Mumps virus - Revision history

Aidan at 14:05, 5 August 2020

2020-08-05T14:05:16Z

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-16T14:37:14Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 14:37, 16 July 2020
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	* Eosinophilic parotitis, often as a drug reaction		* Eosinophilic parotitis, often as a drug reaction

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Incubation period of 16 to 18 days (range 2 to 4 weeks)		* Incubation period of 16 to 18 days (range 2 to 4 weeks)

Aidan at 15:24, 17 August 2019

2019-08-17T15:24:28Z

← Older revision		Revision as of 15:24, 17 August 2019
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		⚫	* Presents with a prodrome followed by parotitis
	= Mumps virus =

		⚫	== Microbiology ==
⚫	* ~~Prodrome~~ followed by parotitis

⚫	= Microbiology =

	* Enveloped single-stranded RNA virus in the genus ''Rubulavirus'' and family Paramyxovirus		* Enveloped single-stranded RNA virus in the genus ''Rubulavirus'' and family Paramyxovirus
Line 14:		Line 12:
	** Inner layer in membrane protein		** Inner layer in membrane protein

	= Epidemiology =		== Epidemiology ==

	* Worldwide distribution		* Worldwide distribution
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	* Before vaccination, it was the leading cause of viral encephalitis and a common cause of viral meningitis		* Before vaccination, it was the leading cause of viral encephalitis and a common cause of viral meningitis

	= Pathophysiology =		== Pathophysiology ==

	* Acquired through virus (contact, droplet, fomites) entering nose or mouth, with tropism for endo/exocrine glands		* Acquired through virus (contact, droplet, fomites) entering nose or mouth, with tropism for endo/exocrine glands
Line 33:		Line 31:
	* Neutralizing antibodies to HN and F are detectable during convalescence		* Neutralizing antibodies to HN and F are detectable during convalescence

	= Differential Diagnosis =		== Differential Diagnosis ==

	* Infectious parotitis		* Infectious parotitis
Line 44:		Line 42:
	* Eosinophilic parotitis, often as a drug reaction		* Eosinophilic parotitis, often as a drug reaction

	= Clinical Presentation =		== Clinical Presentation ==

	* Incubation period of 16 to 18 days (range 2 to 4 weeks)		* Incubation period of 16 to 18 days (range 2 to 4 weeks)
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	* Can lead to sialectasia resulting in recurrent or chronic sialadenitis		* Can lead to sialectasia resulting in recurrent or chronic sialadenitis

	== Mumps epididymo-orchitis ==		=== Mumps epididymo-orchitis ===

	* The most common extrasalivary gland manifestation, occuring in 20-30% of postpubertal men (bilateral in 15%)		* The most common extrasalivary gland manifestation, occuring in 20-30% of postpubertal men (bilateral in 15%)
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	** If bilateral, sterility is rare, and impotence is not a sequela		** If bilateral, sterility is rare, and impotence is not a sequela

	== Mumps oopheritis ==		=== Mumps oopheritis ===

	* In 5% of cases in postpubertal women		* In 5% of cases in postpubertal women
	* May cause impaired fertility		* May cause impaired fertility

	== Mumps meningitis ==		=== Mumps meningitis ===

	* Fever, headache, vomiting, and nuchal rigidity, with an aseptic CSF (lymphocyte-predominant more often than neutrophil-predominant)		* Fever, headache, vomiting, and nuchal rigidity, with an aseptic CSF (lymphocyte-predominant more often than neutrophil-predominant)
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	* Lasts 3 to 10 days, with complete recovery		* Lasts 3 to 10 days, with complete recovery

	== Mumps encephalitis ==		=== Mumps encephalitis ===

	* Non-focal encephalitis, high fever, altered LOC, seizures, paresis, aphasia, and involuntary movements, with an aseptic CSF		* Non-focal encephalitis, high fever, altered LOC, seizures, paresis, aphasia, and involuntary movements, with an aseptic CSF
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	* Can cause sequelae, including psychomotor retardation, seizures, and death		* Can cause sequelae, including psychomotor retardation, seizures, and death

	== Other complications ==		=== Other complications ===

	* Cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barré syndrome, and poliomyelitis-lik syndrome		* Cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barré syndrome, and poliomyelitis-lik syndrome
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	** Myocarditis is rare		** Myocarditis is rare

