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Differential diagnosis and common complications are summarized in this article
Written by | Akiraku
The current diagnosis of mumps is mainly based on the epidemiological data, clinical manifestations and laboratory examination results of patients, and makes a suspected diagnosis, clinical diagnosis and definitive diagnosis after comprehensive analysis.
Today, I will briefly review with you the diagnosis and differential diagnosis of mumps, and mainly share the knowledge points related to the complications that need to be vigilant for this disease.
Diagnostic criteria for mumps[1]
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Suspected diagnosis
Patients with one of the following criteria should be considered suspected cases of mumps:
1. Swelling and pain of unilateral or bilateral parotid glands and/or other salivary glands, aggravation of pain when opening and chewing or eating acidic food;
2. Consistent with epidemiological history (14-28 days before the onset of the disease, there is a history of contact with mumps patients or local epidemic mumps), and there are fever, headache and other manifestations, or accompanied by meningoencephalitis, or accompanied by orchitis, or accompanied by pancreatitis.
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Clinical diagnosis
Those who meet the above two conditions for suspected diagnosis at the same time can be regarded as clinical diagnosis.
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Confirm the diagnosis
In suspected or clinically diagnosed cases, mumps virus-specific lgM antibodies were detected in serum (not vaccinated with live attenuated mumps vaccine within 1 month), or mumps virus lgG antibody titers were 4-fold or more elevated in serum (2-4 weeks apart) in the convalescent and acute phases (including positive conversion of antibodies), or mumps virus was isolated from body fluids such as saliva, urine, and cerebrospinal fluid.
Differential diagnosis of mumps[2]
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Purulent tenaldenitis
It is often one-sided, with obvious local redness, swelling and tenderness, fluctuating sensation in the late stage, pus flowing from the parotid duct when squeezing, and the total number of white blood cells and neutrophils in the blood picture is significantly increased.
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Cervical or preauricular lymphadenitis
The swelling is not centered on the earlobe, but is confined to the neck or preauricular area, and is a nucleus, which is hard, with clear edges, obvious tenderness, and superficial mobility. Inflammation of the tissues associated with the lymph nodes in the neck or anterior auricular area, such as angina, ear boils, etc., and an increase in the total number of white blood cells and neutrophils.
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Symptomatic parotid gland enlargement
In diabetes, malnutrition, chronic liver disease, or the application of certain drugs such as iodide, hydroxyphentazone, isoproterenol, etc., it can cause parotid gland enlargement, which is symmetrical, no swelling and pain, soft to the touch, and tissue examination is mainly steatosis.
Common complications of mumps[2]
Mumps is actually a systemic infection, and the virus often affects the central nervous system or other glands or organs, causing symptoms. Even some complications are not only common, but may occur alone without parotid gland enlargement.
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Neurological complications
▎(1) Aseptic meningitis, meningoencephalitis, encephalitis:
It is a common complication, especially in children, and is more common in boys than girls. The incidence of encephalitis in mumps ranges from 0.3% to 8.2%. It is difficult to calculate the exact incidence of mumps because cerebrospinal fluid (CSF) is not available in all patients, and because parotid gland enlargement is never seen in some cases. In uncomplicated mumps, the number of white blood cells (LECs) in 30% to 50% or even 65% of the cerebrospinal fluid is elevated and is caused by direct viral invasion of the central nervous system.
Symptoms of meningoencephalitis may appear as early as 6 days before or 2 weeks after parotid gland swelling, and usually appear within 1 week after parotid gland swelling. Cerebrospinal fluid (CSF) and symptoms (headache, vomiting, etc.) are similar to those of other viral encephalitis, and acute cerebral edema is more pronounced.
EEG may be changed but not as obvious as in other viral encephalitis, and combined with clinical practice, meningeal involvement is predominant. The prognosis is good, and individual cases of encephalitis can lead to death. There have been cases of mumps encephalitis confirmed by serology in China, and there are no parotid gland swelling and pain from beginning to end.
