Children aged 5-15 years most often suffer from mumps, but adults can also get sick.

As a rule, the disease is not very severe. However, mumps has a number of dangerous complications. To insure against the unfavorable course of the disease, it is necessary to prevent the very possibility of developing mumps. For this purpose, there is an anti-mumps vaccine, which is included in the list of mandatory vaccinations in all countries of the world.

Causes of the disease

Infection occurs through airborne droplets (when coughing, sneezing, talking) from a sick person. A person with mumps is contagious 1-2 days before the first signs of the disease appear and for 9 days after its onset (maximum virus shedding is from the third to the fifth day). After entering the body, the virus multiplies in the glandular tissue and can affect almost all glands of the body - reproductive, salivary, pancreas, thyroid. Changes in the functioning of most glands rarely reach the level at which specific complaints and symptoms begin to arise, but salivary glands are affected first and most severely.

Symptoms of mumps (mumps)

The disease usually begins acutely. The temperature can rise to 40 degrees, there is pain in the ear area or in front of it, especially when chewing and swallowing, and increased salivation. Particularly sharp pain occurs when food enters, causing profuse salivation(for example, sour). Inflammation of the parotid salivary gland causes an enlargement of the cheek - a rapidly spreading swelling appears in front of the auricle, which increases to its maximum by the 5-6th day. The earlobe protrudes upward and forward, which gives the patient a characteristic appearance. Feeling this place is painful. Elevated body temperature persists for 5-7 days.

Complications

Of the complications of mumps, the most common are inflammation of the pancreas () and gonads. Possible inflammation of the thyroid and other internal glands body, as well as damage nervous system in the form of meningitis or encephalitis.

Pancreatitis begins with sharp abdominal pain (often girdling), loss of appetite, and bowel movements. If you notice the appearance of such symptoms, you should immediately consult a doctor.

The gonads can be affected in both boys and girls. If in boys the inflammation of the testicles is quite noticeable, due to their anatomical location and a fairly clear clinical picture (a new rise in temperature, soreness of the testicle, change in the color of the skin over it), then in girls the diagnosis of ovarian damage is difficult. The consequence of such inflammation may subsequently be testicular atrophy in men, ovarian atrophy, infertility, and menstrual dysfunction in women.

What can you do

There is no specific therapy for mumps. The disease is most dangerous in boys during puberty, due to possible damage to the testicles. Treatment is aimed at preventing the development of complications. Do not self-medicate. Only a doctor can correctly diagnose and check whether other glands are affected.

What can a doctor do?

In typical cases, making a diagnosis does not cause difficulties and the doctor immediately prescribes treatment. In doubtful cases, the doctor may prescribe additional methods diagnostics Patients are advised to remain in bed for 7-10 days. It is known that in boys who do not comply with bed rest during the 1st week, (inflammation of the testicles) develops approximately 3 times more often. It is necessary to monitor the cleanliness of the oral cavity. To do this, prescribe daily rinsing with a 2% soda solution or other disinfectants.

A dry, warm bandage is applied to the affected salivary gland. Patients are prescribed liquid or crushed food. To prevent inflammation of the pancreas, in addition, it is necessary to follow a certain diet: avoid overeating, reduce the amount of white bread, pasta, fats, cabbage. The diet should be dairy-vegetable. For cereals, it is better to eat rice; brown bread and potatoes are allowed.

Prevention of mumps (mumps)

The danger of complications from mumps is beyond doubt. That is why methods of preventing this disease in the form of establishing quarantine in children's groups and preventive vaccinations are so widespread. The patient is isolated until the 9th day of illness; children who have been in contact with the patient are not allowed to visit child care institutions (nurseries, kindergartens, schools) for 21 days. However, the problem is that 30-40% of those infected with the virus do not develop any signs of the disease (asymptomatic forms). Therefore, it is not always possible to avoid mumps by hiding from sick people. Accordingly, the only acceptable way of prevention is vaccinations. According to the calendar of preventive vaccinations in Russia, vaccination against mumps is carried out at 12 months and at 6 years.

Contents of the article

Mumps (mumps, mumps)- infectious viral disease, characterized by general intoxication, damage to the salivary glands, less often other glandular organs, as well as the nervous system.

Historical data

The first mention of mumps is associated with the name of Hippocrates. 400 years BC, he first described mumps and identified it as a special nosological unit. Subsequent studies of the epidemiology and clinical picture of mumps have been carried out mainly since the end of the 18th century. Long time Mumps was considered a disease with local damage to the salivary glands. A.D. Romanovsky, observing an epidemic of mumps in the Aleutian Islands, identified damage to the nervous system (1849). N. F. Filatov, considering mumps infectious disease, indicated that it affected not only the salivary glands, but also the gonads. I.V. Troitsky is recognized as the author of a detailed doctrine of mumps, who comprehensively covered the epidemiology, pathogenesis and clinic of mumps (1883-1923). Soviet scientists made a great contribution to the study of mumps after the discovery of the virus (A. A. Smorodintsev, A. K. Shubladze, M. A. Selimov, N. S. Klyachko, etc.).

Etiology of mumps in children

Pathogen mumps is a virus (Paramyxovirus parotidis). Viral nature was initially established in experiments on monkeys by injecting them with saliva filtrates or punctate of the parotid salivary gland from sick people (Nicol, Rousei, 1913), and then by direct isolation of the virus from similarly infected monkeys (Johnson, Goodpasture, 1934). In the Soviet Union, the virus was isolated on chicken embryos by A.K. Shubladze, M.A. Selimov (1950), N.S. Klyachko (1953).
The mumps virus belongs to the myxoviruses, contains RNA, and is cultivated on chicken embryos, in human amnion cell cultures, guinea pig kidneys, etc. Through long passages, a weakened immunogenic virus culture suitable for active immunization was obtained. In addition, an allergen was prepared from cultures of the mumps virus that gives a positive skin reaction in people who have had mumps. The virus is not stable in the external environment, it is quickly inactivated when dried and exposed to high temperatures (at 60 ° C it dies within 5-10 minutes). When exposed to ultraviolet light, it dies immediately; in disinfecting solutions it is inactivated. within a few minutes. Antibiotics have no effect on the mumps virus. The virus tolerates long-term storage at low temperatures (from -10 to -70° C).

Epidemiology of mumps in children

The source of infection is a patient with any form of mumps, which becomes infectious at the end of the incubation period, 1-2 days before clinical manifestations.
Epidemiological observations suggest that the infectiousness of patients ceases after the 9th day of illness.
The greatest danger as sources of infection are patients with latent or asymptomatic forms of the disease, which are often not diagnosed, and patients remain in groups.
The route of transmission of infection is airborne droplets. In patients with mumps, regardless of the localization of the pathological process, the virus is detected in saliva, with droplets of which it is released into the air. Infection occurs only within the room through direct contact. The low spread of the virus in the air is explained by the absence of catarrhal symptoms (runny nose, cough), a small amount of saliva and the instability of the virus in the environment. Infection through objects is unlikely and can only occur through direct transfer of salivated objects from a sick person to a healthy one. In some cases, intrauterine infections with mumps are described.
Susceptibility to mumps is lower than to measles and chicken pox, but still quite high, the infectiousness index is 30-50%. Before the age of one year, children have a "remarkable resistance" to mumps, and the diseases are described as rare exceptions. Maximum susceptibility is observed between the ages of 5 and 15 years.
Morbidity observed in all countries of the world, it is especially high in large cities. The incidence obeys the laws characteristic of acute droplet infections: it increases in the autumn-winter season with periodic rises every 3 - 5 years; During ascents, severe forms are more often recorded. Crowding, bad living conditions contribute to the spread of mumps. The incidence is always higher among organized children. In many countries, peak incidence rates coincide with children entering school. Where the majority of children join groups starting in kindergartens, the maximum numbers occur in the senior preschool years. There is a high incidence among recruits aged 18-19 years who come to military units from remote places where there are no mumps diseases.
Immunity after mumps is persistent, recurrent diseases are rare. It is produced after suffering from both clinically pronounced and asymptomatic illness. Mortality is low; according to various authors, it ranges from thousandths to 1 - 1.5%.

