Mumps: The Daily PANCE Blueprint

The answer is A: The first dose of MMR is given at age 12 – 15 months and a second dose at age 4-6 years

Mumps Pearls

Mumps is a viral disease that is part of the paramyxovirus family. It presents with parotitis (painful parotid gland swelling), orchitis, or aseptic meningitis. It is transmitted through respiratory droplets and has an incubation period of 12-14 days

Patient will present as → a 21-year-old male with a 2-day history of malaise and low-grade fever; develops swelling in the lower face bilaterally with the right side more pronounced. He now has a red, swollen duct on the inside of his right lateral mouth. 

• Prodrome of fever, malaise, and anorexia
• Parotid enlargement (usually bilateral but not always synchronous) 24 h later
• Swelling of submaxillary and submandibular glands
• Orchitis (usually unilateral) with testicular enlargement two to three times normal size
• Mumps is the most common cause of pancreatitis in children

Diagnosis

• During an outbreak, a diagnosis can be made by determining recent exposure and parotitis. Usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed
• If there is uncertainty about the diagnosis, a test of saliva or blood may be carried out; a newer diagnostic confirmation, using real-time nested (PCR) technology, has also been developed
• As with any inflammation of the salivary glands, the serum level of the enzyme amylase is often elevated
• CSF demonstrates increased lymphocytes and decreased glucose 

Treatment

• There is no available cure for mumps and treatment is supportive
• Symptoms usually last for 7-10 days and patients are contagious for up to 9 days after onset
• May need to provide scrotal support if painful or swollen testicle (as in case presentation)
• MMR vaccine is given at 12-15 months then again at 4-6 years of age