Definition

Parotitis, or mumps, is a viral infection that affects the parotid glands, which are salivary glands located in front of and below the ears. This infection typically leads to swelling of one or both sides of the face.

Mumps is highly contagious and spreads through direct contact with respiratory droplets, saliva, and shared household items. While mumps primarily affect children, they can occur in individuals of all ages. The majority of cases occur during late winter and early spring in regions with distinct seasons. However, the widespread implementation of vaccination has significantly reduced the incidence of mumps in communities globally.

Causes

Parotitis is caused by a virus belonging to the family of Paramyxoviruses. This virus is primarily responsible for infections, particularly in children. The virus can spread through the air by:

• Infected individuals coughing or sneezing, releasing droplets of contaminated saliva that can be inhaled by others.
• Infected individuals touch their nose or mouth and then touch objects, such as doorknobs or surfaces, which can transfer the virus to others who touch these objects.
• Sharing household items such as cups, spoons, forks, or plates with an infected person can also lead to transmission.

People infected with parotitis are most contagious from several days before the parotid glands swell until several days after. Due to this, it is recommended to avoid workplaces or schools for 5 days after symptoms appear if diagnosed with parotitis. It's important to note that parotitis can also be transmitted by infected individuals without clear symptoms.

Once contracted, the virus moves from the respiratory tract (nose, mouth, and throat) to the parotid glands, causing them to swell. The virus can also enter the cerebrospinal fluid, which surrounds and protects the brain and spinal cord, leading to potential spread to other parts of the body such as the brain, pancreas, testicles (in males), and ovaries (in females).

Risk factor

The general risk factors for contracting mumps include:

• Contact with individuals who have already been infected
• Absence of a history of immunization against Paramyxoviruses
• History of traveling to endemic areas where mumps is prevalent
• Weakened immune system conditions, such as HIV/AIDS, or as a result of medication consumption can affect the body's immune system

Symptoms

In some individuals with parotitis, symptoms may not manifest or may only present mildly. Symptoms typically arise approximately two weeks after exposure to the virus. Initially, flu-like symptoms may occur, including:

• Swelling of the parotid gland: This swelling may be noticeable in the cheek area around the lower ear and jaw, potentially affecting one or both sides of the face. The swelling may not occur all at once and may appear intermittently
• Pain in the swollen glands, particularly when chewing or swallowing food
• Fatigue
• Muscle aches
• Headaches
• Loss of appetite
• Fever

Diagnosis

In diagnosing parotitis, the doctor will conduct a medical interview to inquire about symptoms such as swelling around the cheek and ear area, fever, pain, headaches, and physical fatigue. Additionally, they will ask about any potential risk factors, such as incomplete vaccination history and contact with individuals suffering from parotitis.

Following the interview, the doctor will perform a physical examination, focusing on the parotid glands, to assess swelling and tenderness upon palpation. Under normal circumstances, the parotid glands cannot be palpated during examination. However, in cases of parotitis, the swelling allows for palpation.

Typically, clinical examination is sufficient for diagnosing parotitis and does not necessitate further testing. Laboratory tests and examinations involving virus cultivation for diagnosing parotitis are rarely performed.

Management

Generally, parotitis is a self-limiting disease, meaning it can be cured by the body's immune system attacking the causing virus. Antibiotics are ineffective against viral diseases. Treatment for parotitis primarily focuses on relieving symptoms until the immune system eliminates the infection. Currently, there is no specific medication to kill the virus causing parotitis. The infection typically resolves within one to two weeks. Meanwhile, these steps can help alleviate symptoms:

• Get plenty of bed rest until the symptoms disappear.
• Take over-the-counter pain relievers such as Ibuprofen or Paracetamol to alleviate pain and fever.
• Drink plenty of fluids, but avoid acidic beverages like fruit juice as they can irritate the parotid glands; water is the best fluid to drink.
• Apply warm or cold compresses to the swollen glands to help reduce pain.
• Eat easily chewable foods, such as soup or porridge.

Infected individuals are typically not contagious to others and can return to work or school around 5-7 days after the onset of the disease. Most people who have been infected before cannot be reinfected because their immune system has already developed protection against the virus.

Complications

Complications of mumps are rare but can be potentially dangerous, as the virus can cause inflammation and swelling in various parts of the body. Some of the complications include:

• Orchitis: This is inflammation of the testicles, which can lead to one or both testicles swelling and pain. While infertility is a rare complication, it can occur.
• Encephalitis: This is inflammation of the brain, which can result in neurological problems and life-threatening conditions.
• Meningitis: Inflammation of the membranes and fluid surrounding the brain and spinal cord can occur if the virus spreads through the bloodstream to infect the central nervous system.
• Pancreatitis: Inflammation of the pancreas may manifest with symptoms such as upper abdominal pain, nausea, and vomiting.
• Hearing impairment: Although rare, mumps can cause hearing impairment in one or both ears. In some cases, this impairment may be permanent.
• Heart disorders: While uncommon, mumps has been associated with abnormal heart rhythms and heart muscle disease.
• Miscarriage: Women who contract mumps, especially in early pregnancy, may be at risk of miscarriage.

Prevention

The most effective way to prevent mumps is through vaccination. The majority of individuals develop immunity to mumps after receiving the full dose of the vaccine. Typically, the mumps vaccine is administered as part of the measles-mumps-rubella (MMR) vaccine. It is recommended that children receive two doses of the MMR vaccine before entering school, with the first dose given at 12-15 months of age and the second dose at 4-6 years of age. A single dose may not provide complete protection against mumps, so two doses are necessary for optimal immunity. While a third dose is not routinely recommended, a healthcare provider may suggest it in areas experiencing a mumps outbreak.

In addition to vaccination, there are several measures to reduce the spread of mumps if you have the disease:

• Stay home from school or work until at least 5 days after the onset of symptoms.
• Practice good hand hygiene by washing your hands regularly with soap and water.
• Cover your mouth and nose with a tissue when coughing or sneezing, and promptly dispose of the tissue in a waste bin.
• Avoid touching surfaces after coughing or sneezing to prevent the spread of respiratory droplets.

When to see a doctor?

It's important to consult a doctor if you or your child experience signs and symptoms of parotitis. While parotitis is typically not a serious condition, its symptoms can resemble those of more severe infections, such as tonsillitis. Therefore, a proper examination by a healthcare professional is necessary to accurately diagnose parotitis and rule out other potential causes of the symptoms.

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