Pathogenesis and pathological anatomy of mumps

The entrance gate is the mucous membrane respiratory tract, and according to some authors, also the conjunctiva and oral mucosa. The accumulation of the virus during the incubation period occurs in the epithelial cells of the respiratory tract, from where, at the end of incubation, it spreads hematogenously throughout the body and penetrates the central nervous system, endocrine and salivary glands. There it accumulates in large quantities, causes an inflammatory reaction with sequential inclusion in pathological process a number of organs and the occurrence of corresponding changes (mumps, then meningitis, orchitis), causing secondary waves of viremia. From the body to external environment the virus is excreted in saliva. Recovery is determined by the formation of virucidal antibodies that accumulate in the blood.
Morphological data for mumps are scarce. They were obtained mainly from needle biopsy affected organs in experimental studies on monkeys. The inflammatory process is characterized by a predominance of edema and lymphohistiocytic infiltration in the connective tissue stroma of the organ, and the presence of foci of hemorrhage. In the salivary glands, foci of inflammation are detected around the salivary ducts, blood vessels. Sometimes changes are found in epithelial cells (up to necrosis of the glandular epithelium). In those who died from meningitis, swelling of the brain and membranes, hyperemia, serous-fibrinous effusion around the vessels, diffuse infiltration of membranes by lymphocytes, and perivascular hemorrhages are detected. Meningitis is serous in nature. With meningoencephalitis, round cell perivascular infiltrates are usually observed in the brain tissue, sometimes hemorrhages into the brain substance.

Clinic of mumps in children

The clinical picture of mumps is very diverse. The glandular organs are most often affected: the salivary and, first of all, the parotid glands, then the pancreas, the thyroid gland, the reproductive glands, and rarely other glands (thyroid, parathyroid, lacrimal, etc.). Typically the nervous system is involved in the pathological process. It often manifests itself in pronounced forms in the form of meningitis, meningoencephalitis, sometimes neuritis, polyradiculoneuritis, etc.
Any of the listed lesions can be autonomous, the only clinical manifestation of the disease, which sometimes occurs only in the form of mumps, submaxillitis, pancreatitis, orchitis, meningitis, meningoencephalitis, neuritis, etc.
Serous meningitis usually joins with damage to the salivary glands, forming different combinations. With combined lesions, changes in the excretory system such as urethritis and cystitis often occur as a manifestation of direct viral damage. In addition, with more severe forms sometimes myocarditis occurs. Finally, in all hospitalized patients, even those suffering from mild forms, changes in the respiratory system are detected. They manifest themselves as clearly visible on radiographs as an increase in the pulmonary and root patterns and in more than half (57.6%) of patients changes in the form of peribronchial compactions of the lung tissue, focal changes, sometimes against the background of emphysema. The changes in the respiratory system are most intense at the end of the 1st - beginning of the 2nd week, then they decrease, but completely disappear slowly and in some children persist at the 5th and even 6th week of the disease.
The incubation period for mumps ranges from 11 to 23 days(on average 18-20 days). In some cases, prodromal phenomena are observed (malaise, headache, lethargy, sleep disturbance, etc.). More often, the disease begins acutely with an increase in temperature and swelling of the parotid salivary gland, usually first on one side, and after 1-2 days on the other.
The child’s face takes on a characteristic appearance, which is why the name “mumps” arose for the disease.
Over the next 1-2 days, local changes and intoxication phenomena reach a maximum; on the 4-5th day of the disease they weaken, the temperature drops step by step and by the 8-10th day the disease disappears. If damage to other organs occurs, then repeated increases in temperature may occur and then the duration of the disease increases.
The enlargement of the parotid glands is clearly visible. The glands protrude from the upper branch of the lower jaw, extend anteriorly to the cheek and posteriorly, where they form a fossa between mastoid process And lower jaw. With a significant increase in glands, the auricle protrudes and the earlobe rises upward. The skin at the site of the swelling is not changed, the enlarged gland is well contoured, the greatest density and pain are determined in the center, noticeably decreasing towards the periphery.
At high magnification Parotid gland may cause swelling of the surrounding subcutaneous tissue, which can spread to the neck, causing pain when chewing and swallowing. Salivation is often reduced, the mucous membranes are dry, and patients feel thirsty. In the area parotid duct Redness and swelling are often noticeable on the mucous membrane of the cheek.
At damage to the submandibular, sublingual salivary glands their sizes increase, the consistency becomes doughy. The glands are well contoured, may be somewhat painful, and are often surrounded by swelling of the tissue, which extends mainly down to the neck.
Damage to the gonads It is more often observed during puberty and in adults. With orchitis, it manifests itself as pain in the testicular area, radiating to the groin; Sometimes pain occurs along the spermatic cord. The testicle sometimes increases in size by 2-3 times, becomes dense, painful, the scrotum stretches, swells, and the skin becomes thinner. Maximum changes last for 2-3 days, then gradually decrease and disappear after 7-10 days. Cases of prostatitis have been described in adults. Girls may develop oophoritis, mastitis, and bartholinitis.
Pancreatitis may occur in a mild, erased form. In these cases, they are detected only by biochemical studies. With more severe lesions they are expressed in increased temperature, girdle pain in the upper abdomen, nausea, vomiting, and decreased appetite. The course of pancreatitis is usually benign. They end in 5-10 days.
Serous meningitis, sometimes meningoencephalitis is characterized by the same manifestations as meningitis of other etiologies: elevated temperature, headache, nausea or vomiting, sometimes confusion, agitation, rarely convulsions. Appear quickly meningeal symptoms(stiff neck, Kernig and Brudzinski symptoms), with lumbar puncture under high blood pressure a clear or slightly opalescent liquid flows out; the Pandey reaction is in most cases weakly positive. Characterized by high lymphocytic cytosis, the protein content is normal or slightly increased. The sugar content is predominantly unchanged. Severe symptoms of meningitis and most high temperature last for 2-3 days, then their severity decreases and after 5-10 days they disappear in almost all patients. In some cases, low-grade fever persists for a longer period. Sanitation of cerebrospinal fluid occurs much more slowly - from the beginning of the 3rd week and later. Serous meningitis with mumps can also occur with very mild, rapidly passing meningeal symptoms. With meningoencephalitis, focal changes occur.
The course of meningitis is benign, but often symptoms of asthenia persist for several months (fatigue, drowsiness, increased irritability). Leukopenia or normocytosis, lymphocytosis, and sometimes monocytosis are usually observed in the blood; ESR is mostly unchanged.
Due to the diversity clinical forms Many classifications of mumps have been proposed. As already indicated, with this infection, damage to any glandular organ and the central nervous system can be observed, however, when determining typicality, it is best to proceed from the damage to the salivary parotid glands, since this damage is the most common. The classification below is based on this principle.
To typical forms Mumps include diseases with severe damage to the salivary parotid glands, erased forms - with barely noticeable damage to them, and atypical forms - without damage to this organ. There is also an asymptomatic form that occurs without clinical changes, which is detected only with an increase in the titers of immunological reactions.
The criterion for the severity of the disease is the severity of general intoxication, usually accepted characteristics(high temperature, feeling unwell, vomiting, headache, etc.).
Towards light forms include diseases with mild symptoms of general intoxication. General (the condition remains satisfactory, the temperature rises within 37.5-38 ° C, the disease ends within 5-7 days. Moderate forms include cases with clearly expressed symptoms of intoxication (lethargy, sleep disturbance, headache, vomiting and high temperature - up to 39° C and even 40° C).
In severe form symptoms of intoxication are pronounced: headache, repeated vomiting are observed, there may be a delusional state, hallucinations, anxiety, sometimes convulsions, the temperature remains at high levels.
In our country, it is also common to divide mumps into three forms: glandular, nervous and mixed.
There is a parallelism between the severity and multiplicity of damage to different organs. Light form Mumps is usually observed with isolated damage to glandular organs, mainly the parotid salivary glands. In the presence of pancreatitis, the severity of the lesion increases slightly; with a multiplicity of organs involved in the process, it reaches a maximum. The most difficult process occurs with the development of meningitis and meningoencephalitis.

