Mumps

Overview of Mumps:

Mumps is a contagious viral illness and at one time was a very common childhood disease. With the implementation of widespread vaccination, the incidence of mumps in the population has decreased substantially.[2] 

Epidemiology of Mumps:

• Mumps is endemic worldwide with epidemic outbreaks occurring approximately every five years in unvaccinated regions.  
• The mumps virus is highly infectious and transmissible through direct contact with respiratory droplets, saliva, and household fomites.  
• Up to one-third of individuals infected exhibit no symptoms,but are contagious. 
• Introduction of the mumps vaccine in the year 1967 resulted in a 99.8% reduction of documented cases in the United States by 2001.[2] 

Causes

• Mumps virus, a paramyxovirus, is pleomorphic and has a diameter ranging from 100 to 300 nm. The virion is composed of RNA and seven proteins.[1] 
• Nucleoprotein, phosphoprotein, and polymerase together with the genomic RNA replicate the virus forming the ribonucleocapsid.  
• A host-derived lipid bilayer surrounds the ribonucleocapsid. Within this lipid bilayer are viral neuraminidase and fusion proteins which allow cell binding and entry of the virus.[2] 

Risk factors

• Immunodeficiency state 
• International travel  
• Lack of vaccination [2]

Pathogenesis of mumps

"The virus is acquired by respiratory droplet transmission. It replicates in the nasopharynx and regional lymph nodes. During viremia, the virus spreads to multiple tissues, including the meninges, salivary glands, pancreas, testes, and ovaries."

This means that the mumps virus enters the body through the respiratory tract, multiplies in the nose and throat, and then spreads through the bloodstream to various organs, causing the characteristic symptoms of the disease. [4]

Pathophysiology of Mumps:

Mumps virus is transmitted by droplet nuclei, saliva, and fomites. 

•  Replication of the virus in the epithelium of the upper respiratory tract leads to viremia, which is followed by infection of glandular tissues and/or the central nervous system (CNS).[1] 

Types

There is only one type of mumps, caused by the mumps virus, a member of the paramyxovirus family. However, the severity and presentation of mumps can vary from person to person.

While some individuals may experience mild or no symptoms, others may develop more severe complications such as orchitis (inflammation of the testicles) or meningitis (inflammation of the membranes surrounding the brain and spinal cord).

[5][6]

Clinical Features

The clinical features of mumps can vary in severity, from asymptomatic infection to severe complications. The most common presentation is acute onset of unilateral or bilateral parotid gland swelling, accompanied by pain and tenderness. Other salivary glands may also be involved.

Additional clinical features may include:

• Prodromal symptoms: Low-grade fever, malaise, headache, myalgia, and anorexia may precede parotitis by 1-2 days.
• Systemic manifestations: Fever, fatigue, and muscle aches are common.
• Complications: Orchitis (inflammation of the testicles), oophoritis (inflammation of the ovaries), meningitis, encephalitis, pancreatitis, and hearing loss can occur less frequently. [7]

Sign & Symptoms of Mumps:

• Fever, malaise, myalgia, and anorexia 
• Parotitis develops within next 24 hours, it is generally bilateral, although the onset on the two sides may not be synchronous and at times only one side is affected. 
• Swelling of the parotid is accompanied by tenderness and obliteration of the space between the ear lobe and the angle of the mandible. 
• The patient frequently reports an earache and finds it difficult to eat, swallow, or talk. Glandular swelling increases for a few days and then gradually subsides, disappearing within a week. 
• Orchitis is the most common manifestation of mumps among post pubertal males, developing in about 20% of cases. The testis is painful and tender and is enlarged to several times its normal size; accompanying fever is common. 
• Aseptic meningitis, which may develop before, during, after, or in the absence of parotitis, is a common manifestation of mumps in both children and adults. Symptoms include stiff neck, headache, and drowsiness. 
• Other CNS problems occasionally associated with mumps include cerebellar ataxia, facial palsy, transverse myelitis, Guillain-Barre´ syndrome, and aqueductal stenosis leading to hydrocephalus. 
• Other unusual complications of mumps include myocarditis, mastitis, thyroiditis, nephritis, arthritis, and thrombocytopenic purpura. An excessive number of spontaneous abortions are associated with gestational mumps when the disease occurs during the first trimester.[1] 

Clinical Examination of Mumps

The clinical examination of mumps primarily focuses on the assessment of the parotid glands and other potentially affected areas. Here’s a breakdown of the key aspects:

1. Inspection:

   • Look for swelling and erythema of the parotid glands, which are located in front of and below the ears. The swelling is usually bilateral but can be unilateral.
   • Observe for redness and swelling around the Stensen’s duct (the opening of the parotid gland) on the inner cheek.
   • Check for other salivary gland involvement (submandibular and sublingual glands).