▎ (2) Polyneuritis, myelitis:
Occasionally, polyneuritis and myelitis occur 1-3 weeks after mumps, and the prognosis is usually good. An enlarged parotid gland may compress a nerve and cause temporary facial nerve palsy. Sometimes there is balance disorder, trigeminal neuritis, hemiplegia, paraplegia, ascending paralysis, etc. Occasionally, patients with hydrocephalus complicated by aqueduct stenosis after mumps.
▎ (3) Deafness:
Caused by auditory nerve involvement. Although the incidence is not high (about 1 in 15,000), it can become permanent and complete deafness, but fortunately 75% are unilateral, so the impact is not large.
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Complications of the reproductive system
Mumps virus tends to invade mature genital glands, so it is more common in patients after late puberty, and rarely in children.
▎ (1) Orchitis:
The incidence ranges from 14% to 35% of adult males, and complications have been reported in 9-year-old children. In general, the incidence increases significantly after the age of 13 to 14 years.
It usually occurs when the parotid gland enlargement begins to subside about 1 week, with sudden high fever, chills, testicular tenderness, and severe tenderness, and the symptoms vary from mild to severe, and generally subside in about 10 days. Scrotal skin edema is also marked, and there may be yellow effusions in the hydrocele.
Most lesions invade one side, and about 1/3 to 1/2 of cases have varying degrees of testicular atrophy, and because the lesions are often unilateral, even if bilateral, only part of the seminiferous ducts are involved, so it rarely leads to infertility. Epididymitis often occurs in combination.
▎ (2) Oophoritis:
It accounts for about 5% to 7% of adult women. Symptoms are mild, do not affect conception, and occasionally cause early amenorrhea. Symptoms of oophoritis include lower back pain, pain in the lower abdomen, irregular menstrual cycle, and in severe cases, palpable enlarged ovaries with tenderness. To date, there have been no reports of infertility as a result.
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pancreatitis
It occurs in about 5% of adults and is rare in children. It usually occurs 3 to 4 days to 1 week after parotid gland swelling, with severe pain and tenderness in the middle and upper abdomen as the main symptoms. Vomiting, fever, bloating, diarrhea, or constipation, and sometimes palpable pancreas.
Pancreatitis symptoms usually go away within a week. Blood amylase is not suitable for diagnosis, and a serum lipase value of more than 1.5 units/dl (normal 0.2 to 0.7 units/dl) indicates a recent episode of pancreatitis. Lipase is usually elevated 72 hours after onset and is of little value for early diagnosis. In recent years, as children have become more and more sick, the complications of pancreatitis have increased.
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nephritis
Mumps virus can be isolated in the urine of most cases in the early cases, so it is believed that the virus can directly damage the kidneys, with a small amount of protein in the urine in the mild cases, and the urine routine and clinical manifestations in the severe cases are similar to nephritis, and some severe cases can cause acute renal failure and death. But most have a good prognosis.
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myocarditis
About 4% to 5% of patients have myocarditis. It is more common in 5 to 10 days of disease and can occur at the same time as parotid gland swelling or during convalescence. Presents with pallor, rapid or slowed heart rate, muffled heart sounds, arrhythmias, transient cardiomegaly, and systolic murmurs.
Electrocardiogram shows sinus arrest, atrioventricular block, ST-segment depression, flat or inverted T waves, and premature systole. In severe cases, it can be fatal. Most have only ECG changes (3% to 15%) without obvious clinical symptoms, and occasionally pericarditis.
Expand your knowledge
Many parents ask if having mumps will affect their child's reproductive ability?
Hua Chunzhen, chief physician of the Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, once gave the following answers:
"Mumps can damage the gonads and cause orchitis and oophoritis, so many people are worried about affecting their fertility, but this is relatively rare and can happen in rare cases, so patients with excessive cheeks don't need to worry too much. ”
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References:[1] Health Industry Standard of the People's Republic of China: Diagnostic Criteria for Mumps (WS 270-2007). [2] Mou Zhuangbo, Diagnosis and Treatment of Common Infectious Diseases, People's Medical Publishing House, 2017.06.
Editor in charge: Xiang Yu
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