Parotitis infection (mumps) in children

Parotite infection (mumps, mumps, hives) is an acute viral disease with a predominant lesion of salivary glands, less often other glandular organs (pancreas - testes, ovaries, mammary glands, etc.), as well as the nervous system.

[1], [2], [3], [4], [5], [6]

Epidemiology

The reservoir of the causative agent is only a person with manifest, erased and subclinical forms of the disease. The virus is contained in the saliva of the patient and is transmitted by airborne droplets during conversation. Infect primarily children who are near the source of infection (from one family or sitting at a desk, sleeping in the same bedroom, etc.).

The patient becomes contagious several hours before the onset of clinical manifestations. The greatest infectiousness is observed in the first days of illness (3-5 day). After the 9th day, the virus can not be isolated from the body and the patient is considered to be non-contagious.

The susceptibility is about 85%. In connection with the widespread use of active immunization in recent years, the incidence among children from 1 to 10 years has decreased, but the proportion of sick teenagers and adults has increased. Children of the first year of life are seldom ill, because they have specific antibodies received from the mother transplacental, which persist up to 9-10 months.

[7], [8], [9], [10], [11]

Causes of the mumps

RNA containing a virus from the family of paramyxoviruses. Because of the stable antigenic structure, the virus does not have antigenic variants.

[12], [13], [14], [15]

Pathogenesis

The entrance gates of the pathogen are the mucous membranes of the oral cavity, nasopharynx and upper respiratory tract. Later the virus penetrates into the blood (primary viremia) and spreads throughout the body, getting hematogenously into the salivary glands and other glandular organs.

The preferred location of the mumps virus is the salivary gland, where its greatest reproduction and accumulation take place. Isolation of the virus with saliva causes an airborne pathway of infection. Primary viralemia does not always have clinical manifestations. In the future, it is supported by a repeated, more massive release of the pathogen from the affected glands (secondary viremia), which causes the defeat of numerous organs and systems: the central nervous system, pancreas, genital organs, etc. Clinical symptoms of damage to an organ can appear in the early days of the disease, simultaneously or sequentially. Viralemia, which persists as a result of repeated entry of the pathogen into the blood, explains the appearance of these symptoms in later terms of the disease.

[16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31]

Symptoms of the mumps

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

The defeat of parotid glands (parotitis) is the most frequent manifestation of mumps infection.

Epidemic parotitis (mumps infection, mumps) begins acutely, with the rise in body temperature to 38-39 ° C. The child complains of headache, malaise, pain in the muscles, a decrease in appetite. Often the first symptoms of the disease are pain in the region of the parotid salivary gland, especially during chewing or talking. By the end of the first, less often on the second day after the onset of the disease parotid glands are enlarged. Usually the process starts on one side, and after 1-2 days the iron is drawn from the opposite side. The swelling appears in front of the ear, descends along the ascending branch of the lower jaw and behind the auricle, lifting it up and out. The increase in the parotid salivary gland may be small and can only be determined by palpation. In other cases, the parotid gland reaches a large size, the hypoderm of the subcutaneous tissue extends to the neck and the temporal region. The skin above the swelling is tense, but without inflammatory changes. When palpation, the salivary gland has a soft or testy consistency, painful. Point painful points NF Filatova: in front of the earlobe, in the region of the apex of the mastoid process and in the place of the incision of the lower jaw.

The increase in parotid glands usually increases within 2-4 days, and then their sizes slowly normalize. Simultaneously or sequentially, other salivary glands are involved in the process - submandibular (submaxillitis), sublingual (sublingual).

Submaxillite is observed in every fourth patient with mumps infection. More often it is combined with the defeat of parotid salivary glands, it is rarely the primary and only manifestation. In these cases, the swelling is located in the submaxillary region in the form of a rounded formation of the testate consistency. In severe forms in the gland can appear fibrotic edema that spreads to the neck.

Isolated lesions of the sublingual salivary gland (sublingual) are observed exceptionally rarely. This swelling appears under the tongue.

The defeat of the genitals. In mumps infection, the testicles, ovaries, prostate gland, mammary glands can be involved in the pathological process.

In adolescents and men under 30, orchitis is more common. This localization of mumps infection is noted in approximately 25% of cases.

After the transferred orchitis there are persistent dysfunctions of the testicles, this is one of the main causes of male infertility. Almost half of the affected orchites are disturbed by spermatogenesis, while a third reveal signs of testicular atrophy.

Orchitis usually appears 1-2 weeks after the onset of salivary gland lesions, sometimes the testicles become the primary localization of mumps infection. Perhaps in these cases, the lesion of the salivary glands is mildly pronounced and not timely diagnosed.

Inflammation of the testicles occurs as a result of the effect of the virus on the epithelium of the seminiferous tubules. The onset of pain syndrome is due to irritation of the receptors in the course of the inflammatory process, as well as the edema of the malodour stomach. Increase in intrachannel pressure leads to disturbance of microcirculation and organ function.