Complications of mumps in children

To specific complications in the past included meningitis, meningoencephalitis, orchitis, pancreatitis, damage to the sensory organs, etc. Currently, they are classified as direct manifestations of mumps. Complications are expressed in various changes that develop already in more late dates as a result of the listed defeats. The consequences of meningitis may be hypertension syndrome, asthenia, stuttering, sometimes urinary incontinence, epilepsy. Complications after encephalitis, meningoencephalitis (paresis, paralysis, mental disorders) are dangerous.
Inner ear damage auditory nerve may lead to irreversible deafness. Optic nerve atrophy, testicular atrophy due to orchitis, diabetes due to pancreatitis, etc. have been described. However, these severe long-term consequences are relatively rare. Complications during illness, manifestations of secondary infection can be observed in the form of pneumonia, otitis, but they are also rare.

Diagnosis, differential diagnosis of mumps in children

In typical cases of damage to the parotid salivary glands, diagnosis is simple. Acute onset of the disease with unilateral or bilateral enlargement of the glands described above clinical features talks about mumps. In erased forms of the disease, diagnosis is also based on signs of damage to the salivary glands.
With atypical forms, epidemiological data (presence of contact) can be of great assistance in diagnosis.
Auxiliary specific diagnostic methods are immunological reactions, RTGA, based on the fact that during mumps, antibodies are produced in the blood that inhibit the ability of the mumps virus to cause agglutination of erythrocytes in humans and many animals (monkeys, chickens, birds, guinea pigs, sheep, etc.). When performing RSC, where the antigen is the mumps virus, the diagnostic indicator is an increase in titer during illness by 4 times or more. During a single examination during the period of convalescence, a titer of 1:80 or higher is considered diagnostic.
Mumps virus in last days incubation and in the first 3-4 days of illness can be isolated from mucus, blood, cerebrospinal fluid, but the isolation method is complex and practically not used.
An intradermal reaction is performed with mumps antigen in the form of an inactivated virus contained in an extract of an infected chicken embryo: 0.1 ml of the drug is administered intradermally. During the period of convalescence of mumps, the reaction becomes positive: skin infiltration and redness up to 1-3 cm in diameter appear at the injection site after 24 - 48 hours, which is regarded as increased sensitivity to the antigen. Positive reaction remains in the future.
Differential diagnosis must be carried out between mumps with damage to the parotid salivary glands and purulent parotitis. The latter are observed extremely rarely, they are usually one-sided, they are distinguished by changes in the form of skin hyperemia, fluctuation, neutrophilic leukocytosis, and increased ESR.
Salivary stone disease characterized gradual development, almost complete absence general changes.
Submaxillitis must be differentiated from secondary lymphadenitis that occurs with tonsillitis, periodontitis, which is characterized by primary focus inflammation in the pharynx and signs of inflammation in the lymph nodes.
Sometimes swelling of the neck tissue during mumps is a reason to suspect diphtheria.
Serous mumps meningitis without damage to the salivary glands and in the absence of contact with patients with mumps, it is indistinguishable from serous meningitis of another viral etiology (Coxsackie, caused by the ECHO virus, polio). In such cases, the diagnosis can only be established using virological and serological methods.
From tuberculous meningitis mumps is characterized by a more acute onset with rapid reverse dynamics, normal content of sugar and chlorides in the cerebrospinal fluid. A positive Pirquet reaction and film formation confirm the diagnosis of tuberculous meningitis.

Prognosis of mumps in children

Lethal outcomes are extremely rare, but damage to the central nervous system, sensory organs, and endocrine organs requires caution regarding the long-term prognosis.

Treatment of mumps in children

There are no etiotropic drugs for mumps; treatment is symptomatic. Taking into account the complexity and versatility of the generalized viral process, the involvement of many organs in the pathological process, and frequent damage to the nervous system, the patient should create the most favorable conditions for the entire duration of the illness until complete recovery. They are also necessary in mild forms, since damage to the glandular organs and nervous system often has a subtle manifestation and may not develop from the onset of the disease, but later.
Bed rest should be provided for the entire acute period until the temperature completely normalizes. Shown dry heat on damaged glands, oral care (frequent drinking, rinsing the mouth after eating boiled water or a weak solution of potassium permanganate, ethacridine lactate, boric acid).
For headaches, analgin is used, acetylsalicylic acid, amidopyrine. For orchitis, bed rest is prescribed until signs of the disease disappear. For the period of pronounced changes, it is recommended to wear a jockstrap and dry heat.
If meningitis is suspected, a spinal puncture is indicated, which has not only diagnostic but also therapeutic value. When this diagnosis is confirmed, the usual treatment is carried out. Patients with multiple lesions, with suspected serous meningitis subject to hospitalization.

Prevention of mumps in children

Patients with mumps are isolated for 9 days from the onset of the disease. Final disinfection is not performed. Contact quarantine is announced on the 21st day. If the time of contact is precisely established, during the first 10 days the contacted children can attend childcare facilities, since during this period they do not get sick, and during the incubation period they are non-infectious. Children under 10 years of age who have not previously had mumps and have not been immunized are subject to isolation. After the 10th day from the moment of contact, systematic medical observation is carried out for early detection diseases.
Currently, active immunization has been introduced with a live attenuated mumps vaccine from the Leningrad-3 (L-3) strain, obtained under the leadership of A. A. Smorodintsev. The vaccine is characterized by very low reactogenicity and high immunological and epidemiological effectiveness. Vaccinations are given to children aged 15-18 months. One vaccination dose of the vaccine is administered once subcutaneously (0.5 ml) or intradermally with a needle-free injector (0.1 ml). Children who have been in contact with people with mumps, have not had it and have not been vaccinated before are subject to urgent vaccination.

Home distinctive feature in the course of the disease is non-purulent damage to the parotid salivary glands. Much less often they are affected large glands, such as: pancreas, mammary and sex glands. Damage to the central nervous system, manifested by meningitis and meningoencephalitis, is also characteristic. According to statistics, mumps occurs in 13.97 people per 100,000 population.

Pathogen

Mumps is caused by an RNA virus belonging to the paramyxoviruses ( family Paramyxoviridae, genus Paramyxovirus). This virus is not resistant to environmental conditions. Easily destroyed by heat and ultraviolet irradiation. Inactivated by exposure to fat solvents.

Epidemiology

The source is an exclusively sick person, with pronounced or erased clinical picture diseases. It becomes contagious to others one to two days before the first symptoms appear, as well as the subsequent five to six days of illness. After all clinical symptoms disappear, the patient becomes harmless to others. The virus spreads by airborne droplets, but transmission through contaminated surrounding objects cannot be ruled out. If we talk about age category patients, then children are much more susceptible to the virus, mainly school age. With age, the possibility of infection decreases, and by the age of 40 it practically disappears. What is associated with the development of immunity to the causative virus in older people. Mumps is also rare in newborns and children in the first year of life, since they are still protected by maternal immunity for some time. Girls get sick 1.5 times less often than boys. Mumps is characterized by pronounced seasonality. Thus, March - April is the peak of incidence, and August - September is the so-called lull. Mumps can occur as isolated diseases or, conversely, as epidemic outbreaks of the disease.

How does the virus affect glandular organs?

Entering the human body by airborne droplets through the mucous membranes of the upper respiratory tract, as well as the tonsils, the virus penetrates directly into the blood. It is transported throughout the body by the blood stream. Penetrating into the glandular organs and nervous system, the virus finds favorable conditions there for its further existence, growth and reproduction. Soon, as a result of the activity of the virus, inflammatory processes in the glands begin to develop. Usually mumps is bilateral. In most cases, the parotid salivary glands are primarily affected. But there are cases when other glands or the nervous system are damaged completely independently of the parotid salivary glands. The localization of the pathogen is very diverse. The clinical manifestations of the disease depend on this.

