What are the signs and symptoms of mumps?
Well, some patients are asymptomatic.
If they have symptoms, they usually appear 2-3 weeks after exposure
and they start with a prodrome which is a low-grade fever, headache, and malaise.
Then the patient will have progressive swelling of one or both parotid glands
and this is the parotitis, and this lasts about one week.
The patient's gonna feel pain in the swollen salivary gland and it may hurt when they chew, eat, or swallow.
The patient may have myalgia or muscle aches and weakness and fatigue.
They're going to have their loss of appetite and then they may experience painful testicular inflammation.
Patients can experience sudden hearing loss and their thyroid gland can enlarge.
Now, here's a patient with bumps.
You can see the boy on the left has the unilateral mumps presentation.
And when the clinicians doing the exam, they want to be sure to palpate
and be sure this is not a swollen lymph node because that is a different anatomical region.
So on exam, you collect your medical history and you want to review your patient's immunization status.
One dose of the MMR vaccine is 78% effective against mumps.
So it's not that high of protection but two doses will provide 88% protection against mumps.
On exam, you're gonna examine your patient's vital signs
and do a thorough head, eyes, ears, nose, throat exam.
And this is where you want to play careful attention
and be sure that they're actually swollen over their parotid gland.
This includes an internal mouth exam and an external exam along the face and neck.
You're gonna palpate down the lymph nodes
and be sure what you're feeling is not lymphadenopathy
because this is in a different anatomical location.
You'll also do a cardiac exam and a respiratory exam.
Now, because this can cause orchitis and other GU complications,
you're gonna wanna do a testicular exam and a full neuro check.
Mumps is a mandatory notifiable condition for the health department.
Here you can see the mumps infection timeline.
The patient's gonna get exposed and then they're gonna have salivary virus shedding
and this is how they can pass this to other people.
They are gonna start with their clinical illness about 2 weeks after the start
and this is the swelling of the parotid gland.
This might be what brings the patient in to be examined.
They're gonna have a viremia the whole time.
They may also have the orchitis or meningitis symptoms.
And as this resolves, you're gonna see their serum antibody titer rises
and then should keep them protected but we know that this antibody does wane.
So what are the risk factors for heightened clinical suspicion?
What's gonna make you wanna test your patient for mumps?
Well, first if they're unvaccinated because we know that MMR is pretty effective.
And you're gonna see an absence of other causes of this swelling.
So that means your patient does not have HIV, coxsackievirus, influenza, or other obvious viral cause.
This can be a clinical diagnosis. So you're gonna look at your local outbreak data
and if the patient potentially was exposed during the local outbreak,
this is going to increase your clinical suspicion. And then of course, parotitis.
So lab testing. Before you test your patient for mumps,
you need to consult with your local and state health department for guidance
and they will tell you which test to obtain.
You can obtain a salivary sample and this is a buccal swap for PCR
and they can also do a culture with this.
You can draw your patient's blood to look for antibodies.
The IgM is gonna show you an acute infection and the IgG antibody
shows you this patient has either previously had mumps or has been immunized and is protected.
You can do pancreatic enzyme testing and this includes amylase and lipase
because those can be elevated. And finally, a lumbar puncture
because this would be done if a patient has meningitis or encephalitis symptoms.
Imaging. Imaging's not generally needed but it can be used to exclude other causes of parotitis.
You can do a neck CT if the cause of the neck swelling is unknown.
You wanna rule out trauma, maybe your patient has an abscess, or a malignancy
and this can help you see those differences.
The patient may get a brain CAT or an MRI if they're showing encephalopathic symptoms
and patients might have seizures or other neurologic abnormalities.
You can do an abdominal CT scan or an ultrasound and this is to evaluate for pancreatitis.
And finally, a testicular ultrasound if orchitis is present to rule out other causes of testicular swelling.