2. Palpation:

   • Gently palpate the parotid glands for tenderness, warmth, and consistency. The glands are usually tender and doughy in consistency.
   • Assess for fluctuation, which may indicate the presence of an abscess.
   • Palpate the other salivary glands for any signs of inflammation.

3. Additional assessment:

   • Evaluate for signs of complications such as orchitis (testicular pain and swelling), oophoritis (ovarian pain and tenderness), meningitis (neck stiffness, headache, photophobia), or pancreatitis (abdominal pain).
   • Assess for cranial nerve involvement, especially the facial nerve, as mumps can rarely cause facial paralysis. [8]

Diagnosis

• It is made based on the presence of acute bilateral parotitis and a history of recent exposure with the disease, but when parotitis is unilateral or absent or when sites other than the parotid gland are involved, laboratory diagnosis may be required.[1] 

Differential Diagnosis of Mumps 

• Ductal obstruction due to stones or strictures 
• Parotid cyst  
• Parotid tumour 
• Aseptic Meningitis  
• Testicular torsion 
• Coxsackievirus infection 
• HIV infection [1] 

Complications of Mumps

While mumps is typically a mild illness, it can lead to several complications, particularly in unvaccinated individuals or those with weakened immune systems.

Common Complications:

• Orchitis: Inflammation of one or both testicles, occurring in about 20-30% of post-pubertal males. It can cause testicular pain, swelling, and tenderness. In rare cases, it can lead to testicular atrophy and infertility.
• Oophoritis: Inflammation of the ovaries, causing pelvic pain, tenderness, and fever.
• Meningitis: Inflammation of the meninges (membranes surrounding the brain and spinal cord), leading to headache, fever, stiff neck, and sensitivity to light.
• Pancreatitis: Inflammation of the pancreas, resulting in abdominal pain, nausea, vomiting, and fever.
• Hearing loss: Sensorineural hearing loss can occur, usually unilateral and often permanent.

Less Common Complications:

• Encephalitis: Inflammation of the brain, causing confusion, seizures, and even coma.
• Myocarditis: Inflammation of the heart muscle, leading to chest pain, shortness of breath, and palpitations.
• Arthritis: Joint inflammation, causing pain, swelling, and stiffness.

Rare Complications:

• Mastitis: Inflammation of the breast tissue.
• Thrombocytopenia: Low platelet count.
• Death: Although rare, death can occur due to severe complications like encephalitis. [9]

Investigations for Mumps

• Reverse transcriptase-polymerase chain reaction (RT-PCR)  
• Serum IgM & IgG antibodies. 
• Virus culture from oral secretions, urine, blood, and cerebrospinal fluid (CSF).[2] 

Treatment

• The administration of analgesics and the application of warm or cold compresses to the parotid area may be helpful. 
• Testicular pain may be minimized by the local application of cold compresses and gentle support for the scrotum.  
• Anaesthetic blocks may also be used.[1] 

Prevention of Mumps

• Live attenuated mumps vaccine (Jeryl Lynn strain) given subcutaneously induces antibodies that protect the recipient against infection in more than 95% of cases. 
• Mumps vaccine is usually administered as part of the measles-mumps-rubella (MMR) vaccine at the age of 12 to 15 months and again at 4 to 12 years of age.[1] 

Homeopathic Treatment of Mumps

• Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

• The medical history of the patient, 
• Physical and mental constitution, 
• Family history, 
• Presenting symptoms, 
• Underlying pathology, 
• Possible causative factors etc. 

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?  The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.  The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Mumps: 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.  So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath). 