Clinical picture

During the course of the disease, several stages can be distinguished:

• The incubation period is two to three weeks
• The prodromal period lasts no more than a day
• 
  The period of full-blown clinical manifestations is from 7 to 10 days
• Convalescence period – up to two weeks

During the incubation period, the patient is active and does not complain about anything. The prodromal period is characterized by the manifestation of general symptoms that are nonspecific only for mumps:

• Malaise
• Muscle pain
• Joint pain
• Feeling overwhelmed and tired
• Increased body temperature
• Chills
• Appetite disturbance
• Sleep disturbance

Then, as the inflammatory processes in the salivary glands progress, the signs of their damage become more pronounced.
That's when they appear:

• Dry mouth
• Pain in the ear area that gets worse when talking and chewing
• Swelling of the affected tissue and its bulging upward and forward onto the face
• Redness of the buccal mucosa at the site of the exit of the Stenon's duct ( excretory duct of the parotid salivary gland)

When the submandibular salivary glands are damaged, the following appears:

• severe swelling in the floor of the mouth, accompanied by pain in the corresponding area.

When the central nervous system is damaged, the following symptoms occur:

• Headache
• Nausea and vomiting
• Sleep disturbance
• A sharp increase in body temperature
• Impaired consciousness

Damage to the pancreas is accompanied by:

• Pain in the upper abdomen, sometimes girdling
• Repeated vomiting

If the male gonads are affected, then the following appear:

• Swelling and tenderness in the testicular area
• Swelling and redness of the scrotum

Mumps (Parotitis epidemica) is an acute infectious disease caused by the mumps virus, transmitted by airborne droplets and characterized by an intoxication syndrome, damage to the salivary glands, the central nervous system, and frequent involvement of other organs and systems in the pathological process.

Historical data. Mumps (EMP) was first described and identified as an independent nosological form 400 years BC. e. Hippocrates. In 1849, A.D. Romanovsky, analyzing the mumps epidemic in the Aleutian Islands, described damage to the central nervous system. N.F. Filatov, I.V. Troitsky pointed to inflammation of the gonads in both men and women.

Etiology. The causative agent of mumps is a virus belonging to the Paramyxoviridae family. The pathogen was discovered in 1934 by N. Johnson and E. Goodpasture, contains RNA, is unstable in the external environment, sensitive to heat, drying, chemicals, disinfectants (at a temperature of 60 ° C it dies within 5-10 minutes, with ultraviolet irradiation - immediately, in disinfectant solutions - within a few minutes). The virus is not sensitive to chemotherapy and antibiotics and is resistant to low temperatures(at -20°C it lasts 6-8 months); non-volatile - infection occurs only within a room or ward through direct contact. The antigenic structure is homogeneous. The mumps virus can be detected in saliva, blood, and CSF taken from a patient in the last days of the incubation period and in the first 3-4 days from the onset of the disease.

Epidemiology. Epidemic parotitis (mumps, mumps, mumps infection) is a typical anthroponotic infection. By artificially infecting animals, an experimental infection was caused in monkeys.

The source of infection is a sick person who is contagious from the end of the incubation period (1-2 days before the onset of clinical manifestations) and, especially, during the first 3-5 days. diseases. The infectiousness of patients with mumps stops after the 9th day of illness. Patients with atypical forms are of great importance in the spread of infection. The existence of healthy virus carriers is assumed.

The transmission mechanism is drip.

The route of transmission is airborne. The virus is released into the external environment with droplets of saliva, where it is found in all children, regardless of the location of the pathological process.

Contact-household transmission is unlikely and is possible only through direct transfer of infected objects from a sick person to a healthy person (for example, toys).

Contagiousness index - 50-85%.

The incidence is recorded in all countries of the world, both in the form of sporadic cases and epidemic outbreaks (in children's groups, barracks for recruits). Outbreaks are characterized by gradual spread over 2.5-3.5 months, with a wave-like course.

Age structure. Mumps occurs at any age. Children aged 7-14 years are most often affected; in children under 1 year of age, especially the first 6 months. life, EP is extremely rare. Males get sick somewhat more often.

Seasonality. Cases of EP are recorded throughout the year, but during the cold period (autumn-winter and early spring) their number increases. This is due to the activation of the droplet transmission mechanism due to changes in people’s lifestyles and the formation of new groups.

Periodicity. An increase in incidence occurs after 3-5 years and is due to an increase in the number of susceptible individuals.

Immunity is persistent, developed both after manifest forms and after atypical ones. Recurrent diseases are observed in no more than 3% of cases.

Pathogenesis. The entrance gates are the mucous membranes of the mouth, nose and pharynx. The site of primary localization of the EP virus is the salivary glands, possibly other glandular organs, and the central nervous system. The virus penetrates the salivary glands through the bloodstream, through the lymphatic ducts, as well as through the excretory ducts: parotid (stenon), etc. The virus multiplies in the glandular epithelium, after which it enters the blood again; The virus is released into the external environment with saliva.

The virus infects glands of exoepithelial origin, different in function, but united by the same anatomical and histological structure: salivary (parotid, submandibular, sublingual), pancreas (exocrine part), male reproductive organs (testes, prostate gland), female reproductive organs (ovaries, Bartholin glands) ), milk, thyroid, lacrimal. Consequently, the virus, in the process of evolution, has adapted to the epithelium of glands with an alveolar, alveolar-tubular and follicular structure.

Long-term circulation of the pathogen in the blood promotes its penetration through the blood-brain barrier. Data from CSF studies indicate that in most cases there is central nervous system involvement (even in the absence of clinical manifestations).

Pathomorphology. In the salivary glands, hyperemia and swelling, expansion of the excretory ducts are noted. With mumps orchitis, multiple hemorrhages, swelling of the interstitial tissue and destruction of the germinal epithelium are observed, in the seminiferous tubules there is fibrin, leukocytes, and remnants of epithelial cells. Degenerative changes spermatogenic epithelium is also detected in men without clinical signs of testicular involvement in the pathological process. Inflammation of the epididymis connective tissue, the epithelium remains intact. Meningitis is serous in nature, and the development of focal and diffuse encephalitis is possible.

Classification of mumps

Typical:

isolated (mumps);

· combined (mumps + submandibulitis; mumps + orchitis; mumps + serous meningitis, etc.).

Atypical:

· isolated;

· combined (pancreatitis + sublinguitis; pancreatitis + encephalitis, etc.);

· erased;

· asymptomatic.

By severity:

1. Light form.

2. Moderate form.

3. Severe form.

Severity criteria:

· severity of fever syndrome;

· severity of intoxication syndrome;

· severity of local changes.

By flow (by character):

1. Smooth.

2. Unsmooth:

· with complications;

with a layer of secondary infection;

with exacerbation of chronic diseases.

Clinical picture. The incubation period of mumps ranges from 11 to 21 days. (usually 15-19 days).

Typical forms (with an increase in the size of the parotid salivary glands) can be isolated, when there is only mumps, and combined - combined damage to the parotid salivary gland and other glandular organs (submandibular and sublingual salivary glands, pancreas, gonads, etc.); damage to the parotid salivary gland and central nervous system; damage to the parotid salivary gland and other organs and systems of the body.

Damage to the parotid salivary glands (mumps) is a typical, isolated form.

Initial period: in some cases, malaise, lethargy, headache, sleep disturbance may be observed (within 1-2 days). However, more often the disease begins acutely with an increase in body temperature.

During the peak period, children complain of pain when opening their mouth, chewing, and, less often, in the area of ​​the earlobe and neck. An increase in the size of the parotid salivary gland is detected, and after 1-2 days, as a rule, the other parotid salivary gland. On the affected side, a swelling appears in front of the ear (along the ascending branch of the lower jaw), under the earlobe, behind the auricle, so that the earlobe is located in the center of the “tumor”. Swelling with a doughy or elastic consistency; the skin is tense, its color is not changed. An enlarged parotid salivary gland is painless or moderately painful on palpation.

