological form
	parotitis	bacterial mumps	sialolithiasis
Start	Acute	Acute	gradual
Fever	Precedes local changes	Appears simultaneously or later than local changes	Not typical
Unilateral defeat	Bilateral, other salivary glands may be affected	Usually unilateral	Usually unilateral
pain	not characteristic	Characteristic	Stitching, paroxysmal
Local soreness	Minor	Expressed	Minor
skin over gland	Normal color, tense	Hyperemic	Not changed
Consistency	dense	Dense, later - fluctuation	dense
Stenon's duct	Symptom Mursu	Hyperemia, purulent discharge	Mucous discharge
blood picture	Leukopenia, lymphocytosis, ESR - no change	Neutrophilic leukocytosis with a shift to the left, an increase in ESR	No characteristic changes

Indications for consulting other specialists

In the presence of neurological symptoms, a consultation with a neurologist is indicated, with the development of pancreatitis (abdominal pain, vomiting) - a surgeon, with the development of orchitis - a urologist.

Diagnosis example

B26, B26.3. Epidemic parotitis, pancreatitis, moderate course of the disease.

Treatment of mumps

Hospitalize patients from closed children's groups (orphanages, boarding schools, military units). As a rule, patients are treated at home. Hospitalization is indicated for severe disease (hyperthermia over 39.5 ° C, signs of CNS damage, pancreatitis, orchitis). In order to reduce the risk of complications, regardless of the severity of the course of the disease, patients should remain in bed for the entire period of fever. It was shown that in men who did not observe bed rest in the first 10 days of illness, orchitis developed 3 times more often.

In the acute period of the disease (up to the 3-4th day of illness), patients should receive only liquid and semi-liquid food. Considering salivation disorders, great attention should be paid to oral care, and during the recovery period it is necessary to stimulate the secretion of saliva, using, in particular, lemon juice.

For the prevention of pancreatitis, a milk-vegetable diet is advisable (table No. 5). Plentiful drinking is shown (fruit drinks, juices, tea, mineral water).

With a headache, metamizole sodium, acetylsalicylic acid, paracetamol are prescribed. It is advisable to prescribe desensitizing drugs.

To reduce local manifestations of the disease, light and heat therapy (sollux lamp) is prescribed for the area of ​​​​the salivary glands.

For orchitis, prednisolone is used for 3–4 days at a dose of 2–3 mg/kg per day, followed by a dose reduction of 5 mg daily. Be sure to wear a suspension for 2-3 weeks to ensure an elevated position of the testicles.

In acute pancreatitis, a sparing diet is prescribed (on the first day - a starvation diet). Shows cold on the stomach. To reduce the pain syndrome, analgesics are administered, aprotinin is used.

If meningitis is suspected, a lumbar puncture is indicated, which has not only diagnostic, but also therapeutic value. At the same time, analgesics, dehydration therapy using furosemide (lasix) at a dose of 1 mg / kg per day, acetazolamide are also prescribed.

With severe cerebral syndrome, dexamethasone is prescribed at 0.25-0.5 mg / kg per day for 3-4 days with meningoencephalitis - nootropic drugs in courses of 2-3 weeks.

Forecast

Favorable, lethal outcomes are rare (1 per 100 thousand cases of mumps). Some patients may develop epilepsy, deafness, diabetes mellitus, decreased potency, testicular atrophy, followed by the development of azospermia.

Approximate periods of incapacity for work

The terms of disability are determined depending on the clinical course of mumps, the presence of meningitis and meningoencephalitis, pancreatitis, orchitis and other specific lesions.

Clinical examination

Not regulated. It is carried out by an infectious disease specialist depending on the clinical picture and the presence of complications. If necessary, specialists of other specialties (endocrinologists, neurologists, etc.) are involved.

Prevention of mumps

Patients with mumps are isolated from children's groups for 9 days. Contact persons (children under 10 years of age who did not have mumps and were not vaccinated) are subject to separation for a period of 21 days, and in cases of an exact establishment of the date of contact - from the 11th to the 21st day. Carry out wet cleaning of the premises using disinfectants and airing the premises. For children who had contact with the patient, medical supervision is established for the period of isolation. The basis of prevention is vaccination within the framework of the national calendar of preventive vaccinations in Russia.

Vaccination is carried out with a mumps cultural live dry vaccine of domestic production, taking into account contraindications at 12 months and revaccination at 6 years. The vaccine is injected subcutaneously in a volume of 0.5 ml under the shoulder blade or into the outer surface of the shoulder. After the introduction of the vaccine, a short fever, catarrhal phenomena for 4-12 days are possible, very rarely - an increase in the salivary glands and serous meningitis. For emergency prevention, unvaccinated against mumps and not ill, the vaccine is administered no later than 72 hours after contact with the patient. The mumps-measles cultural live dry vaccine (manufactured in Russia) and the vaccine against measles, mumps and rubella live attenuated lyophilized (manufactured in India) are also certified.

The incubation period varies from several days to a month, more often it lasts 18-20 days.
In children, quite rarely, after it, a short (1-3 days) prodromal period may develop, manifested by chilling, headache, muscle and joint pain, dry mouth, unpleasant sensations in the region of the parotid salivary glands. More often, the disease begins acutely with chills and fever from subfebrile to high numbers; fever persists for no more than 1 week. However, cases of the disease occurring with normal body temperature are not uncommon. Fever is accompanied by headache, general weakness, malaise, insomnia. The main manifestation of mumps is inflammation of the parotid, and possibly also submandibular and sublingual salivary glands. A swelling appears in the projection of these glands, painful on palpation (more in the center), having a pasty consistency. With a pronounced increase in the parotid salivary gland, the patient's face becomes pear-shaped, the earlobe rises from the affected side. The skin in the area of ​​swelling is tense, shiny, hardly gathers into folds, its color is usually not changed. More often the process is bilateral, exciting in 1-2 days parotid gland and on the opposite side, but unilateral lesions are also possible. The patient is disturbed by a feeling of tension and pain in the parotid region, especially at night; when the tumor squeezes the Eustachian tube, noise and pain in the ears may appear. When pressing behind the earlobe, severe pain appears (Filatov's symptom). This symptom is the most important and early sign mumps. The mucous membrane around the opening of the stenon duct is hyperemic and edematous (Mursu's symptom); throat hyperemia is often noted. In some cases, the patient cannot chew food because of pain, and in even more severe cases, functional trismus of the masticatory muscles develops. There may be a decrease in salivation and dry mouth, hearing loss. The pains last 3-4 days, sometimes radiate to the ear or neck, and gradually subside by the end of the week. Approximately by this time or a few days later, swelling in the projection of the salivary glands disappears. In mumps, regional lymphadenopathy is usually not noted.
In adults, the prodromal period is noted more often, it is characterized by more pronounced clinical manifestations. In addition to general toxic during this period, catarrhal and dyspeptic phenomena are possible. The acute phase of the disease is usually more severe. Significantly more often than in children, lesions (possibly isolated) of the submandibular and sublingual salivary glands are observed. With submaxillitis, the salivary gland has a doughy consistency and is slightly painful, elongated along the course of the lower jaw, which is recognized when the head is tilted back and to the side. Edema of the subcutaneous tissue around the gland sometimes extends to the neck. Sublinguitis is manifested by swelling in the chin area of ​​the same nature, pain under the tongue, especially when it protrudes, local hyperemia and swelling of the mucous membrane. Swelling in the projection of the salivary glands in adults persists longer (2 weeks or more).