Bar-c.

In the case of scrofulous person, when other glands are swollen at the same time; when glands grow. Glands around ears painful and swollen. Affects right ear and right parotid most 

Bell..

Swelling bright red and hot, esp, on right side, or when swelling suddenly disappears, resulting in brain troubles, such as delirium, unconsciousness, etc. Stitches extend into ears.

Bryon.

When swelling suddenly disappears and alarming brain symptoms ensue.

Merc-s.

Swelling is pale; jaws are stiff; tongue flabby, takes the imprint of teeth. Salivary glands swollen and painful. Profuse salivation.

Phyto.

Parotid and submaxillary glands swollen. Violent cases with difficult swallowing. Fetid breath.

Rhus-t.

Swelling and inflammation of parotids with fever; swelling is dark red; left side particularly affected; or left side is more affected than right. Suppuration of parotids. Inflammation has an erysipelatous character.

Arsen.

Mumps associated with fever, measles. small-pox. Of a malignant type. Paroxysmal and unbearable pain. (Author) Anxious restlessness.

Carb-v.

When swelling does not subside, but grows harder. Hoarseness.[3] 

Diet & Regimen

The diet and regimen for mumps primarily focus on managing the symptoms and promoting comfort while the body fights off the infection. Here are some recommendations:

Diet:

• Soft, bland foods: Opt for foods that are easy to chew and swallow, as chewing can be painful due to swollen glands. Soups, broths, mashed potatoes, yogurt, applesauce, and cooked cereals are good options.
• Liquids: Stay hydrated by drinking plenty of water, clear broths, and electrolyte drinks. Dehydration can worsen symptoms and hinder recovery.
• Avoid acidic foods and drinks: Citrus fruits, juices, and other acidic foods can irritate the salivary glands and exacerbate pain.
• Small, frequent meals: Eating smaller meals more frequently can help ensure adequate nutrition without overwhelming the digestive system.
• Avoid spicy and salty foods: These can irritate the throat and worsen discomfort.

Regimen:

• Rest: Adequate rest is crucial for allowing the body to fight the infection and recover.
• Pain relief: Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage fever and discomfort. Consult a doctor for appropriate dosage and usage.
• Cold or warm compresses: Applying cold or warm compresses to swollen glands can help reduce pain and inflammation.
• Isolate: Mumps is highly contagious, so it’s important to isolate yourself from others to prevent the spread of the virus.
• Oral hygiene: Maintaining good oral hygiene can help prevent secondary infections. Use a warm salt water rinse to soothe the mouth and throat.

Additional tips:

• Gargle with warm salt water: This can help soothe a sore throat and reduce inflammation.
• Elevate the head: Sleeping with the head elevated can help reduce swelling and discomfort.
• Avoid strenuous activity: Restrict physical activity until symptoms subside.

Do’s & Don’ts 

Mumps do’s & dont’ts 

Do’s:

• Do get vaccinated: The MMR (measles, mumps, rubella) vaccine is the best way to prevent mumps. It is safe and effective.
• Do stay hydrated: Drink plenty of fluids to prevent dehydration, which can worsen symptoms.
• Do eat soft, bland foods: Stick to foods that are easy to chew and swallow, like soups, mashed potatoes, and yogurt.
• Do rest: Get plenty of rest to help your body fight off the infection.
• Do take over-the-counter pain relievers: Acetaminophen or ibuprofen can help manage fever and pain.
• Do apply cold or warm compresses: This can help reduce swelling and discomfort in the affected glands.
• Do practice good hygiene: Wash your hands frequently and cover your mouth and nose when coughing or sneezing.
• Do isolate yourself: Mumps is highly contagious, so stay home from work or school and avoid contact with others until at least five days after the onset of symptoms.

Don’ts:

• Don’t eat acidic or spicy foods: These can irritate the salivary glands and make the pain worse.
• Don’t drink acidic beverages: Avoid citrus juices, sodas, and other acidic drinks.
• Don’t share utensils or personal items: This can spread the virus to others.
• Don’t participate in strenuous activities: Restrict physical activity until you have fully recovered.
• Don’t give aspirin to children or teenagers: Aspirin has been linked to Reye’s syndrome, a rare but serious illness, in children and teenagers recovering from viral infections.

