Clinical presentation of true mumps infection
The disease starts acutely with high fever (39–40°C). A new temperature spike usually accompanies the involvement of the next glandular organ or the nervous system in the process.
The main local symptom is the appearance of swelling located between the angle of the mandible and the mastoid process (the process can be either unilateral or bilateral).
Features of pain syndrome and local changes:
- Pain is localized in the area of the parotid salivary gland, increases with chewing, and can radiate to the ear.
- A positive Filatov's sign is detected.
- Upon palpation, the gland itself has a doughy consistency and is moderately painful.
- The skin over the affected organ is tense and characteristically shiny, but without pronounced hyperemia.
- Dryness of the mucous membrane and a specific Mursu's sign (simptom Mursu) are noted in the oropharynx.
Differential diagnosis with local inflammations
When determining patient management tactics (indications for hospitalization, examination plan), the physician must exclude other causes of neck and facial swelling.
- Acute purulent parotitis. It differs by a dense consistency of the gland and sharp tenderness. The skin over it becomes hot and hyperemic, and fluctuation may appear. The pain is spontaneous and throbbing, and pus may be discharged from the orifice of Stensen's duct.
- Sialolithiasis. Characterized by a gradual onset without fever. The gland is dense, and pain occurs predominantly during eating (so-called "salivary colic").
- Upper cervical lymphadenitis. It often has a clear epidemiological history (e.g., invasive procedures in non-sterile home settings—piercing earlobes at home). In this case, a dense and painful lymph node is palpated behind the angle of the mandible, the skin over it is hyperemic, and inflammatory foci may be present in the oral cavity.
Differences from systemic infectious diseases
Mumps infection must also be differentiated from diseases presenting with pronounced lymph node and oropharyngeal involvement.
- Infectious mononucleosis. Characterized by generalized lymphadenopathy (elastic-dense nodes). Pain is localized in the throat during swallowing and in the neck when turning the head. "Granularity" of the posterior pharyngeal wall and tonsillitis are visible in the oropharynx. There are no lesions of other glands.
- Oropharyngeal diphtheria (toxic form). Accompanied by painless edema of the subcutaneous tissue of doughy consistency without clear contours, altering the configuration of the neck. The skin is pale. In the fauces—stagnant hyperemia with a cyanotic tint and extensive fibrinous plaque.
In addition, when comprehensively diagnosing infections, the presence of exanthema is taken into account. Unlike measles, rubella, scarlet fever, or chickenpox, rash is not a characteristic symptom in true mumps.
Differential diagnosis of infections with exanthema
During differential diagnosis, it is important to remember the key signs of other childhood infections accompanied by fever, intoxication, and changes in the skin and mucous membranes.
| Disease | Features of exanthema | Mucosal changes and other symptoms |
|---|---|---|
| Measles | Appears on days 4–8, large, confluent. Stepwise eruption (top to bottom). After fading—brown pigmentation. | Koplik spots, pronounced conjunctivitis, scleritis. Leukopenia. |
| Rubella | Appears on days 1–3, fine-spotted, on extensor surfaces. | Enlargement of postauricular and occipital lymph nodes, Forchheimer spots. |
| Scarlet fever | On days 1–2, fine-petechial against the background of hyperemia, crowding in folds (Pastia's sign). Desquamation after fading. | "Flaming" fauces, pale nasolabial triangle, purulent-necrotic tonsillitis. Leukocytosis. |
| Chickenpox | From days 1–3, false polymorphism (spots, papules, vesicles, crusts). Phenomenon of successive eruptions. | Vesicles on the oropharyngeal mucosa, pruritus. |
Briefly: answers to topical questions
What drugs are used for etiotropic and pathogenetic treatment of mumps?
There is no etiotropic treatment for mumps infection, and the use of gamma globulin is considered ineffective. Pathogenetic and symptomatic therapy includes the following drug groups:
- Detoxification agents — glucose-saline solutions orally and/or parenterally.
- Antipyretics — prescribed exclusively when body temperature is above 38.5°C.
- Nonsteroidal anti-inflammatory drugs — used in a short course.
- Desensitizing drugs and gastrointestinal enzymes.
- Glucocorticosteroids (prednisolone) — used parenterally in a 3-4 day course for orchitis (dose 2-3 mg/kg/day).
- Protease inhibitors (gordox, contrykal, trasylol) — administered parenterally according to indications if pancreatitis develops.
What are the schedule and scheme of specific prevention (vaccination) for mumps?
Specific prevention is carried out with live attenuated mumps vaccine.
- Routine vaccination — performed at 12 months of age subcutaneously (under the scapula or into the outer surface of the shoulder).
- Routine revaccination — performed at 6 years of age.
- Emergency prophylaxis — indicated for individuals not vaccinated and not previously infected with mumps, administration of the drug is carried out no later than 72 hours after contact with an infected person.
What is Mursu's sign in mumps, and how does it appear upon examination?
Mursu's sign in mumps is the edema and hyperemia of the orifice of the excretory duct of the parotid salivary gland (Stensen's duct / ductus parotideus) on the affected side. Upon examination, it is identified as a local change in the area of the papilla of the parotid salivary gland excretory duct.
Which specific glandular organs, other than the salivary glands, can be affected in mumps?
In mumps, other target organs can also be involved in the pathological process due to hematogenous dissemination of the virus and its high tropism for glandular tissue. These include:
- Pancreas — with the development of the clinical picture of acute pancreatitis.
- Reproductive system organs — with the development of mumps orchitis in male patients.
What is Filatov's sign upon palpation in a patient with mumps?
In mumps, Filatov's sign manifests as tenderness upon palpation. This feature is considered the earliest symptom, preceding the visual enlargement of the salivary gland. The tenderness is localized behind the earlobe (at the projection site of the parotid salivary gland), as well as in the postauricular and preauricular regions where an inflammatory infiltrate subsequently develops.
To quickly differentiate mumps from sialolithiasis, remember the "temperature and time" rule: mumps starts acutely with high fever, whereas sialolithiasis develops gradually, without fever, with pain specifically during meals ("salivary colic").
Class and exam questions
Can a diagnosis of mumps be made if the swelling occurred after a non-sterile ear piercing?
In such a scenario, the diagnosis of mumps infection is doubtful. Most likely, this is a case of reactive upper cervical lymphadenitis or a local pyogenic-inflammatory process due to wound infection.
What is the consistency of the salivary gland characteristic of mumps?
In uncomplicated mumps infection, the gland has a doughy consistency. If it becomes firm, hot, and acutely tender, this indicates acute suppurative parotitis.
Are other organs affected in mumps?
Yes, mumps infection is characterized by the potential involvement of other glandular organs and the nervous system, which is accompanied by new waves of high fever.
What else to study on this topic
- Detailed epidemiological history (contacts, timeline of symptom onset)
- Indications for hospitalization or outpatient treatment in infectious diseases
- Specific hemogram changes in measles, rubella, and infectious mononucleosis
- Generalized lymphadenopathy and hepatosplenic syndrome in infections
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