The disease begins with an increase in body temperature to 38-39 ° C and is often accompanied by chills. Characterized by headache, weakness, intense pain in the groin, intensifying when trying to walk, with irradiation in the testicle. The pains are localized mainly in the scrotum and testicles. The testicle is enlarged, compacted, sharply painful when palpated. The skin of the scrotum is hyperemic, sometimes with a cyanotic shade.

One-sided process is most often observed. Signs of organ atrophy are revealed later, after 1-2 months, while the testicle is reduced and becomes soft. Orchids can be combined with epididymitis.

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

Perhaps the defeat of the tear gland is dacryoadenitis, clinically manifested by pain in the eyes and edema of the eyelids.

The defeat of the nervous system. Usually, the nervous system is involved in the pathological process after the defeat of the glandular organs, and only in rare cases, the defeat of the nervous system is the only manifestation of the disease. In these cases, the defeat of the salivary glands is minimal and therefore it is viewed. Clinically, the disease manifests with serous meningitis, meningoencephalitis, rarely neuritis, or polyradiculoneuritis.

Neuritis and polyradiculoneuritis are rare, polyradiculitis of the Guillain-Barre type is possible.

Parotite pancreatitis usually develops in combination with the damage of other organs and systems.

Diagnostics of the mumps

In typical cases with the defeat of salivary glands, the diagnosis of mumps is not difficult. It is more difficult to diagnose mumps infection in atypical variants of the disease or isolated lesions of one or another organ without involving parotid salivary glands in the process. With these forms of great importance is an epidemiological anamnesis: cases of illness in the family, children's institution.

A clinical blood test does not have a significant diagnostic value. Usually there is leukopenia in the blood.

To confirm the diagnosis of mumps (mumps) by ELISA, specific IgMs are revealed in the blood, indicating active current infection. In parotitis infection, specific IgM is detected in all forms, including atypical 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.

[32], [33], [34], [35], [36], [37]

Differential diagnosis

The defeat of salivary glands in parotitis infection is differentiated with acute mumps in typhoid fever, sepsis, as well as with other diseases having externally similar symptoms.

Treatment of the mumps

Patients with mumps infection are usually treated at home. Hospitalized only children with severe forms of mumps (mumps), especially in the case of serous meningitis, orchitis. Pancreatitis. There is no specific treatment for mumps (mumps). In an acute period of mumps (mumps), a bed rest is prescribed for 5-7 days. It is especially important to comply with bed rest for boys over 10-12 years old, because they believe that exercise increases the frequency of orchitis.

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

In severe cases of mumps (mumps), intravenous drip fluids with proteolysis inhibitors (aprotinin, gordoks, kontrikal, trasilol 500,000) are administered.

For the removal of the pain syndrome prescribe antispasmodics and analgesics (analgin, papaverine, no-shpa).

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

• Patient with orchitis is better to be hospitalized. Assign bed rest, Suspension for an acute period of illness. As anti-inflammatory agents, glucocorticoids are used at a dose of 2-3 mg / kg per day (according to prednisolone) in 3-4 doses for 3-4 days, followed by a rapid dose reduction 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. Analgesics and desensitizing drugs [chloropyramine (suprastin) are prescribed to relieve the pain syndrome. Promethazine, fenkarol]. With a significant edema of the testicle in order to eliminate pressure on the parenchyma of the organ, surgical treatment is justified - dissection of the belly coat.
• If suspected of mumps with diagnostic purpose, a lumbar puncture is indicated, in rare cases it can be performed as a therapeutic measure for lowering intracranial pressure. For the purpose of dehydration, introduce furosemide (lasix). In severe cases resort to infusion therapy (20% glucose solution, B vitamins).

Prevention

Those infected with parotitis infection are isolated from the children's collective until the disappearance of the clinical manifestations (no more than 9 days). Among the contact disconnections are children under 10 years who have not had a mumps infection and have not received active immunization for a period of 21 days. In cases of precise establishment of the contact date, the separation period is shortened and the children are to be isolated from the 11th to the 21st day of the incubation period. Final disinfection in the outbreak is not carried out, but the room should be ventilated and wet cleaning should be carried out using disinfectants.

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

Vaccine prophylaxis

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

The vaccine strain of the domestic vaccine is grown on the cell culture of Japanese quail embryos. Each vaccine 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 (prioriks and MMR II) are also allowed. Children under 12 months of age with revaccination at the age of 6-7 years who were not infected with mumps infection should be vaccinated. Vaccination according to epidemiological indications of adolescents and adults, seronegative for epidemiological mumps, is also recommended. The vaccine is injected once subcutaneously in a volume of 0.5 ml under the scapula or in the outer surface of the shoulder. After the vaccination and revaccination, a strong (possibly lifelong) immunity is formed.

The vaccine is not very reactogenic. There are no direct contraindications to the introduction of mumps vaccine.

[38], [39]