Terminology

• Mumps: An acute viral illness caused by the mumps virus, characterized by fever, swelling, and tenderness of one or more salivary glands, usually the parotid glands.
• Parotitis: Inflammation of the parotid gland, the largest salivary gland located in front of and below the ear. This is the hallmark symptom of mumps.
• Orchitis: Inflammation of one or both testicles, a common complication of mumps in post-pubertal males.
• Oophoritis: Inflammation of the ovaries, a less common complication of mumps in females.
• Meningitis: Inflammation of the meninges, the membranes surrounding the brain and spinal cord. Mumps can cause aseptic meningitis, which is usually less severe than bacterial meningitis.
• Encephalitis: Inflammation of the brain, a rare but serious complication of mumps.
• Pancreatitis: Inflammation of the pancreas, another potential complication of mumps.
• MMR vaccine: The measles, mumps, and rubella vaccine, which is highly effective in preventing mumps.
• Incubation period: The time between exposure to the virus and the onset of symptoms, typically 16-18 days for mumps.
• Prodrome: The initial period of illness, characterized by non-specific symptoms like fever, headache, muscle aches, and fatigue.
• Contagious period: The period during which an infected person can transmit the virus to others, typically from a few days before to a few days after the onset of parotitis.
• Isolation: The separation of infected individuals from healthy individuals to prevent the spread of the virus.
• Herd immunity: The indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune.

Some commonly used homeopathic remedies for mumps include:

• Belladonna: For sudden onset with high fever, red face, throbbing pain, and sensitivity to light and noise.
• Mercurius solubilis: For swollen glands with excessive salivation, bad breath, and a tendency to sweat profusely.
• Phytolacca: For hard, painful glands with a feeling of rawness and shooting pains.
• Pulsatilla: For shifting symptoms, changing moods, and a desire for company and consolation.
• Rhus toxicodendron: For restlessness, stiffness, and pain that is worse on initial movement but better with continued motion.

Reference 

1] Harrison’s Principles of Internal Medicine 16th Edition

[2] Mumps – StatPearls – NCBI Bookshelf (nih.gov) 

[3] The Homoeopathic Prescriber by K. C. Bhanja

[4] Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases" (14th Edition, 2021) by the Centers for Disease Control and Prevention (CDC)

[5] Mumps: Methods and Protocols (Methods in Molecular Biology) 1st Edition, by Paul Yeo (Editor), W. Paul Duprex (Editor), 2018.

[6] Vaccines 6th Edition, by Stanley A. Plotkin (Editor), Walter A. Orenstein (Editor), Paul A. Offit (Editor), 2012.

[7] Harrison’s Principles of Internal Medicine 21st Edition, by Dennis L. Kasper (Editor), Anthony S. Fauci (Editor), Stephen L. Hauser (Editor), Dan L. Longo (Editor), J. Larry Jameson (Editor), Joseph Loscalzo (Editor), 2022, McGraw Hill Medical.

[8] Ferri’s Clinical Advisor 2024: 5 Books in 1 by Fred F. Ferri, 2023, Elsevier.

[9] Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases 9th Edition, by John E. Bennett (Editor), Raphael Dolin (Editor), Martin J. Blaser (Editor), 2020, Elsevier.

Also Search As

Online Resources:

• Homeopathic websites: Several websites specialize in homeopathic information. These websites often have articles, blogs, or forums discussing mumps and its homeopathic treatment.
• Homeopathic journals and publications: Many peer-reviewed journals and publications focus on homeopathy.
  
  Searching their databases using keywords like "mumps" and "homeopathy" can yield relevant articles.
• Online bookstores: Online bookstores like Amazon often have books on homeopathic treatment of various illnesses, including mumps.

Offline Resources:

• Homeopathic libraries: Many cities have homeopathic libraries that house a collection of books and journals on homeopathy. These libraries can be a valuable resource for finding information on mumps.
• Homeopathic practitioners: Consulting a qualified homeopathic practitioner can provide personalized advice and information on the homeopathic treatment of mumps.

There are several ways to search for information on mumps, depending on the type of information you are looking for and your preferred method of research.