Parotitis( mumps) - Causes, symptoms and treatment. MF.

Parotitis, or, as the patients call it, mumps is an acute infectious viral disease, with a predominant lesion of glandular organs and / or the nervous system, accompanied by fever and general intoxication.

Still Hippocrates described the epidemic parotitis, but only in 1934 the final idea of ​​the symptoms was formed and the viral nature of the pathogen was proved. There is an opinion that the name came from two Latin and Greek word combinations: para-around and otos-ear, and the ending -its-indicates inflammation. Thus, the name reflects the most frequent localization of the inflammatory process - the parotid gland.

Parotitis causative agent

Parotitis causative agent( Parotits epidemica) is an RNA-containing virus belonging to the family of paramyxoviruses and corresponding to the characteristic parameters of this family: large sizes, irregular spherical shape, with typical antigenic structure - N( neuraminidase) and H( hemagglutinin).N - causes the attachment and further penetration of the virus through the mucosa of the upper respiratory tract;Н - causes gluing and destruction of erythrocytes.

The virus is relatively stable in the external environment: it is stored at room temperature for several days, at low temperatures up to 6 months. Absolute inactivation of the virus occurs when it is heated to 80 ° C for 30 minutes, UVI, 1% lysol solution and 2% formalin solution and other disinfectants also have a harmful effect.

Prevalence of mumps

Infection is registered throughout the year, with an increase in the incidence in the winter-spring period. Distribution ubiquitous and susceptibility reaches 50%.The greatest incidence is observed from 3-6 years, the children of the first year of life who are on natural feeding are resistant to the virus due to the passive immunity created by the parent IgA, providing the first line of protection. Nonimmunized people retain susceptibility for life. After the transferred infection, stable immunity forms. After vaccination, stable immunity is formed for 20 years.

Causes of mumps

The source is a sick person, mumps infection begins already in the incubation period, which is asymptomatic, namely 1-2 days before the onset of obvious symptoms and 8 days after the clinical manifestations. Ways of infection - airborne, contact-household( through contaminated with saliva household items).Infection facilitates population crowding, background respiratory diseases and immunodeficiency states( IDS).

Symptoms of mumps

The incubation period 9-26 days( an average of 15-19) is characterized by the absence of any clinical manifestations. During this period, the virus mounts and multiplies on the mucosal upper respiratory tract, after which its concentration reaches a maximum and it breaks into the blood - there is primary viremia .

This gives a start to an acute onset - an increase in temperature in the evening to 38-40 ° C and intoxication( malaise, muscle and joint pain).In the course of the first day after the onset of the disease, an increase in the parotid salivary gland appears, and a second salivary gland is affected a second day later. Parotid and / or submaxillary are affected at the first stages.

Parotite lesions in the early stages of

It should be noted that not the glandular tissue itself is affected, but the tissue near the excretory ducts, ie their blockage occurs, which causes the formation of the following symptoms:

• dry mouth;
• soreness and an increase in the projection of the affected gland;
• soreness on palpation of the affected area, it is soft in texture, as dough, therefore external edema does not have clear boundaries.

As the pathogen accumulates in the gland tissues and the maximum amount is reached, the virus breaks through and re-enters the bloodstream - secondary viremia .After that, the hematogenous way( by blood), the virus reaches other glands and / or nervous tissue, which will form the following stages of symptoms. Possible:

• Testicular lesions in boys - orchitis, in girls - with oophoritis( because they are also glandular tissue): abdominal pains radiating into the scrotum and testicle, after which they become denser and sharply painful due to impaired excretory ducts, as in any other glandular tissue, the skin of the scrotum becomes hyperemic, with a bluish tinge. The symptom runs after 1.5 weeks, on average.

Parotitic infection. Bilateral orchitis

• Defeat of the membranes of the brain and spinal cord( serous meningitis): develops 3-5 days after the moment of salivary gland involvement and the symptoms change place - the parotitis subsides and the general condition worsens:
- new temperature rise up to 38-39 ° C
- lethargy and adynamia
- headache, which can cause nausea and vomiting, which does not bring relief to
, - positive meningic symptoms become positive( stiff neck muscles - in lying position can not touch podborocom to the sternum; Brudzinskogo symptoms - an attempt to tilt the head to the chest, causing flexion in the knee / hip joints; Kernig symptom - a violation of straightening the bent leg at the knee joint) - when these symptoms need immediate hospitalization !
• Polyneuropathies( multiple peripheral nerve lesions):
- compression of the facial nerve, leads to impaired mimic muscles or neuralgia( acute pain, shooting character) - in parotid involvement
- paralysis of the lower extremities and / or pain syndrome( with polyradiculoneuropathy)
- persistent loss of hearing( cochlear nerve damage)
• Pancreatic lesion( pancreatitis): develops on the 5th-9th day of the first symptoms of
- a new rise in temperature against the background of a general worsening of the condition
- nausea and vomiting that brings relief,
- abdominal pain / left hypochondrium, with irradiation( spread of pain) in the back or shingles,
- a thin fatty stool in the younger age bracket, and the presence of constipation in older age groups.