	== Pregnancy ==		=== Pregnancy ===

	* Pregnant women who are infected have increased risk of spontaneous abortion in the first trimester, as well as low birth weight		* Pregnant women who are infected have increased risk of spontaneous abortion in the first trimester, as well as low birth weight
	* Not clearly related to any significant birth defects		* Not clearly related to any significant birth defects

	= Diagnosis =		== Diagnosis ==

	* Traditionally a clinical diagnosis		* Traditionally a clinical diagnosis
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	** Can be detected in urine up to 2 weeks after onset		** Can be detected in urine up to 2 weeks after onset

	= Management =		== Management ==

	* Symptomatic		* Symptomatic
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	* Reportable disease, public health may do outbreak investigation and consider booster MMR in high-risk populations		* Reportable disease, public health may do outbreak investigation and consider booster MMR in high-risk populations

	= Prevention =		== Prevention ==

	* Live attenuated vaccine in the MMR is given at 12-15 months and again at 4-6 years		* Live attenuated vaccine in the MMR is given at 12-15 months and again at 4-6 years

Aidan at 23:36, 14 August 2019

2019-08-14T23:36:23Z

← Older revision		Revision as of 23:36, 14 August 2019
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	* Prodrome followed by parotitis		* Prodrome followed by parotitis

	== Microbiology ==		= Microbiology =

	* Enveloped single-stranded RNA virus in the genus ''Rubulavirus'' and family Paramyxovirus		* Enveloped single-stranded RNA virus in the genus ''Rubulavirus'' and family Paramyxovirus
Line 14:		Line 14:
	** Inner layer in membrane protein		** Inner layer in membrane protein

	== Epidemiology ==		= Epidemiology =

	* Worldwide distribution		* Worldwide distribution
Line 22:		Line 22:
	* Before vaccination, it was the leading cause of viral encephalitis and a common cause of viral meningitis		* Before vaccination, it was the leading cause of viral encephalitis and a common cause of viral meningitis

	== Pathophysiology ==		= Pathophysiology =

	* Acquired through virus (contact, droplet, fomites) entering nose or mouth, with tropism for endo/exocrine glands		* Acquired through virus (contact, droplet, fomites) entering nose or mouth, with tropism for endo/exocrine glands
Line 33:		Line 33:
	* Neutralizing antibodies to HN and F are detectable during convalescence		* Neutralizing antibodies to HN and F are detectable during convalescence

	== Differential Diagnosis ==		= Differential Diagnosis =

	* Infectious parotitis		* Infectious parotitis
Line 44:		Line 44:
	* Eosinophilic parotitis, often as a drug reaction		* Eosinophilic parotitis, often as a drug reaction

	== Clinical Presentation ==		= Clinical Presentation =

	* Incubation period of 16 to 18 days (range 2 to 4 weeks)		* Incubation period of 16 to 18 days (range 2 to 4 weeks)
Line 58:		Line 58:
	* Can lead to sialectasia resulting in recurrent or chronic sialadenitis		* Can lead to sialectasia resulting in recurrent or chronic sialadenitis

	=== Mumps epididymo-orchitis ===		== Mumps epididymo-orchitis ==

	* The most common extrasalivary gland manifestation, occuring in 20-30% of postpubertal men (bilateral in 15%)		* The most common extrasalivary gland manifestation, occuring in 20-30% of postpubertal men (bilateral in 15%)
Line 70:		Line 70:
	** If bilateral, sterility is rare, and impotence is not a sequela		** If bilateral, sterility is rare, and impotence is not a sequela

	=== Mumps oopheritis ===		== Mumps oopheritis ==

	* In 5% of cases in postpubertal women		* In 5% of cases in postpubertal women
	* May cause impaired fertility		* May cause impaired fertility

	=== Mumps meningitis ===		== Mumps meningitis ==

	* Fever, headache, vomiting, and nuchal rigidity, with an aseptic CSF (lymphocyte-predominant more often than neutrophil-predominant)		* Fever, headache, vomiting, and nuchal rigidity, with an aseptic CSF (lymphocyte-predominant more often than neutrophil-predominant)
Line 83:		Line 83:
	* Lasts 3 to 10 days, with complete recovery		* Lasts 3 to 10 days, with complete recovery