With a significant increase in the size of the parotid salivary gland, the auricle is pushed upward and anteriorly. The configuration of the retromandibular fossa is smoothed - between the branch of the lower jaw and the mastoid process. The degree of increase in the size of the parotid salivary glands varies: from imperceptible upon examination (determined by palpation) to significant, with a change in the configuration of the face and neck. At sharp increase size of the parotid salivary glands, swelling of the subcutaneous tissue may develop, spreading to the neck, supraclavicular and subclavian areas.

In patients with EP, “Filatov’s pain points” are determined: pain when pressing on the tragus, mastoid process and in the area of ​​the retromandibular fossa. They also reveal characteristic changes oral mucosa: swelling and hyperemia around the external opening of the excretory duct of the parotid salivary gland (Murson's symptom).

An increase in the size of the affected salivary glands is usually observed within 5-7 days, but sometimes disappears after 2-3 days or persists for up to 10 days. from the onset of the disease.

During the period of convalescence, the body temperature is normal, the patient’s well-being improves, and the functional activity of the salivary glands is restored (by the end of the 3-4th week).

In patients with a typical form of EP, other glandular organs may be affected: submandibular and sublingual salivary glands, pancreas, gonads (typical, combined form).

Damage to the submandibular salivary glands (submandibulitis) is often bilateral. It usually occurs in combination with damage to the parotid salivary glands, but sometimes it can be the only manifestation of mumps infection. With submandibulitis, a “tumor” in the form of an oblong or round formation is determined medially from the edge of the lower jaw. The gland has a doughy consistency, somewhat painful on palpation: swelling of the subcutaneous tissue is possible.

Damage to the sublingual salivary glands (sublinguitis) in isolated form is rare, usually combined with mumps or submandibulitis. Swelling and pain are detected in the chin area and under the tongue: a “tumor” of doughy consistency. With a pronounced increase in the submandibular and sublingual salivary glands, swelling of the pharynx, larynx, and tongue may develop.

Damage to the pancreas (pancreatitis) occurs in half of patients. In most children, it develops simultaneously with damage to the parotid salivary glands, less often - in the 1st week of illness and in isolated cases - in the 2nd week. Pancreatitis may develop until the size of the parotid salivary glands increases; extremely rarely, damage to the pancreas is the only symptom of the disease. Clinically, pancreatitis manifests itself as sharp, cramping pain in the left hypochondrium, often of a girdling nature. Body temperature rises with possible fluctuations of up to 1-1.5 ° C (stays up to 7 days or more). Nausea, repeated vomiting, loss of appetite, hiccups, constipation, and in rare cases- diarrhea. In children during the first 2 years of life, the nature of the stool changes - liquid, poorly digested, with the presence of white lumps. The tongue is coated and dry. In severe forms, repeated vomiting is observed; pulse is increased, blood pressure reduced, a collaptoid state may develop.

Lesions of the male gonads (orchitis, prostatitis). Inflammation of the testicles (orchitis). The incidence of orchitis in men reaches 68%, in boys of preschool age - 2%. With the onset of puberty, orchitis occurs more often: in the age group of 11-15 years - in 17% of patients; at 16-17 years old - in 34% of patients.

Cases of the development of mumps orchitis in infant boys have been described.

Orchitis develops acutely, most often on the 3rd-10th day of illness. Orchitis may occur on the 14th-19th day of EP and even after 2-5 weeks. Orchitis can precede an increase in the size of the parotid salivary glands (“primary” orchitis), develop simultaneously with mumps (“concomitant” orchitis) and be the only manifestation of the disease (“autonomous” orchitis). However, most often, along with damage to the testicles, other organs and systems of the body (salivary glands, pancreas, central nervous system) are involved in the pathological process. Orchitis can be combined with damage to the epididymis (orchiepididymitis). With EP, predominantly unilateral damage to the seminal glands is observed. The right testicle is involved in the process more often than the left, which is due to the peculiarities of its blood circulation.

When orchitis occurs, the general condition of patients deteriorates sharply - body temperature rises to 39-41 °C. The temperature curve acquires a “two-humped” character, and with sequential involvement of both testicles in the pathological process, a third peak of increase in body temperature is observed. At the same time, pain appears in the testicles, radiating to the lower back and perineum, intensifying when getting out of bed and moving. In some cases, headache and vomiting are observed. Along with the symptoms of intoxication, local signs of orchitis develop - an increase in the volume of the testicle, its soreness, hyperemia, thinning or swelling of the skin of the scrotum. Signs of orchitis are most pronounced within 3-5 days, then gradually decrease and disappear.

Damage to the prostate gland (prostatitis) is observed mainly in adolescents and adults. The patient notes discomfort and pain in the perineal area, especially during bowel movements and urination. An increase in the size of the prostate gland is detected using a digital examination of the rectum.

Damage to the female reproductive glands. Oophoritis is observed in girls during puberty. Inflammation of the ovaries is characterized by the severity of the process, severe pain in iliac region, high body temperature. The reverse dynamics are usually rapid (5-7 days). The outcomes of oophoritis are often favorable.

Mastitis of mumps etiology occurs in women and men. There is an increase in body temperature, soreness, and hardening of the mammary glands. The process is eliminated quickly - in 3-4 days; No suppuration of the glands is observed.

Damage to the thyroid gland (thyroiditis) is extremely rare. The disease occurs with high body temperature, pain in the neck, sweating, and exophthalmos.

Damage to the lacrimal gland (dacryoadenitis) is characterized by severe pain in the eyes, swelling of the eyelids, and their pain on palpation.

In patients with a typical form of EP, the central nervous system is often affected (typical, combined form).

Serous meningitis usually occurs before the 6th day of illness and may be the only manifestation of mumps infection. Most often, mumps meningitis occurs in children aged 3 to 9 years.

The onset is acute, sometimes sudden. Celebrate sharp increase body temperature, repeated vomiting that is not associated with food intake and does not bring relief; convulsions, delirium, loss of consciousness are possible. Patients complain of headache, lethargy, drowsiness, poor sleep, and loss of appetite. Meningeal symptoms are detected - stiff neck, Brudzinski's symptoms I, II, III, Kernig's symptom (moderately or weakly expressed for 5-7 days). Spinal puncture helps in diagnosis; CSF pressure is increased, the fluid is clear or opalescent, moderate pleocytosis (up to 500 - 1000 cells/μl) of a lymphocytic nature (lymphocytes 96-98%). In most patients, the protein content is normal or moderately increased (0.6 g/l), the chloride concentration is usually within normal limits.

There are asymptomatic liquor-positive meningitis, which are extremely difficult to diagnose.

Meningoencephalitis is rare. In typical cases, it develops on the 6-10th day of the disease, more often in children under 6 years of age. The pathological process involves the cranial nerves, pyramidal and vestibular systems, and the cerebellum.

The condition of the patients is extremely serious; high body temperature, severe headache, repeated vomiting, lethargy, drowsiness, impaired consciousness, delirium, tonic and clonic convulsions, paresis are noted. cranial nerves, hemitype limbs, cerebellar ataxia.

Lesions of the cranial nerves (mononeuritis) are rare, mainly in children of the older age group. The most common are lesions of the VII pair of peripheral type and VIII pairs. When the auditory nerve is damaged, dizziness, nystagmus, tinnitus, hearing loss, and even deafness are noted.

Myelitis and encephalomyelitis appear more often on the 10-12th day of illness. They are manifested by spastic lower paraparesis (increased muscle tone and tendon reflexes of the lower extremities, foot clonus, pathological foot signs, decreased abdominal reflexes), fecal and urinary incontinence.

Severe damage to the nervous system in the form of polyradiculoneuritis occurs on the 5-7th day of the disease. Manifests itself as distal flaccid paralysis and paresis in combination with radicular pain syndrome and loss of sensitivity of the distal-peripheral type.

Along with inflammation of the parotid salivary gland, damage to other organs and systems of the body is possible (typical, combined form).

Respiratory system lesions. With mumps infection, physical changes in the lungs are scant.

