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Mumps Clinical Presentation

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Apr 26, 2016
 

History

Symptoms in the patient’s history consist mostly of fever, headache, and malaise. Within 24 hours, patients may report ear pain localized near the ear lobe that is aggravated by a chewing movement of the jaw. Older children may describe a swelling sensation at the mandibular angle and an associated sour taste in the mouth. Fever usually subsides within 7 days, notably before parotid gland edema disappears. Sudden hearing loss may occur due to a vestibular reaction.

Diffuse, tender swelling of the thyroid gland (thyroiditis) may occur about 1 week after parotitis. Antithyroid antibodies are detected in the serum.

Pancreatitis is a severe but, fortunately, rare complication. A sudden onset of mid-epigastric pain and tenderness occurs, accompanied by fever, chills, nausea, and vomiting. Patients generally recover within 1 week with appropriate supportive treatment.

Orchitis can occur in up to 50% of postpubertal males, and as many as 30% have bilateral involvement.[17] Orchitis presents acutely with fever, chills, nausea, vomiting, and lower abdominal pain. After the fever, the testes begin to swell rapidly. Increase in testicular size can be minimal or as much as 4 times normal size. As the fever decreases, the accompanying testicular pain and edema subside. Loss of turgor is noticed, with up to 50% of cases demonstrating atrophy.

Oophoritis in postpubertal females is associated with abdominal and/or pelvic pain and tenderness.

Mumps can also cause aseptic meningitis, a CNS complication which usually is indistinguishable from other viral etiologies, such as enteroviruses, herpesviruses, or poxviruses. CSF analysis reflects less than WBC 500 cells/µL with a lymphocytic predominance. 

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Physical Examination

Parotid glands are not palpable in the craniofacial exam of a healthy patient. But for patients with mumps, the parotid glands rapidly progress to maximum swelling over several days. Patients may have trismus.

Submaxillary gland edema, palpable underneath and anterior to the angle of the mandible, may be accompanied by edema spreading onto the cheek and downward onto the neck. These clinical findings can make it difficult for the examiner to differentiate from cervical adenitis. The opening of the submandibular duct (also known as Wharton duct) may be erythematous and edematous.

Sublingual gland involvement, most commonly bilateral, is a less common finding in mumps. The sublingual gland is palpated on the floor of the mouth and submental area. In severe and extensive cases, the edema may extend to the presternal area due to obstruction of lymphatic vessels from compression by enlarged salivary glands. Submandibular glands may also be involved and swollen.

The opening of Stensen's duct can be enlarged, edematous, and erythematous.

In addition, a morbilliform rash may be present.

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Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Cem S Demirci, MD Consulting Staff, Division of Endocrinology/Diabetes, Connecticut Children's Medical Center

Disclosure: Nothing to disclose.

Walid Abuhammour, MD, MBA, FAAP Professor of Pediatrics, Michigan State University College of Medicine; Director of Pediatric Infectious Disease, Department of Pediatrics, Al Jalila Children's Hospital

Walid Abuhammour, MD, MBA, FAAP is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Eileen C Quintana, MD Assistant Professor, Departments of Pediatrics and Emergency Medicine, St Christopher's Hospital for Children; Adjunct Clinical Professor, Pediatrics and Emergency Medicine Departments, Temple University Hospital, Pediatric Emergency Dept, Philadelphia, PA

Eileen C Quintana, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Hosseinali Shahidi, MD, MPH Assistant Professor, Departments of Emergency Medicine and Pediatrics, State University of New York and Health Science Center at Brooklyn

Hosseinali Shahidi, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and American Public Health Association

Disclosure: Nothing to disclose.

Garry Wilkes, MBBS, FACEM Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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Child with mumps.
This patient with mumps has marked bilateral swelling of the salivary glands. Courtesy of Sheldon Mintz, DDS.
 
 
 
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