	=== Mumps encephalitis ===		== Mumps encephalitis ==

	* Non-focal encephalitis, high fever, altered LOC, seizures, paresis, aphasia, and involuntary movements, with an aseptic CSF		* Non-focal encephalitis, high fever, altered LOC, seizures, paresis, aphasia, and involuntary movements, with an aseptic CSF
Line 92:		Line 92:
	* Can cause sequelae, including psychomotor retardation, seizures, and death		* Can cause sequelae, including psychomotor retardation, seizures, and death

	=== Other complications ===		== Other complications ==

	* Cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barré syndrome, and poliomyelitis-lik syndrome		* Cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barré syndrome, and poliomyelitis-lik syndrome
Line 100:		Line 100:
	** Myocarditis is rare		** Myocarditis is rare

	=== Pregnancy ===		== Pregnancy ==

	* Pregnant women who are infected have increased risk of spontaneous abortion in the first trimester, as well as low birth weight		* Pregnant women who are infected have increased risk of spontaneous abortion in the first trimester, as well as low birth weight
	* Not clearly related to any significant birth defects		* Not clearly related to any significant birth defects

	== Diagnosis ==		= Diagnosis =

	* Traditionally a clinical diagnosis		* Traditionally a clinical diagnosis
Line 115:		Line 115:
	** Can be detected in urine up to 2 weeks after onset		** Can be detected in urine up to 2 weeks after onset

	== Management ==		= Management =

	* Symptomatic		* Symptomatic
Line 123:		Line 123:
	* Reportable disease, public health may do outbreak investigation and consider booster MMR in high-risk populations		* Reportable disease, public health may do outbreak investigation and consider booster MMR in high-risk populations

	== Prevention ==		= Prevention =

	* Live attenuated vaccine in the MMR is given at 12-15 months and again at 4-6 years		* Live attenuated vaccine in the MMR is given at 12-15 months and again at 4-6 years
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	* Titres positive for at least 10 years, but immunity wanes		* Titres positive for at least 10 years, but immunity wanes
	* Contraindicated in pregnant women		* Contraindicated in pregnant women

			[[Category:Paramyxoviridae]]

Aidan: Aidan moved page RNA Mumps virus to Mumps virus

2019-08-14T23:35:28Z

Aidan moved page RNA Mumps virus to Mumps virus

← Older revision		Revision as of 23:35, 14 August 2019
(No difference)

Maintenance script: Imported from text file

2019-08-11T18:05:57Z

Imported from text file

New page

= Mumps virus =

* Prodrome followed by parotitis

== Microbiology ==

* Enveloped single-stranded RNA virus in the genus ''Rubulavirus'' and family Paramyxovirus
* Only one serotype but 13 genotypes (A to M)
* Genome encodes eight proteins: hemagglutinin-neuraminidase (HN), fusion (F), nucleocapsid (NP), phosphoprotein (P), matrix (M), hydrophobic (SH) and L protein
** P contains V and I proteins
* Irregular spherical shape with nucleocapsid enclosed by a three-layered envelope
** Surface studded with glycoproteins: HN and F, which are the most important for immunity
** Middle layer is lipid bilayer from the host cell
** Inner layer in membrane protein

== Epidemiology ==

* Worldwide distribution
* Epidemics every 2 to 5 years in unimmunized settings, with a peak between January and May
* Spread primarily by schoolchildren
* Outbreaks have happened amongst immunized people, suggesting that a third dose of MMR may be needed to confer ongoing immunity
* Before vaccination, it was the leading cause of viral encephalitis and a common cause of viral meningitis

== Pathophysiology ==

* Acquired through virus (contact, droplet, fomites) entering nose or mouth, with tropism for endo/exocrine glands
** Salivary, pancreatis, testicular
* Less infectious that measles or varicella
* Peak contagion is just before parotitis
* Immune response begins with antibodies against NP protein (S antigen), and may be detectable at presentation, but decline quickly over months
* Antibodies against HN protein (V antigen) follow, peaking at 2 to 4 weeks and persist for years
** IgM antibodies fall within 2 to 6 months
* Neutralizing antibodies to HN and F are detectable during convalescence

