Mumps (mumps) infection in children

Mumps infection (epidemic parotitis, mumps, mumps) is an acute viral disease with predominant damage to the salivary glands, less often to other glandular organs (pancreas - testicles, ovaries, mammary glands, etc.), as well as the nervous system.

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Epidemiology

The reservoir of the pathogen is only a person with manifest, latent and subclinical forms of the disease. The virus is contained in the saliva of the patient and is transmitted by airborne droplets during conversation. Children who are close to the source of infection (from the same family or sitting at the same desk, sleeping in the same bedroom, etc.) are mainly infected.

The patient becomes contagious several hours before the onset of clinical manifestations. The highest contagiousness is observed in the first days of the disease (3-5th day). After the 9th day, the virus cannot be isolated from the body and the patient is considered non-contagious.

Susceptibility is about 85%. Due to the widespread use of active immunization in recent years, the incidence among children aged 1 to 10 years has decreased, but the proportion of sick adolescents and adults has increased. Children in their first year of life rarely get sick, as they have specific antibodies received from the mother transplacentally, which persist for up to 9-10 months.

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Causes mumps in a baby

An RNA-containing virus from the paramyxovirus family. Due to its stable antigen structure, the virus has no antigen variants.

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Pathogenesis

The entry points for the pathogen are the mucous membranes of the oral cavity, nasopharynx and upper respiratory tract. Subsequently, the virus enters the blood (primary viremia) and spreads throughout the body, entering the salivary glands and other glandular organs by hematogenous route.

The favorite localization of the mumps virus is the salivary glands, where its greatest reproduction and accumulation occur. The release of the virus with saliva causes the airborne transmission of the infection. Primary viremia does not always have clinical manifestations. It is subsequently supported by a repeated, more massive release of the pathogen from the affected glands (secondary viremia), which causes damage to numerous organs and systems: the central nervous system, pancreas, genitals, etc. Clinical symptoms of damage to one or another organ may appear in the first days of the disease, simultaneously or sequentially. Viremia, which persists as a result of repeated entry of the pathogen into the blood, explains the appearance of these symptoms at later stages of the disease.

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Symptoms mumps in a baby

The incubation period of epidemic parotitis (mumps infection, mumps) is 9-26 days. Clinical manifestations depend on the form of the disease.

Parotitis (mumps) is the most common manifestation of mumps infection.

Epidemic parotitis (mumps infection, mumps) begins acutely, with a rise in body temperature to 38-39 ° C. The child complains of headache, malaise, muscle pain, loss of appetite. Often the first symptoms of the disease are pain in the parotid salivary gland, especially during chewing or talking. By the end of the first, less often on the second day from the onset of the disease, the parotid salivary glands enlarge. Usually the process begins on one side, and after 1-2 days the gland on the opposite side is involved. Swelling appears in front of the ear, descends along the ascending branch of the lower jaw and behind the auricle, lifting it up and outward. The enlargement of the parotid salivary gland may be small and determined only by palpation. In other cases, the parotid gland reaches large sizes, the edema of the subcutaneous tissue spreads to the neck and temporal region. The skin over the swelling is tense, but without inflammatory changes. On palpation, the salivary gland is soft or doughy in consistency and painful. N. F. Filatov's painful points are identified: in front of the earlobe, in the area of the apex of the mastoid process, and in the place of the lower jaw notch.

The enlargement of the parotid glands usually increases over 2-4 days, and then their size slowly normalizes. Simultaneously or sequentially, other salivary glands are also involved in the process - submandibular (submaxillitis), sublingual (sublingualitis).

Submaxillitis is observed in every fourth patient with mumps infection. More often it is combined with damage to the parotid salivary glands, rarely it is the primary and only manifestation. In these cases, the swelling is located in the submandibular region in the form of a rounded formation of doughy consistency. In severe forms, edema of the tissue may appear in the gland area, spreading to the neck.

Isolated damage to the sublingual salivary gland (sublingualitis) is extremely rare. In this case, swelling appears under the tongue.

Damage to the genitals. In case of mumps infection, the testicles, ovaries, prostate gland, and mammary glands may be involved in the pathological process.

Orchitis is more common in adolescents and men under 30. This localization of mumps infection is observed in approximately 25% of patients.

After orchitis, persistent dysfunction of the testicles remains, this is one of the main causes of male infertility. Almost half of those who have had orchitis have impaired spermatogenesis, and a third show signs of testicular atrophy.

Orchitis usually appears 1-2 weeks after the onset of damage to the salivary glands, sometimes the testicles become the primary localization of mumps infection. Perhaps in these cases, the damage to the salivary glands is weakly expressed and not diagnosed in time.

Inflammation of the testicles occurs as a result of the virus affecting the epithelium of the seminiferous tubules. The occurrence of pain syndrome is caused by irritation of receptors during the inflammatory process, as well as swelling of the inflexible protein membrane. Increased intratubular pressure leads to disruption of microcirculation and organ function.

The disease begins with an increase in body temperature to 38-39 °C and is often accompanied by chills. Headache, fatigue, intense pain in the groin, which intensifies when trying to walk, with irradiation to the testicle are characteristic. The pain is localized mainly in the area of the scrotum and testicle. The testicle increases in size, becomes denser, and is very painful upon palpation. The skin of the scrotum is hyperemic, sometimes with a bluish tint.

A unilateral process is more often observed. Signs of organ atrophy are revealed later, after 1-2 months, while the testicle is reduced and becomes soft. Orchitis can be combined with epididymitis.

