Laboratory Diagnosis and Control of Mumps (Epidemic Parotitis)

Laboratory studies are not usually required to establish the diagnosis of typical cases. However, mumps can sometimes, be confused with enlargement of the parotids due to suppuration, foreign bodies in the salivary ducts, tumors, etc. In cases without parotitis, particularly in aseptic meningitis, the laboratory can be helpful in establishing the diagnosis.

Recovery of Virus
Virus can be isolated from saliva, cerebrospinal fluid, or urine collected within 4 days after onset of illness. After treatment with antibiotics, the specimen are inoculated into monkey kidney cell cultures. Virus growth can be detected in 5-6 days by adsorption of suitable erythrocytes by the infected cells. The isolate can be identified with specific antiserum that can inhibit the hemadsorption. Immunofluorescent serum can also identify a virus isolate in cell culture within 2-3 days.

Serology
Antibody rise can be detected in paired sera. The CF test is best for specificity and accuracy, although the HI test may be used. A 4 fold or greater rise in antibody titer is evidence of mumps infection. A CF test on a single serum sample obtained soon after onset of illness may serve for a presumptive diagnosis. S (Soluble) antibodies develop within a few days after onset and sometimes reach a high titer before V (viral) antibodies can be detected. In early convalescence, both S and V antibodies are present at high levels. Subsequently, S antibodies disappear more rapidly, leaving V antibodies as a marker of previous infection for several years. The intra-dermal injection of inactivated virus results in reappearance of V antibodies in high titer. Neutralizing antibodies also appear during convalescence and can be determined in cell culture.

Skin Test Antigen
Delayed type hypersensitivity may be noted about 3-4 weeks after onset. The skin test is less reliable than serologic tests to establish evidence of past infection.

Immunity
Immunity is permanent after a single infection. Only one antigenic type exists. Passive immunity is transferred from mother to offspring; thus it is rare to see mumps in infants under age 6 months.

Treatment
Gamma globulin is of no value for decreasing the incidence of Orchitis, even when given immediately after parotitis is first noted.

Epidemiology
Mumps occurs throughout the world endemically throughout the year. Outbreaks occur where crowding favors dissemination of the virus. The disease reaches its highest incidence in children age 5-15 years, but epidemic occur in army camps. Although morbidity rates are high, the mortality rate is negligible, even when the nervous system is involved. Humans are the only known reservoirs of virus. The virus is transmitted by direct contact, airborne droplets, or formites contaminated with saliva and, perhaps urine. The period of communicability is from about 4 days before to about a week after the onset of symptoms. More intimate contact is necessary for the transmission of mumps than for measles or varicella.

About 30-40% of infections with mumps virus are in-apparent. Individuals with sub-clinical mumps acquire immunity. During the course of in-apparent infection, they can serve as sources of infection for others. Antibodies to mumps virus are transferred across the placenta and are gradually lost during the first year of life. In urban areas, antibodies are then acquired gradually, so that the 15-year-old group has about the same prevalence of persons with antibodies as the adult group. Antibodies are acquired at the same rate by persons living under favorable and unfavorable socio-economic conditions.

Control
Mumps is usually a mild childhood disease. A live vaccine made in chick embryo cell culture is available. It produces a sub-clinical non-communicable infection. The vaccine is recommended for children over age 1 year and for adolescents and adults who have not had mumps parotitis, a single does of the vaccine given subcutaneously produces detectable in 95% of vaccines, and antibody persists for at least 8 years. Combination of live virus vaccines (measles-mumps-rubella) produces antibodies to each of the viruses in about 95%.

Mumps Or Parotitis Disease

Mumps is an infectious disease where someone is infected by a virus (paramyxovirus) which attacks the salivary glands (parotid glands) in between the ears and jaw, causing swelling of the neck of the top or bottom cheek.

As for they who are at greater risk for suffering or contracting this disease are they who use or consume certain drugs to suppress the thyroid gland hormones and their Iodine deficiency in the body.