The recovery period of occurs after the disappearance of symptoms - after about 9 days.

Diagnosis of mumps

1.Oktktivny method( inspection), taking into account information about contacts with possible infectious patients.
2. Laboratory diagnostics:
• Virological - use of biological materials where the virus can be: urine, saliva and cerebrospinal fluid, but no later than 5 days of
• RIF( expressing immunofluorescence) is an express method and allows to determine in the culture cultures the virus already2 days after sampling
• Serological methods determine the presence of AT( antibodies)
-RSK( complement fixation reaction) - is considered the most highly specific and sensitive method by whichdetermine the presence of antibodies to the s-antigen or v-antigen, and thus determine the incidence period or the degree of antiparasitic immunization;The presence of antibodies to the s-antigen indicates an acute period, and the presence of antibodies to the v-antigen indicates a recovery period if it is in high titres, if low titers( against the background of antibodies to s-antigen) is an acute period of the disease.
- RTGA( hemagglutination inhibition reaction) - determine the antibody titer;
- pH( neutralization reaction) - will indicate the qualitative and quantitative ratio of antibodies( or antitoxin) and antigen( or antitoxin)
- ELISA( immunoassay) - determination of immunoglobulins IgM and G, which determine the period of the disease: M - saysabout the acute period, G - about the process's stagnation.

Treatment of mumps

1. Bed / half table.
2. A glowing vitaminized diet with the exception of obligate allergens( all artificial, containing a lot of chemistry and dyes) + plentiful drink;Vitamins can be tableted or as a dragee.
3. Etiotropic therapy( against the pathogen): antiviral( isoprinosine, divided into 4 receptions and taken within 7-10 days for 50-100 mg / kg / day), immunomodulators( interferon - intranasal 5 drops every 30 minutes for 4 hours,in the following days - 5 times a day for 5-7 days, viferon - 2 candles per day);immunostimulants( tsikloferon-used only from 4 years to 1 tab / day, from 7 years - 2 tablets, adults - 3 tablets).
4. Antipyretic drugs( from NSAIDs-paracetamol / ibuprofen / nurofen, in the absence of contraindications).
5. dry heat on the affected gland

When the neural form of infection( meningitis and / or polyneuropathy) is attached to the above clinic, some more groups of drugs are added and transferred to inpatient treatment, for example, when prescribing some drugs, laboratory monitoring should be carried out:

1. Strict bed rest.
2. Dehydration, detoxification and glucocorticosteroid therapy( in order to avoid brain edema and / or peripheral nerves due to swelling of other glands) - diacarb and furosemide in combination with potassium preparations.
3. Preparations improving cerebral blood flow and metabolic activity( actovegin, trental, agopurin, etc.).
4. Vitamins C, B, E and PP acids

When orchitis is attached, the surgeon is monitored, taking into account the standard

therapy. With pancreatitis, strict bed rest is prescribed, and in the first 2 days of the disease - hungry days( complete refusal of food intake and administrationnutritious preparations only parenterally, i.e. intravenously), then gradually pass to a light diet - table number 5 with fractional food.

1. to standard therapy, which is presented above - prescribe inhibitors of proteolytic enzymes( contrikal, gordoks, etc.) - because due to plugging of the excretory ducts, the gland "self-hardening" occurs due to its own enzymes
2. non-narcotic analgesics and spasmolytics( spasmalgon, ketorolac)
3. enzyme preparations for improving digestion, because liver enzymes for the same reason of blockage cease to enter the duodenum;for this purpose, appoint pancreatin, mezim-forte,

enzyme. Iron mumps can be treated at home, but any other manifestation( orchitis, meningitis, polyneuritis, pancreatitis) should be treated only in the hospital. The duration of treatment is 2 weeks on average

After the mumps

The rehabilitation consists in dispensary observation by convalescents, the duration of which depends on the form of mumps infection:
• with the transferred meningitis - observation for a month in a polyclinic and then for 2 years;repeated neurological and electrophysiological examinations with an interval of 1.3.6 months;restriction of physical and mental stress throughout the year
• with orchitis( oophoritis) - endocrinologist's observation during the year
• with pancreatitis - observation by a pediatrician and / or gastroenterologist

Complications of mumps

Encephalitis, lethargic fetal lethargy, infertility as in men, and in women( associated with a previous inflammation of the gonads at an early age), the development of diabetes mellitus, unilateral hearing loss without recovery. In 2000 the lethality was 1.5%.

Prevention of mumps

• isolation of patients for 10 days
• isolation of contact unvaccinated for 21 days
• active immunization by vaccination with HPV( live mumps vaccine) or MMR-II( measles mumps, rubella) - first at 12 months, and then at6 years. On the 4-12 day after vaccination, there may be an increase in temperature and a slight increase in parotid salivary glands. Vaccinations are conducted taking into account all contraindications. And the vaccine is not introduced to those who received immunoglobulin as an immuno-prophylaxis, its administration is postponed for a certain period, which is set by the doctor.

Doctor therapist Shabanova IE