However, in all patients, X-ray examination reveals circulatory-vascular changes (expansion of the roots of the lungs, increased pulmonary pattern), peribronchial compaction of the lung tissue. They occur from the 1st to the 15th day of the disease and persist for a long time.

Lesions of the urinary system (urethritis, hemorrhagic cystitis). Changes in urine are more often detected in preschool children, in half of the cases - in the 1st week of illness. They occur acutely and are manifested by proteinuria, hematuria, leukocyturia. Patients complain of frequent painful urination, macrohematuria is often observed. The total duration of damage to the urinary system is no more than 1 week.

Damage to the cardiovascular system manifests itself in the form of myocardial dystrophy and, less commonly, myocarditis. Signs of myocarditis are detected by the end of the 1st week of illness, after 1.5-2 weeks. noted an improvement in electrocardiographic parameters.

The pathological process may involve: liver, spleen, organ of hearing (labyrinthitis, cochleitis), organ of vision (conjunctivitis, scleritis, keratitis, neuritis or optic nerve paralysis), serous membranes joints.

Isolated damage to organs and body systems is observed only in 15% of cases, in 85% of patients the lesions are combined or multiple.

Atypical forms occur without an increase in the size of the parotid salivary glands. They can be isolated (one organ/system is affected) or combined (two or more organs/systems are affected).

Erased form - with ephemeral damage to the parotid salivary gland (an increase in the size of the gland is determined by palpation and quickly disappears).

Asymptomatic form - no clinical signs; Diagnosed in foci of infection by an increase in the titer of specific antibodies over the course of the study.

According to severity, mild, moderate and severe forms of EP are distinguished. Isolated damage to the parotid salivary glands (mumps) occurs, as a rule, in a mild to moderate form. Severe forms of the disease are caused by the involvement of other organs and systems of the body (central nervous system, pancreas, gonads) in the pathological process.

In mild forms of the disease, the symptoms of intoxication are mild. The general condition remains satisfactory, body temperature rises to 37.5-38.5 °C. The increase in the size of the parotid salivary glands is moderate, there is no swelling of the subcutaneous tissue.

The moderate form is characterized by severe symptoms of intoxication (lethargy, sleep disturbance, headache, vomiting), an increase in body temperature to 38.6-39.5 °C. There is a marked increase in the size of the parotid salivary glands, and in some cases there is a slight pastiness of the subcutaneous tissue of the neck.

In severe forms, the symptoms of intoxication are pronounced: severe headache, repeated vomiting, delirium, hallucinations, anxiety, sometimes convulsions: body temperature reaches high numbers (39.6 ° C or more). The parotid salivary glands are significantly enlarged in size, painful on palpation; swelling of the subcutaneous area of ​​the neck is noted.

The course of EP (by nature) can be smooth or non-smooth (with complications, layers of secondary infection, exacerbation of chronic diseases).

Outcomes. After damage to the male gonads, the following unfavorable outcomes are possible: testicular atrophy, testicular tumors, “chronic orchitis,” hypogonadism, prialism (prolonged painful erection of the penis, not associated with sexual arousal), infertility, impotence; gynecomastia.

Impaired spermatogenesis, up to azoospermia, can develop not only as a result of mumps orchitis, but also after mumps, which occurred without clinical symptoms of testicular inflammation.

After oophoritis, the development of infertility, early menopause (premature ovarian failure), ovarian carcinoma, ovarian atrophy, menstrual irregularities, juvenile uterine bleeding is possible.

In some cases, after damage to the pancreas, chronic pancreatitis, diabetes mellitus, obesity.

In 70% of convalescents of nervous forms of EP, various disorders of the general condition are noted ( increased fatigue, headaches, tearfulness, aggressiveness, night terrors, sleep disturbances, decreased academic performance). The phenomena of cerebrovascular disease and neuroses persist for 3 months. up to 2 years or more. In some cases, severe asthenovegetative or hypertensive syndrome, enuresis, and rarely epilepsy, deafness, and blindness develop.

Complications are caused by the layering of secondary microbial flora (pneumonia, otitis, tonsillitis, lymphadenitis).

Features of mumps in young children. Children in the first year of life practically do not get sick; at the age of 2-3 years, EP is rare. The disease is not severe, usually in the form of an isolated lesion of the parotid salivary glands and, less often, of the submandibular and sublingual glands. Other glandular organs and the nervous system are usually not affected.

In women who undergo EN during pregnancy, spontaneous abortions and the birth of children with developmental defects, in particular with primary myocardial fibroelastosis, are possible. The EP virus can cause the development of hydrocephalus in the fetus.

Diagnostics

Supportive diagnostic signs of mumps:

Contact with a patient with EP;

Increased body temperature;

Complaints of pain when chewing;

Swelling in the area of ​​the parotid salivary glands;

Filatov's pain points;

Murson's symptom;

Multiple organ lesions (mumps, submandibulitis, sublingualitis, pancreatitis, orchitis, serous meningitis, etc.).

Laboratory diagnostics. Virological and serological methods are used. Isolation of the virus from blood, saliva and CSF is an indisputable confirmation of the diagnosis. In the hemagglutination inhibition reaction, antibodies (antihemagglutinins) to the EP virus are detected. Complement-fixing antibodies appear on the 2-5th day of the disease and remain in the blood serum for a long time, which allows the use of CSC for both early and retrospective diagnosis. A diagnostic sign is an increase in the titer of specific antibodies by 4 times or more. With a single serological examination during the period of convalescence, a titer of 1:80 or more is considered diagnostic.

Differential diagnosis. Damage to the parotid salivary glands during EP must be differentiated from acute purulent parotitis that occurs against the background of any severe general illness(typhoid fever, septicemia), or with local purulent infection (necrotizing or gangrenous stomatitis). With purulent parotitis, an increase in the size of the parotid salivary glands is accompanied by severe pain and significant density of the gland. The skin in the area of ​​the affected gland quickly becomes hyperemic, then fluctuation appears. Neutrophilic leukocytosis is observed in the blood, in contrast to leukopenia and lymphocytosis in EP.

Toxic mumps are rare, usually in adults, and are occupational diseases (in acute poisoning with iodine, mercury, lead). They are characterized by slow development, while, along with mumps, other lesions typical of poisoning are detected (for example, a dark border on the mucous membrane of the gums and teeth). Possible kidney damage digestive tract, CNS.

Salivary stone disease develops as a result of blockage of the excretory ducts of the salivary glands, occurs more often in adults and children over 13 years of age, is characterized by gradual development at normal body temperature, and has a recurrent course. Depending on the degree of blockage of the excretory duct, the size of the salivary gland changes - the swelling periodically increases and decreases, and intermittent pain is noted (“salivary colic”). The pain intensifies when eating. The process is often one-sided; damage to other organs and systems of the body is not typical. The diagnosis is confirmed by sialography with a contrast agent.

In rare cases, EP must be differentiated from a foreign body in the ducts of the salivary glands, actinomycosis of the salivary glands, cytomegalovirus infection, Mikulicz syndrome (observed in leukemia, chloroma; in adults it develops gradually, with normal temperature body, bilateral).

Submandibulitis must be differentiated from lymphadenitis that occurs with tonsillitis and periodontitis. In patients with regional lymphadenitis (submandibular, anterior cervical), individual lymph nodes are enlarged and painful on palpation. Possible suppuration lymph nodes. Body temperature is increased. In the peripheral blood, neutrophilic leukocytosis and increased ESR are detected.

In some cases it is difficult differential diagnosis EP and periostitis, in which subperiosteal accumulation of pus occurs, resulting in swelling and infiltration in the lower jaw. The diagnosis of periostitis is confirmed by the presence of a painful carious tooth and swelling of the gums at the root of the tooth.

Mumps sometimes has to be differentiated from toxic diphtheria of the pharynx. Swelling with toxic diphtheria of the pharynx is painless, jelly-like consistency; the skin over the edema is unchanged. The retromandibular fossa remains free; When examining the pharynx, swelling is determined soft palate, palatine tonsils, uvula, widespread fibrinous plaque.

