Mumps is the name usually given to a viral infection located in the parotid salivary gland. Such infection generally produces visible and painful swelling of the cheeks. Only 1/3rd cases of mumps occur without any apparent symptoms. It usually takes 1-2 weeks for symptoms to appear to a full extent. The leading cause of infection is a virus known as mumps virus, which can be transmitted from one person to another. This virus affects any salivary gland, but the parotid glands are most commonly involved. These glands are present on both sides of the face, between the ear and the jaw, and they are responsible for producing saliva. After being infected, they get swollen, giving rise to certain symptoms such as fever, pain, and difficult swallowing. Children are most commonly affected by this infectious disorder. To detect mumps infections, we should understand its symptoms, and here we have the most important symptoms in mumps:
Fever
High-grade fever(103°F) is a well-known symptom of mumps infection. Mumps virus is highly contagious, usually transmitted by coughing and sneezing via air droplets. After a person gets infected, high-grade fever usually develops within 12-16 days. It usually lasts for 3-4 days, and then starts declining. Fever generally arise as a result of the ongoing viral replication within the epithelium of the salivary glands. Patients should readily visit a doctor as soon as possible, primarily when other characteristic symptoms of mumps infection have appeared within this time. Ignorance can lead to extremely devastating complications, like orchitis, deafness, pancreatitis, and seizures. Fever can be controlled with acetaminophen but treating the viral cause should be our priority in order to ward off from complications. Other characteristic symptoms of mumps should also be observed in order to reach the final diagnosis.
Headache and body aches
Headache and muscle aches are also very common in patients with mumps. Body ache is a relatively common constitutional symptom, along with high-grade fever during the earliest phase of the infection. If you are suffering from malaise and muscle aches, try to reach to your doctor immediately to find out the cause. Body aches occur in all parts of the body, but the legs and the arms are most commonly affected. Patients usually report feeling lethargic and tired. Headache mainly occurs as a prodromal symptom during the infection and can be relieved with acetaminophen. In rare cases, it may occur due to encephalitis, which is considered to be one of the severe complications of long-standing mumps infection in adults. It is highly advisable to contact your doctor as early as possible because unnecessary delay would potentially give rise to unwanted complications ultimately leading to death. Doctors usually diagnose mumps clinically, based on symptoms, but certain tests such as the immunofluorescence assay for a viral antigen can also be utilized for an accurate diagnosis.
Painful swelling close to the jaw
Mumps virus has tropism for glandular structures, and the parotid gland is its most common target. The infection of the parotid gland produces visible and painful swelling between the ear and the jaw. Swelling can either occur unilaterally or bilaterally. 80% of all the cases of mumps are caused by a unilateral infection, and only the remaining 20% develop bilateral swelling of the cheek. In the early phase of the infection, this swelling is visible just below the ear, but then it moves downward and forward as fluids start accumulating within the skin of the face and neck. Swelling is at its peak after 1-3 days and then diminishes during the next 5-6 days. As the swelling increases, the ear may be pushed forward. In extreme cases, the angle of the jaw may not be visible anymore. It is a must to visit your doctor immediately in such case in order to prevent serious complications. The doctor will differentiate this condition from commonly confused swelling of lymph nodes of the neck. Protrusion of the ear and disappearance of the angle of the jaw are two major characteristic features of swelling in mumps infection.
Gastrointestinal problems
Mumps virus can cause severe pancreatitis in adults. The exocrine pancreas, which is responsible for producing digestive enzymes, is the one most commonly affected. When this happens, patients report abdominal pain, low-grade fever, vomiting, and abdominal distension. Serum lipase is also increased in such circumstances. In pancreatitis, digestive enzymes normally secreted by the pancreas get activated prematurely, before they are released in the small intestine. They start damaging the pancreas leading to several symptoms such as bloating, fever and abdominal pain. Abdominal pain and diarrhea in pancreatitis caused by mumps are usually self-limiting, but other causes may need proper clinical management for a full recovery. Doctors need to differentiate the symptoms of pancreatitis from biliary colic, gastroduodenal ulcer or perforation. For this reason, an immediate visit to a doctor is essential, especially because this complication can also lead to death.
Loss of appetite is another major problem during a mumps infection. In rare cases, the patient suffers from cachexia and severe weight loss. The doctor might need to perform a CT scan, MRI and chest X-Ray in order to diagnose the condition accurately before devising a proper treatment plan.
Difficulty to chew
Difficulty to chew can be a significant problem in a patient suffering from mumps infection. The patient can also report difficulty to swallow food if the bolus is large enough to cause an obstruction of the esophagus. The patient reports a sensation that the food just swallowed is stuck in the chest. It mostly occurs when patients eat very fast with not proper or sufficient chewing. Dysphagia in children can lead to behavioral problems, as well as disturbed physical and mental development. Malnutrition and dehydration are other fearsome complications of dysphagia in children. In adults, dysphagia can further lead to aspiration pneumonia and choking. The openings of the parotid and submandibular ducts get swollen and red as well, often presenting with pinpoint hemorrhages. Consultation with the doctor is always a wise choice under these circumstances to diagnose the proper cause.
Ear-ache and deafness
Children suffering from mumps can develop a temporary earache and deafness in one or both ears. Permanent loss of hearing is infrequent in children but can frequently occur in long-standing mumps in adults. Mumps virus damages the cochlea, an organ in the inner ear that plays a major part in hearing. Hair cells inside the cochlea are damaged by the infection, leading to deafness. These hair cells are responsible for translating sound vibration into nerve impulses, which are further converted to sound by the brain. In most cases, the sense of hearing improves within one week after the infection is treated, but ignorance can lead to permanent deafness and severe ear ache. Tinnitus and other vestibular symptoms can also be reported in some cases.
