Mumps (parotitis)

SIGIT WIDYATMOKO
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH
SURAKARTA
 Introduction

Mumps is an acute respiratory tract

infectious disease caused by mumps virus
occurs primarily in school-aged children
and adolescents.
The most prominent manifestation is
nonsupurative swelling and tenderness of
the salivary glands with
one or both parotid glands involved in most
cases.
Meningitis, meningoencephalitis,
epididymo-orchitis, oophoritis and
pancreatitis are the common extrasalivary
gland manefestations of mumps.
Mumps (parotitis)

 Inflammation of the salivary glands.

 Mainly the parotid glands are affected.
 There are three pairs of salivary glands.
 Two parotid glands, the largest, one in each cheek, over the
angle of the jaw , in front of the ear.
 Two sub mandibular glands at the back of the mouth.
 Two sub-lingual glands, under the floor of the mouth.
Salivary glands .
Viral etiology

 Caused by mumps virus.

 Family: paramyxoviridae.
 Genus: parainfluenza virus.
 Pleomorphic, enveloped with helical nucleocapsid.
 The viral genome is ss-RNA, with negative polarity.
 The viral envelope is covered with two glycoprotein spikes,
the HN which posses both hemagglutinine and
neuraminidase activities , and the fusion glycoprotein.
Viral etiology

 The fusion protein enables the virus to form

multinucleated giant cell by fusing infected cells together
 Sensitive to ether,ultraviolet and high temperature

 Humans are the only natural host

 Insiden dan Epidemiologi

 Penyebaran virus terjadi dengan kontak langsung,

percikan ludah, bahan muntah, mungkin dengan urin
 Virus dapat diisolasi dari faring dua hari sebelum
sampai enam hari setelah terjadi pembesaran kelenjar
parotis.
 Pada penderita parotitis epidemika tanpa pembesaran
kelenjar parotis, virus dapat pula diisolasi dari faring. V
 Virus dapat ditemukan dalam urin dari hari pertama
sampai hari keempat belas setelah terjadi pembesaran
kelenjar.
 Baik infeksi klinis maupun subklinis menyebabkan
imunitas seumur hidup
 Bayi sampai umur 6 – 8 bulan tidak dapat terjangkit
parotits epidemika karena dilindungi oleh anti bodi yang
dialirkan secara transplasental dari ibunya.
 Insiden tertinggi pada umur antara 5 sampai 9 tahun,
kemudian diikuti antara umur 1 sampai 4 tahun, kemudian
umur antara 10 sampai 14 tahun.5
Transmission

 By inhalation of respiratory droplets, during sneezing and

coughing.
 The virus sheds in saliva.
 Also, the virus can be transmitted by direct contact with
saliva.
 Epidemic features:
Endemic throughout the world.
The peak incidence in winter and spring.
School-aged children at high risk.
Post-infection immunity is stable and long-lasting.
 Mumps Virus

Paramyxovirus

RNA virus

One antigenic type

Rapidly inactivated by
chemical agents, heat and
ultraviolet light
Pathogenesis and Pathology

The virus usually infecting glandular tissue such as

parotid, orchis or oophoron.
The main pathologic findings are nonsupurative
inflammatory reactions.
The meningoencephalitis may involve the Fusion
protein.
Clinical features

 Mumps is a highly infectious child-hood disease.

 IP, about three weeks.
 Mumps starts with moderate fever, malaise, pain on
chewing or swallowing, particularly acidic liquids.
 Followed by inflammation of the salivary glands,
particularly the parotid glands.
 The swelling appears in front of the ear.
Sekali seseorang terpapar virus, gejalanya dapat timbul
14 sampai 24 hari. Gejala awal berupa kedinginan, sakit
kepala, tidak nafsu makan dan kurang tenaga.
Tetapi pada orang yang terinfeksi virus tidak
berpengalaman dengan gejala-gejala ini.
Pembengkakan pada kelenjar liur pada wajah (parotitis)
biasanya timbul 12 sampai 24 jam setelah gejala-gejala
tadi timbul, bersamaan dengan nyeri pada waktu
mengunyah dan menelan terutama pada makanan-
makanan yang rasanya asam seperti lemon
Demam dapat timbul 40oC
Pembengkakan kelenjar mencapai waktu maksimum
pada hari kedua dan menghilang di hari ketujuh.
Sekali seseorang telah terinfeksi mumps, mereka menjadi
kebal terhadap mumps walaupun seberapa ringan atau
berat gejala yang terjadi.
Parotid tenderness and ipsilateral earache
within 1 or 2 days after the llness onset,
then
parotid is visibly enlarged and go to size
over next 2 to 3 days accompanied severe
pain and normal or high temperature. One
parotid enlarges after the other maximum
Other salivary glands involved include
submandibular adenitis and sublingual adenitis
Clinical meningitis occurs in 15% of patients
with mumps. Its onset averages 4-5 days after
parotitis but may before, after or in the absence
of parotitis. Clinical features are headache,
vomiting, fever and nuchal rigidity.
CSF pleocytosis. Prognosis is benign.
The onset of orchitis is abrupt with high
temperature, chills , testicular pain and
swelling. Impaired fertility is rare

ophoritis develops in 5% postpubertal

women with mumps. Impaired fertility
is rare.
Parotitis .
Parotitis .
Complications