Transmission of Disease Mumps

Spread of the virus can be transmitted through direct contact, splashing saliva, vomit material, possibly with urine. The virus can be found in the urine from the first day until the fourteenth day after the enlargement of the gland.

Mumps disease is extremely rare in children less than 2 years because generally they still have or be protected by good anti-bodies. Someone who had suffered from mumps disease, and then he will have lifetime immunity.

Diagnosis Disease Mumps (Mumps or Parotitis)

Diagnosis is established when there is clearly an infection symptom of epidemic parotitis in physical examination, including details of contact with the mumps 2-3 weeks before. In addition, it is by examination of laboratory results of urine and blood.

Laboratory Examination

In addition to leucopenia with relative limfosiotsis, it is also showed that the increase in serum amylase levels that reached a peak after one week and then be back to normal within two weeks.

If the patient did not show any swelling of glands below the ear, but other signs and symptoms leads to mumps so it doubt the diagnosis, Doctors will give an order to do further tests such as blood serum. At less there are 3 test serums (serologic) to prove the specific mumps antibodies: antibodies, complement fixation (CF), Hemagglutination inhibitor antibodies (HI), virus neutralizing antibodies (NT).

Complications Due to Mumps

Almost all children who suffer from mumps will recover fully without complications, but sometimes the symptom comes back worse after about 2 weeks. This condition can cause complications which the virus can attacks other organs. This may occur especially if the infection occurs after puberty.

Below are the complications that can occur due to handling or a lack of early treatment:

1. Orchitis, inflammation of one or both testicles. After recovery, the affected testis may shrink. It rarely becomes permanent testicular damage resulting in infertility.

2. Ovoritis: inflammation of one or both ovaries telus. Arise mild abdominal pain and rarely causes sterility.

3. Encephalitis or meningitis: inflammation of the brain or the lining of the brain. Symptoms include headache, neck stiffness, drowsiness, coma or convulsions. 5-10% of sufferers experience meningitis and most of them will recover completely. 1 of 400-6000 patients experiencing enserfalitis likely suffered brain damage or permanent nerve, such as deafness or paralysis of facial muscles.

4. Pancreatitis: inflammation of the pancreas can occur at the end of the first week. Patients feel the nausea and vomiting accompanied by abdominal pain. These symptoms will disappear within 1 week and patients will recover completely.

5. Kidney inflammation can cause sufferers take the thick urine out in significant amounts

6. Inflammation of the joints can cause pain in one or several joints.

Treatment of Disease Mumps

Treatment aims to reduce complaints (symptomatic) and rest during the sufferer heat and gland (parotid) swelling. We can use heat and pain relief medication (antipyretics and analgesics) such as paracetamol and the like. Aspirin should not be given to children because it has a risk of Reye’s syndrome (Effect of aspirin in children).

In patients who experience swelling of the testicles, the patient should undergo a rest in bed. The pain can be reduced with ice compress on the swollen testicle area. While patients who experienced a virus attack in pancreas organ (pancreatitis), which cause symptoms of nausea and vomiting should be given fluids intravenously.

Giving Corticosteroids for 2-4 days and 20 ml of convalescent gammaglobulin is expected to prevent the occurrence of orchitis. For the virus itself can not be influenced by the anti-microbial, so treatment is only oriented to relieve symptoms until the patient returned either by itself.

Mumps disease is classified in the “self-limiting disease” (a disease which heals itself without treatment). People with mumps should avoid sour food or drink so sore is not getting worse, given the liquid diet and soft diet.

Prevention of Mumps

Mumps vaccination is part of routine immunization in childhood, namely immunization MMR (mumps, morbili, rubella) given by injection at the age of 15 months.

MMR immunization can also be given to adolescents and adults who have not yet Mumps. This immunization does not cause heat or other symptoms. Simply eating foods that contain iodine levels can reduce the risk of mumps disease attack.