A rare manifestation of mumps infection is thyroiditis. Clinically, this form of the disease is manifested by an enlarged thyroid gland, fever, tachycardia, and pain in the neck.

It is possible that the lacrimal gland is damaged - dacryoadenitis, which is clinically manifested by pain in the eyes and swelling of the eyelids.

Nervous system damage. Usually the nervous system is involved in the pathological process following damage to the glandular organs, and only in rare cases is nervous system damage the only manifestation of the disease. In these cases, damage to the salivary glands is minimal and therefore overlooked. Clinically, the disease manifests itself as serous meningitis, meningoencephalitis, rarely neuritis or polyradiculoneuritis.

Neuritis and polyradiculoneuritis are rare; polyradiculitis of the Guillain-Barré type is possible.

Mumps pancreatitis usually develops in combination with damage to other organs and systems.

Diagnostics mumps in a baby

In typical cases with damage to the salivary glands, the diagnosis of epidemic parotitis (mumps) does not cause difficulties. It is more difficult to diagnose mumps infection in atypical variants of the disease or isolated lesions of one or another organ without involvement of the parotid salivary glands. In these forms, the epidemiological anamnesis is of great importance: cases of the disease in the family, children's institution.

Clinical blood analysis has no significant diagnostic value. Usually there is leukopenia in the blood.

To confirm the diagnosis of epidemic parotitis (mumps), the ELISA method is used to detect specific IgM in the blood, indicating an active infection. In case of parotitis infection, specific IgM is detected in all forms, including atypical ones, as well as in isolated localizations: orchitis, meningitis and pancreatitis. This is of exceptional importance in diagnostically difficult cases.

Specific antibodies of the IgG class appear somewhat later and persist for many years.

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Differential diagnosis

Damage to the salivary glands during mumps infection is differentiated from acute mumps during typhoid fever, sepsis, and other diseases that have outwardly similar symptoms.

Treatment mumps in a baby

Patients with mumps infection are usually treated at home. Only children with severe forms of epidemic parotitis (mumps) are hospitalized, especially in the case of serous meningitis, orchitis, pancreatitis. There is no specific treatment for epidemic parotitis (mumps). In the acute period of epidemic parotitis (mumps), bed rest is prescribed for 5-7 days. It is especially important to observe bed rest for boys over 10-12 years old, since it is believed that physical activity increases the frequency of orchitis.

• When clinical symptoms of pancreatitis appear, the patient needs bed rest and a stricter diet: the first 1-2 days are prescribed maximum unloading (hunger days), then the diet is gradually expanded, maintaining restrictions on fats and carbohydrates. After 10-12 days, the patient is transferred to diet No. 5.

In severe cases of epidemic parotitis (mumps), intravenous drip administration of fluid with proteolysis inhibitors (aprotinin, gordox, contrical, trasylol 500,000) is used.

To relieve pain, antispasmodics and analgesics (analgin, papaverine, no-shpa) are prescribed.

To improve digestion, it is recommended to prescribe enzyme preparations (pancreatin, panzinorm, festal).

• It is better to hospitalize a patient with orchitis. Bed rest and a jockstrap are prescribed for the acute period of the disease. Glucocorticoids are used as anti-inflammatory drugs at a rate of 2-3 mg/kg per day (prednisolone) in 3-4 doses for 3-4 days with subsequent rapid reduction of the dose with a total course duration of no more than 7-10 days. Specific antiviral drugs (specific immunoglobulin, ribonuclease) do not have the expected positive effect. To relieve pain, analgesics and desensitizing drugs are prescribed [chloropyramine (suprastin), promethazine, fenkarol]. In case of significant testicular edema, surgical treatment is justified in order to eliminate pressure on the organ parenchyma - dissection of the protein membrane.
• If mumps meningitis is suspected, a lumbar puncture is indicated for diagnostic purposes; in rare cases, it can also be used as a therapeutic measure to reduce intracranial pressure. Furosemide (Lasix) is administered for dehydration. In severe cases, infusion therapy is used (20% glucose solution, B vitamins).

Prevention

Those infected with mumps are isolated from the children's group until clinical manifestations disappear (for no more than 9 days). Among contacts, children under 10 years of age who have not had mumps and have not received active immunization are subject to isolation for a period of 21 days. In cases where the date of contact is precisely established, the isolation period is reduced and children are subject to isolation from the 11th to the 21st day of the incubation period. Final disinfection is not carried out at the site of infection, but the room should be ventilated and wet cleaning should be carried out using disinfectants.

Children who have had contact with a patient with mumps infection are monitored (examination, thermometry).

Vaccination

The only reliable method of prevention is active immunization, vaccination against measles, mumps and rubella. Live attenuated mumps vaccine is used for vaccination.

The vaccine strain of the domestic vaccine is grown on a cell culture of Japanese quail embryos. Each vaccination dose contains a strictly defined amount of attenuated mumps virus, as well as a small amount of neomycin or kanamycin and a trace amount of bovine serum protein. Combined vaccines against mumps, measles and rubella (Priorix and MMR II) are also approved. Children aged 12 months with revaccination at the age of 6-7 years who have not had mumps infection are subject to vaccination. Vaccination is also recommended for adolescents and adults who are seronegative for epidemiological mumps according to epidemiological indications. The vaccine is administered subcutaneously once in a volume of 0.5 ml under the shoulder blade or on the outer surface of the shoulder. After vaccination and revaccination, strong (possibly lifelong) immunity is formed.

The vaccine is slightly reactogenic. There are no direct contraindications to the administration of the mumps vaccine.

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