In some cases, damage to the sublingual salivary gland must be differentiated from phlegmon of the floor of the mouth (Ludwig's tonsillitis). Patients complain of a sore throat that gets worse when swallowing and talking, weakness, malaise, and an increase in body temperature to 38.0-39.5 °C. An infiltrate appears in the chin area, spreading to the anterior, sometimes lateral surface neck. The skin over the infiltrate is hyperemic. Opening the mouth is severely difficult, the tongue is raised, an unpleasant putrid odor appears from the mouth, swallowing is almost impossible. On examination, moderate hyperemia and swelling of the oral mucosa and palatine tonsils are noted, usually with. one side; the tongue is displaced. When palpating the soft tissues of the floor of the mouth, their compaction is determined. The general condition of the children is extremely serious. There is a high mortality rate. The cause of death is the spread of infection through the interfascial gaps into the mediastinum and cranial cavity.

Great difficulties are presented by the differential diagnosis of isolated serous meningitis of mumps etiology and serous meningitis of another nature (see “Meningitis”).

Treatment of patients with mumps infection is complex, taking into account the form, severity and period of the disease, the age of the patients and their individual characteristics.

At home, treatment is indicated for patients only with isolated lesions of the parotid salivary glands, occurring in a mild or moderate form. Children with severe mumps, damage to the central nervous system, gonads, and combined damage to organs and systems are subject to mandatory hospitalization. In order to prevent the development of mumps orchitis, it is recommended to hospitalize all boys over 12 years of age. If you follow bed rest, the incidence of orchitis decreases sharply (by 3 times or more).

Bed rest is mandatory throughout the entire acute period of the disease: up to 7 days. - for isolated mumps, at least 2 weeks. - for serous meningitis (meningoencephalitis), 7-10 days. - with inflammation of the testicles.

A child’s nutrition is determined by his age, the severity of local changes and possible occurrence pancreatitis. The patient should be fed warm liquid or semi-liquid food if regular food causes pain when chewing. Recommended pureed soups, liquid porridges, mashed potatoes, applesauce, steamed cutlets, chicken, vegetable puddings, fruits, fish. Products that have a pronounced juice effect (juices, raw vegetables), as well as sour, spicy and fatty foods are excluded.

To prevent gingivitis and purulent inflammation parotid salivary glands, it is necessary to rinse your mouth after eating with boiled water or a weak solution of potassium permanganate, furatsilin.

Dry heat is applied locally to the salivary gland area. Use wool (woolen scarf, scarf), heated sand or heated salt, gray cotton wool, an electric heating pad, blue light, a Sollux lamp, paraffin applications. Local therapy is carried out until the tumor disappears. Compresses are contraindicated.

For mild and moderate forms of isolated damage to the parotid salivary glands, the following are prescribed: bed rest, diet, dry heat (locally). Antipyretic drugs are used: ibuprofen (Nurofen for Children in the form of a suspension is used in children aged 3 months to 12 years, Nurofen in tablets - over 6 years) is used in a single dose of 7.5-10 mg/kg 3-4 times a day, paracetamol is prescribed in a single dose of 15 mg/kg no more than 4 times a day with an interval of at least 4 hours. According to indications, desensitizing agents are prescribed (loratidine, suprastin, tavegil). For moderate and severe forms, Viferon is used.

Treatment of patients with severe EP is carried out using etiotropic drugs. For meningitis, meningoencephalitis, orchitis, ribonuclease and recombinant interferons (reaferon, viferon) are used. Patients with central nervous system damage also undergo dehydration therapy (Lasix, Diacarb); drugs that improve brain trophism (pantogam, encephabol, nootropil, trental, instenon) and resorption therapy (aloe, lidase) are prescribed. According to indications, glucocorticoids are used (prednisolone at a dose of 1-2 mg/kg/day).

With mumps orchitis, along with etiotropic therapy, use antipyretics, conduct detoxification therapy (intravenous drip of 10% glucose solution with ascorbic acid, rheopolyglucin), prescribe glucocorticoids (prednisolone at the rate of 2-3 mg/kg/day).

Local treatment of orchitis: elevated position of the testicles is achieved using a support bandage - a suspensor. In the first 2-3 days. Cold (cold water lotions or an ice pack) has a positive effect, then heat on the testicles (dry warm cotton wool bandage, bandage with Vishnevsky ointment). Surgical treatment (incision or puncture of the tunica albuginea) is used for severe forms of orchitis, especially bilateral, in the absence of effect from conservative therapy. Surgical intervention helps quick withdrawal pain and prevents the development of testicular atrophy.

For pancreatitis, antispasmodics (papaverine, no-spa), inhibitors of proteolytic enzymes (trasylol, contrical, aniprol), detoxification therapy, glucocorticoids, enzymes (Creon) are prescribed.

Antibiotics are prescribed when secondary bacterial microflora is attached.

During the period of convalescence, the use of drugs that help increase the level of nonspecific reactivity of the body is indicated: Immunal is prescribed in a single dose: for children from 1 year to 6 years - 1.0 ml; 6-12 years - 1.5 ml; over 12 years old - 2.5 ml (children over 4 years old can use the tablet form) 1-3 times a day for a course of 1 to 8 weeks. As restoratives Vitamin and mineral complexes are prescribed: multitabs, complivit active (children over 7 years old, 1 tablet once a day for 1 month).

Dispensary observation. All convalescent patients with EP must undergo clinical observation for 1 month. at the children's clinic. Convalescents of nervous forms of EP are observed for at least 2 years by a neurologist and a pediatric infectious disease specialist. Boys who have had mumps orchitis are observed by an endocrinologist and urologist for at least 2 years. Convalescents of pancreatitis are under the supervision of an endocrinologist for 1 year. Children who have had cystitis are observed by a nephrologist for 1 year.

Prevention. A patient with EP is isolated until clinical signs disappear (at least 9 days from the onset of the disease).

Disinfection after isolation of the patient is not required; Enough wet cleaning and ventilation.

The children's institution is quarantined for 21 days. Children who have not previously had EP and who have not been immunized against this infection are subject to quarantine. If the period of contact with a patient with EP is precisely established, those in contact can visit children's institutions for the first 9 days. Children under the age of 10 who have had family contact are not allowed into the child care facility from the 10th to the 21st day from the moment of isolation of the patient. From the 10th day of contact, systematic medical observation is carried out for early detection of the disease.

In the outbreak, emergency vaccination of all contact persons who have not been vaccinated and have not had mumps (after registration of the first case of the disease) is carried out.

There are typical and atypical forms (erased and asymptomatic) of mumps. Typical forms: glandular - isolated damage to only the glandular organs (parotid, submandibular glands, testicles, etc.); nervous - isolated damage to the central nervous system only (serous meningitis, meningoencephalitis); combined - damage to the central nervous system and glandular organs (serous meningitis in combination with mumps or submaxillitis in combination with pancreatitis and meningoencephalitis and other combinations). Depending on the severity of changes in the glandular organs, central nervous system and general intoxication, mild, moderate and severe forms are distinguished.

The incubation period is 11-23 days (average 18-20 days). In typical cases, the disease, as a rule, occurs in a moderate form, beginning acutely with an increase in temperature to 38-39° and above. Swelling and tenderness of the parotid glands appears, first, as a rule, on one side, and after 1-2 days on the other. Intoxication is moderate. In some cases, 1-2 days before the appearance of swelling of the parotid glands, prodromal phenomena are observed (general malaise, lethargy, headache, sleep disturbance).

Damage to the parotid gland (which is most often observed) is manifested by an increase in its size; When palpated, the iron has a pasty consistency with a thickening in the center, painful. The enlarged parotid glands protrude from the ramus of the mandible, the swelling extends anteriorly to the cheek and posteriorly, creating a fossa between the mastoid process and the mandible. With a significant increase in the parotid glands, the auricles protrude and the earlobe rises upward. The face takes on a characteristic appearance, which is why the disease is called “mumps.” The skin in the area of ​​the enlarged salivary gland is stretched, but not hyperemic. Sometimes there is swelling of the subcutaneous tissue surrounding the salivary gland. The patient has difficulty opening his mouth and complains of pain when chewing. On the mucous membrane of the oral cavity on the side of the affected parotid gland, swelling of the external opening of the parotid (Stenon's) duct and hyperemia around it are noted.