== Differential Diagnosis ==

* Infectious parotitis
** Parainfluenza 3 virus, coxsackieviruses, and influenza A
** HIV infection (bilateral, parotid)
** Staph. aureus or GNBs
* Drugs (bilateral, mild)
* Metabolic disorders, including diabetes, malnutrition, cirrhosis, and CKD (bilateral, mild)
* Tumours, cysts, sialolithiasis, and stricture (unilateral)
* Eosinophilic parotitis, often as a drug reaction

== Clinical Presentation ==

* Incubation period of 16 to 18 days (range 2 to 4 weeks)
* One-day prodrome of low-grade fever, anorexia, malaise, and headache
* Earache and parotitis soon follow
** Parotitis progresses over 2 to 3 days, with severe pain
** The other parotid usually follows, but it can be unilateral
** Stensen's duct is edematous and erythematous
** Pain exacerbated by citrus
** Can involve other salivary glands in 10%
* Temperature can be as high as 40º C
* Pain, fever, tenderness resolve, with parotid returning to normal within 1 week
* Can lead to sialectasia resulting in recurrent or chronic sialadenitis

=== Mumps epididymo-orchitis ===

* The most common extrasalivary gland manifestation, occuring in 20-30% of postpubertal men (bilateral in 15%)
* Occurs in first 1-2 weeks after parotitis
* Fevers up to 41º C, chills, headache, vomiting, and testicular pain
* Swollen warm testicles with scrotal erythema
* Fever resolves within 5 days, followed by slower resolution of the orchitis
** Tenderness can sometimes last longer than 2 weeks
* Longterm testicular atrophy in 50%
** If unilateral, no concerns
** If bilateral, sterility is rare, and impotence is not a sequela

=== Mumps oopheritis ===

* In 5% of cases in postpubertal women
* May cause impaired fertility

=== Mumps meningitis ===

* Fever, headache, vomiting, and nuchal rigidity, with an aseptic CSF (lymphocyte-predominant more often than neutrophil-predominant)
** Amylase may be elevated
* Onset usually after parotitis, but can be 1 week before or up to 2 weeks after
* Can also occur without parotitis
* Lasts 3 to 10 days, with complete recovery

=== Mumps encephalitis ===

* Non-focal encephalitis, high fever, altered LOC, seizures, paresis, aphasia, and involuntary movements, with an aseptic CSF
** Fever can be up to 41º C
* Can occur concurrent with or up to 10 days after onset of parotitis
* Early-onset is from virus; late-onset is a postinfectious autoimmune demyelinating disease; but there is likely a continuum between these two extremes
* Gradually resolves over 1 to 2 weeks
* Can cause sequelae, including psychomotor retardation, seizures, and death

=== Other complications ===

* Cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barré syndrome, and poliomyelitis-lik syndrome
* Migratory polyarthritis, usually starting 10-14 days after parotitis and lasting up to 5 weeks
* Pancreatitis
* ECG changes with ST depression and T-wave changes, 1st degree heart block
** Myocarditis is rare

=== Pregnancy ===

* Pregnant women who are infected have increased risk of spontaneous abortion in the first trimester, as well as low birth weight
* Not clearly related to any significant birth defects

== Diagnosis ==

* Traditionally a clinical diagnosis
* CBC and diff are normal or mild leukopenia; amylase may be up from parotitis, or lipase from pancreatitis
* Can be diagnosed with serology or PCR
* ELISA for IgM, or a fourfold rise from acute to convalescent ELISA or HAI serologies, are diagnostic
** HAI may be affected by parainfluenza
* PCR or culture detectable in saliva, though relatively low level after 5 days; also found in CSF
** Can be detected in urine up to 2 weeks after onset

== Management ==

* Symptomatic
* Immune globulin not helpful
* Post-exposure immunization may not be helpful, though in an outbreak situation, may consider giving an MMR booster
* Isolation for 5 days after onset of parotitis to reduce spread
* Reportable disease, public health may do outbreak investigation and consider booster MMR in high-risk populations

== Prevention ==

* Live attenuated vaccine in the MMR is given at 12-15 months and again at 4-6 years
* Vaccine 65-70% effective, so need high vaccination rate to achieve herd immunity
* Titres positive for at least 10 years, but immunity wanes
* Contraindicated in pregnant women