There is no proper treatment of mumps virus. You can ward off the complications by effective vaccination of your children and high-risk individuals in the community. MMR vaccine is most commonly used all over the world to prevent mumps infection. In case of permanent hearing damage, your doctor may give you an option of a cochlear implant or hearing aid. You must ask your doctor as soon as possible if you suspect mumps infection as a cause of your deafness. Unilateral sensorineural hearing loss is more common than the bilateral conductive hearing loss due to mumps. Routine hearing studies should be done in patients with a history of mumps.
Orchitis and Oophoritis
Orchitis is the inflammation of the testicles, and it occurs in 50% percent of cases of long-standing mumps infection in adults. In case of orchitis, the most common complaint is a painful swelling of the scrotum, and it can lead to sterility in rare instances. Other symptoms are fever, chills, nausea, vomiting, and severe abdominal pain. Only 5% of cases develop bilateral involvement of the testes. The size of the testes is increased four times to the average size. Most patients would also report loss of turgor and testicular atrophy as a major complication of untreated mumps. Fever, edema, pain, and other constitutional symptoms subside within a week, but proper consultation with the doctor is unavoidable to initiate a proper treatment and avoid suffering from fatal complications. Enzyme immunoassay for mumps antibodies is used as a laboratory diagnosis of the infection. In the earliest phase of the infection, IgM antibodies are seen in the serum, but after few days, a fourfold increase in IgG titer is considered diagnostic for mumps infection. People who have not received MMR vaccine are at high risk of developing orchitis as a complication. It is rare in children of age less than 10 years of age, but the risk is highly enhanced in patients aged 15 years old and above (post-pubertal age).
Oophoritis is the inflammation of the ovaries. It is far less common than orchitis as it only occurs in 5% of post-pubertal females. Patients report severe pelvic pain, fever, and abdominal tenderness. Female may suffer from premature menopause due to oophoritis. Aberrant menstrual function and menstrual irregularities can also be seen in such cases.
Dry mouth
Mumps infection primarily affects the parotid gland and decrease the production of saliva, which leads to the so-called dry mouth syndrome. Risk of infection and dental caries is severely increased due to excessive dryness of the mouth. The saliva becomes thick and stringy, and during inspection, doctors will notice a visible roughness of the tongue. Dental caries and mouth ulcers can make it very difficult for patients to chew food properly. Lips and gums get dry, and a burning sensation in the mouth makes the life miserable for the patient. Seeking advice from a doctor is a great option as he may recommend saliva substitutes and antibiotics. Good oral hygiene is very important in such circumstances as it can prevent dental caries, which mostly develops along the gum line. Lower front teeth are most commonly affected due to dry mouth syndrome as these are generally protected by the saliva produced from the floor of the mouth.
Viral meningitis
Viral meningitis is another severe warning sign and complication of the mumps infection. It may not differ from meningitis caused by other common viruses, such as like enterovirus and herpes virus. WBC count is less than 500 cells/µL. The inflammation of meninges covering the brain and spinal cord is called viral or aseptic meningitis. Only 1% of the patients develop this complication, but it is one of the fatal sequalae of the disease.
Non-vaccinated children aged less than 1 month and those with a decreased immunity are at extremely high risk of contracting mumps infection and developing aseptic meningitis. Children present with fever, irritability, sleepiness, lethargy, vomiting, and sensitivity to bright light. Adults may present with the same symptoms, but fever, headache, and stiff neck are the major complaints. Lumbar puncture and blood sample is taken to make a proper diagnosis. Mild cases may recover on its own within 8 to 11 days, but severe cases need adequate treatment plan and management to ensure a complete recovery.
Encephalitis
The inflammation of the brain is called encephalitis. It is another commonly reported neurological manifestation of mumps infection. Non- vaccinated children and people with a decreased immunity are at severe risk of developing this complication. Encephalitis is difficult to diagnose in children, but modern techniques like MRI and CT scan have solved a lot of such problems. Headache, nuchal rigidity and stiffness of the limbs are some of the major symptoms of encephalitis. It is essential to differentiate it from meningitis, as most of the symptoms overlap between both neurological disorders. In severe cases, hallucinations, seizures, mental disorientation, and memory loss can occur. Steroids are given in order to mitigate the inflammation. Apart from this, management is purely symptomatic. MRI and CT scan can prove to be very helpful for the doctor to reach to the proper diagnosis. You need to get immediate care if you are suffering from these severe symptoms, such as seizures, hallucinations and memory loss.
Conclusion
Mumps is a viral infection of the parotid gland produced by paramyxovirus. Major symptoms are fever, headache, muscle ache, and general fatigue, but the classical signs are painful mandibular swelling near the jaw and just below the ear. Minor symptoms or complications of the disease are orchitis, oophoritis, meningitis, encephalitis, dysphagia and difficulty to chew food. Symptoms start appearing within 1-2 weeks of the infection. Mumps and its complication are more common in children of age 5-14-years. Unimmunized children with decreased immunity can develop severe complications like orchitis and meningitis. MMR vaccine is typically used to prevent this infection and its severe complications. If you suspect mumps infection or any of its warning signs or complications, it is critical to seek proper advice from your doctor.