 Aseptic meningitis.
 Encephalitis.
 Orchitis, after puberty. Inflammation of one or both
testicles. Usually unilateral , rarely leads to sterility .
 Pancreatitis.
 Oophoritis.
 Thyroiditis.
 •Mumps Complications

CNS involvement• 15% of clinical cases•

Orchitis• 20%-50% in post- pubertal •

males

Pancreatitis• 2%-5%•

Deafness• 1/20,000 •

Death• Average 1 per year (1980 •

– 1999)
 Beberapa komplikasi mumps terjadi lebih sering pada
orang dewasa daripada pada anak-anak.
 Kadang-kadang orkitis terjadi pada 38% kasus di laki-
laki post pubertal. Walaupun frekuensinya sering
bilateral.
 Mastitis pernah dilaporkan sekitar 31% pada pasien
wanita dengan usia lebih dari 15 tahun yang terkena
mumps. Komplikasi lain yang juga jarang adalah ooforitis
dan pankreatitis.
 Mumps pada kehamilan tidak lebih parah dibanding
pada orang dewasa tidak hamil dan tidak terdapat bukti
bahwa virus bersifat teratogenik.
lab diagnosis

 Isolation of mumps virus

 Detection of mumps nucleic acid by PCR
 Serologic testing
 Positive IgM antibody
 Significantincrease in IgG antibody between
acute and convalescent specimens
 Pankreatitis

 Kelainan berat tetapi jarang sekali, tiba-tiba ada keluhan

hebat di epigastrium disertai demam, menggigil, lemah
sekali,nausea dan muntah
 Gejala klinis hilang perlahan – lahan dalam 37 hari,
biasanya sembuh sempurna
 Diagnosis Banding

 parotitis sebab lain, seperti pada infeksi virus termasuk

infeksi virus imunodefisiensi manusia (HIV), influenza,
parainfluenza 1 dan 3, sitomegalovirus, atau keadaan
koksakivirus yang jarang dan infeksi koriomeningitis
limfositik
 Parotitis supuratif, dimana nanah sering dapat
dikeluarkan dari duktus
 Kalkulus salivarius: menyumbat saluran parotis,
atau lebih sering saluran submandibuler
Prevention

 A live attenuated vaccine is available (MMR).

 It contains mumps, measles and rubella attenuated
virus strains.
 Administered in one dose, intramuscularly or
subcutaneously.
 The vaccine is protective.
 History of Mumps Vaccines in US

Mumps virus isolated 1945

Inactivated vaccine developed 1948
Live attenuated vaccine licensed 1967
(Jeryl Lynn strain)
Combined measles- 1971
mumps-rubella vaccine
Routine 1-dose mumps vaccination 1977
Two-dose MMR schedule 1989
 Mumps Vaccine

 Composition Live virus (Jeryl Lynn strain)

 Clinical Efficacy 95% (Range, 90% - 97%)

 Effectiveness 1-dose: 75% - 91%

2-doses: 90%
 Duration of
Immunity Lifelong
 MMR Adverse Reactions

 Fever 5%-15%
 Rash 5%
 Joint symptoms 25%
 Thrombocytopenia <1/30,000 doses
 Parotitis rare
 Deafness rare
 Encephalopathy <1/1,000,000 doses
treatment

 Terapi bersifat simptomatik

 Karena terdapat kesulitan menelan maka sedapat mungkin

membuat pasien tetap dapat makan dan tidak kekurangan cairan.
 Biasanya pasien harus mengkonsumsi diet lunak seperti sereal,
kentang tumbuk, sup, makanan bayi.
 Dapat dipakai Aspirin, asetaminofen atau ibuprofen untuk
menghilangkan klhn bengkak, sakit kepala ,demam
 Haruslah ditanyakan apakah pasien sudah menerima vaksin
mumps, karena vaksin dapat menurunkan titier virus pada
pemeriksaan serologi.
Child care

 The child must rest in bed until the fever goes away.
 Isolate the child, to prevent spreading the disease to
other.
 Use analgesics and anti-pyretic to ease symptoms.
 Avoid food that require chewing.
 Avoid sour foods that stimulate saliva production.
 Drink plenty of water.
 Use cold compress to ease the pain of swelling
glands.