Mumps

Mumps - Acute
Rahul Soman, M. Pharm

 

Definition  

Illness with acute onset of unilateral or bilateral tenderness and swelling of the parotid or other salivary and extrasalivary glands

 

Medical History  

* Finding of immune status

* Vaccination failure

 

Findings  

* Abdominal pain - Acute

* Altered mental status

* Nuchal rigidity

* Seizure

* Vomiting

* Dysphagia

* Edema of larynx

* Edema of the tongue

* Epididymitis - Acute

* Facial edema

* Fever

* Headache

* Loss of appetite

* Malaise

* Myalgia

* Nasal discharge

* Otalgia

* Parotid swelling

* Tenderness

* Trismus

 

Tests  

 

Suspected mumps exposure; determination of immunity to mumps  

* Mumps Virus antibody assay: Positive mumps serology can indicate recent illness, previous exposure, or seroconversion by comparing baseline and post-vaccination titers .

 

Suspected mumps infection  

* Viral culture, urine: Shell vial culture of urine is used to confirm, versus diagnose, acute mumps infection .

 

Suspected mumps  

* Viral culture, Saliva: Mumps virus is typically present in saliva from from 2 to 3 days prior and 4 to 5 days after the onset of parotitis .

 

Suspected mumps encephalitis  

* Viral culture, Cerebrospinal fluid: Mumps can be isolated in cerebrospinal fluid for up to 1 week after presentation .

 

Suspected mumps  

* Cerebrospinal fluid examination: In patients with mumps, the cerebrospinal fluid examination typically reveals an elevated WBC count and normal to mildly abnormal glucose and protein levels .

 

Mumps  

* Amylase measurement, serum: Pancreatic (P-type) and salivary (S-type) amylase isoenzymes may help to differentiate the cause of hyperamylasemia in mumps .

 

Differential Diagnosis  

* Mumps parotitis

* Mumps meningitis

* Mumps encephalitis

* Mumps orchitis

* Mumps pancreatitis

* Mumps nephritis

* Mumps oophoritis

* Mumps arthritis

* Mumps myocarditis

* Mumps thyroiditis

* Bacterial meningitis - Acute

* Viral meningitis - Acute

* Parotitis - non-mumps

* Viral disease

* Cervical lymphadenitis

* Dental abscess

* Sialolithiasis

* Testicular torsion - Acute

* Epididymitis - Acute

* Malignant lymphoma of lymph nodes of head, face AND/OR neck

* Mastoiditis - Acute

* Drug allergy

* Neoplasm of parotid gland

 

Treatment  

 

Drug Therapy  

 

Fever  

ACETAMINOPHEN

Adults: 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

Acute pain  

 

ACETAMINOPHEN

Adults: 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

HYDROCODONE BITARTRATE/ACETAMINOPHEN  

Adults: Hydrocodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics (2 to 13 years): 0.27 mL/kg (0.135 mg/kg hydrocodone and 9 mg/kg acetaminophen) orally every 4 hours as needed (maximum 6 doses/day)

 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics: 0.05 to 0.15 mg/kg of the oxycodone ingredient orally every 4 hours as needed

 

ACETAMINOPHEN/CODEINE PHOSPHATE  

Adults: Codeine 15 to 60 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 360 mg codeine and 4 g acetaminophen/day)

Pediatrics (3 to 6 years): 5 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed

Pediatrics (7 to 12 years): 10 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed

 

Procedural Therapy  

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .

 

Non-Procedural Therapy  

 

Mumps parotitis or orchitis  

* Ice Packs

* Scrotal Support

* Bed Rest