Mumps Clinical Presentation

Updated: Jan 17, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Presentation

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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