With damage to the submandibular (submaxillitis) and sublingual glands their swelling and pain are also noted. At the beginning of the disease, any salivary gland may be affected in isolation, then other salivary glands are affected, or various salivary glands are simultaneously involved in the process. The swelling of the affected glands lasts 5-7 days, sometimes longer, but there may be a very rapid reverse dynamics. No suppuration of the glands is observed. Orchitis, epididymitis, oophoritis, mastitis, bartholinitis, prostatitis and pancreatitis develop much less frequently. The gonads are affected more often in adults and in older children (during puberty). With orchitis, pain appears in the testicular area, which radiates to the groin, and sometimes there is pain along the spermatic cord. The testicle increases in size, becomes dense, painful, the scrotum is swollen. Orchitis can develop either in isolation or simultaneously with damage to the salivary glands.

Pancreatitis often occurs in a mild and subclinical form. In severe cases it is accompanied severe pain in the abdomen, repeated vomiting, constipation (sometimes stools are liquid), decreased appetite.

Damage to the central nervous system often manifests itself as serous meningitis, and in more severe cases, meningoencephalitis. Since early viremia is observed in mumps, changes in other organs and systems (cardiovascular, urinary) are also possible.

Leukopenia and lymphocytosis are often detected in the blood (in some cases, leukocytosis may be present in the first days of the disease), ESR is moderately elevated or normal.

The course of mumps infection is often wavy with repeated rises in temperature associated with the sequential involvement of glandular organs or the central nervous system in the process. The erased form of the disease is characterized by a mild course at normal body temperature. Swelling of one or both parotid or submandibular glands is insignificant and quickly disappears. The asymptomatic form is diagnosed only through serological tests.

Newborns and children in their first year of life rarely get mumps. If a woman experiences the disease a week before giving birth, the baby is born with clinical signs of the disease, or they develop in the postnatal period. The disease is not severe, usually in the form of mumps or submaxillitis. Other glands, as well as the central nervous system, are not involved in the process. There are some indications of spontaneous abortions and the birth of children with developmental defects from women who suffered from the disease at the beginning of pregnancy, but there is no convincing evidence of a connection between mumps suffered by a pregnant woman and abnormal development of the fetus.

In adults, the disease is usually more severe than in children, intoxication is more pronounced, the febrile period is longer, complications occur more often and the gonads are affected. Less often than in children, the central nervous system is affected. Orchitis, pancreatitis, serous meningitis or their combinations can sometimes be observed without previous enlargement of the salivary glands, which causes difficulties in diagnosis. In these cases, great importance is attached to a carefully collected epidemiological history, as well as data laboratory research. Of great danger are outbreaks of mumps that occur in the barracks among recruits, in dormitories among teenagers and children of high school age.

Complications occur rarely and mainly in patients with central nervous system damage. After encephalitis, meningoencephalitis, paresis, paralysis, and damage to the inner ear can be observed, which leads to deafness. Cases of optic nerve atrophy have been described.

Description

The causative agent is an RNA virus belonging to the paramyxovirus family. Sensitive to heat, drying, and disinfectants, but resistant to low temperatures. Not sensitive to chemotherapy drugs. It can be detected in saliva in the first 2 days of the disease, in urine - up to the 14th day from the onset of the disease, in cerebrospinal fluid - in the first 6 days after the appearance of the first clinical symptoms of central nervous system damage.

The source of the infectious agent is a person who becomes infectious already in the last days of the incubation period and especially during the first 3-4 days of illness. The duration of the infectious period is until clinical manifestations disappear, but not less than 9 days from the onset of the disease. Great value in the spread of infection are patients with erased and asymptomatic forms. Virus carriage is also suspected. The infectious agent is released from the patient's body in saliva. Infection occurs through airborne droplets through direct contact with a patient. The transmission of infectious agents through a third party and objects used by the patient has not been proven. Susceptibility to mumps is 30-50%. The disease occurs at any age, but children of preschool and primary school age are most susceptible to it. Children under 1 year of age rarely get sick. Mumps is observed in the form of sporadic cases, epidemic outbreaks in children's institutions, and sometimes in groups of adults. There is a seasonality in the incidence, with the greatest rises occurring in the winter and autumn months.

After past illness stable immunity is developed. Cases of recurrent disease are very rare. Passive immunity (obtained from the mother) provides immunity to mumps during the first 6 months of life.

Diagnostics

The diagnosis in typical cases, especially those starting with damage to the parotid glands, is not difficult. They occur with primary or isolated damage to the pancreas, sublingual and other glands, with isolated damage to the central nervous system. In these cases, it is especially important to take into account epidemiological history data.

From laboratory methods for diagnosing mumps infection in practical work use the complement fixation reaction and the hemagglutination inhibition reaction in paired blood sera. The increase in antibody titer in the dynamics of the disease is of great diagnostic importance. A standard diagnosticum is used as an antigen in the complement fixation reaction.

Treatment

Patients with mild form and those with moderate illness are treated at home. Children with severe forms of the disease and all patients with central nervous system damage, pancreatitis and orchitis are subject to mandatory hospitalization.

No specific etiotropic treatment has been developed. Assign symptomatic remedies. In the acute period of the disease, bed rest is necessary. Recommended drinking plenty of fluids, liquid or semi-liquid gentle food. You should rinse your mouth after eating with boiled water or 2% sodium bicarbonate solution. If the salivary glands are affected, dry heat (a heating pad or blue light) is applied to the affected area; if there is a significant increase in body temperature, antipyretics are indicated.

For pancreatitis, a milk diet is prescribed, fats and proteins are limited, with frequent vomiting, intravenous drip administration of an isotonic sodium chloride solution with contrical in age-related doses is indicated, pancreatin for 5-6 days. With serous meningitis, a spinal puncture is necessary not only as a diagnostic, but also as a therapeutic event(decrease intracranial pressure), dehydration therapy - intramuscular magnesium sulfate solution, intravenous 25% glucose solution with ascorbic acid and vitamin B1. In severe cases of serous meningitis and meningoencephalitis, corticosteroids are prescribed for 6-8 days. With a pronounced increase in intracranial pressure, diuretics are indicated.

For orchitis, strict bed rest, wearing a suspensor, cold in the first 2-3 days are prescribed, antihistamines, anti-inflammatory drugs. With pronounced swelling of the scrotum and enlargement of the testicles, along with conservative therapy apply surgical treatment- dissection of the tunica albuginea of ​​the testicles. There is experience in treating orchitis with ribonuclease.

The prognosis in most cases is favorable: complete recovery occurs. However, after serous meningitis and, especially, meningoencephalitis, cerebrasthenic syndrome (increased excitability and irritability, fatigue, headaches, etc.), and sometimes hypertension syndrome, often develops. Therefore, convalescents with damage to the central nervous system of mumps etiology are subject to dispensary observation by a pediatrician and neurologist. The observation period is individual. Immediately after discharge from the hospital, it is recommended to stay at home for 2-4 weeks, depending on the condition. It is advisable to limit the school load and exempt the child from sports for 6 months, as well as from preventive vaccinations for 1 year. Those who have had mumps orchitis may subsequently experience testicular atrophy, impaired spermatogenesis, and decreased reproductive and sexual function.

Prevention

Active immunization with a live vaccine from the attenuated strain L-Z is carried out at the age of 15-18 months. Sick people are isolated until clinical symptoms disappear (at least 9 days from the onset of the disease). Preschool children who have had contact with a person with mumps are not allowed into the child care facility from the 11th day from the moment of contact to the 21st day. Final disinfection is not carried out.

Medical encyclopedia of the Russian Academy of Medical Sciences