What Are the Symptoms of Mumps In Adults?

Recurrent parotitis in adults was first proposed by Mandel in 1976. The author collectively referred to recurrent parotitis in adults as recurrent parotitis to distinguish it from recurrent parotitis in children. Wang Songling, Zou Zhaoju et al. (1989) suggested that the diagnosis of recurrent mumps in adults should be limited to children with recurrent mumps that do not heal before puberty and continue to swell into the adult parotid glands to distinguish them from other types of adult parotid swelling.

Recurrent Mumps in Adults

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Recurrent parotitis in adults was first proposed by Mandel in 1976. The author collectively referred to recurrent parotitis in adults as recurrent parotitis to distinguish it from recurrent parotitis in children. Wang Songling, Zou Zhaoju et al. (1989) suggested that the diagnosis of recurrent mumps in adults should be limited to children with recurrent mumps that do not heal before puberty and continue to swell into the adult parotid glands to distinguish them from other types of adult parotid swelling.

Western Medicine Name

Recurrent Mumps in Adults

English name

recurrent parotitis in adults

The main symptoms

Repeated swelling of both parotid glands

Diet health

Mostly light food, pay attention to diet

All patients have a history of repeated swelling of the parotid glands in childhood. Each swelling lasts for about 1 week. With the increase of age, the number of swelling attacks decreases and the duration shortens. In adulthood, swelling attacks usually occur after a cold or general fatigue. A typical case reported in China was a 35-year-old woman who reported swelling of both parotid glands after a cold that lasted 3 to 4 days. In patients with a history of illness, between 100 days and 10 years after birth, the parotid glands repeatedly swelled, and they occurred about 10 times a year for 7 to 10 days; 10 to 15 years old, swelling 3 to 5 times a year for about 1 week; 15 years old The right parotid angiography in the outer hospital showed a large number of peripheral ductal points and spherical expansion (point expansion). The parotid gland swelled after a cold for more than 15 to 35 years, and lasted for 3 to 4 days. At the age of 35, the right parotid angiography showed a small number of dots and spherical Dilation, but significantly reduced; 38-year-old return to the clinic for 3 years without clinical symptoms, the parotid angiography point and spherical expansion completely disappeared, and healed on the angiography.

Because the disease tends to increase with age, self-relieving, and healing, the conservative treatment and symptomatic treatment are the principles in the treatment. The main measures include: Persistence of daily massage before and after eating, sleep before and after massage from both parotid glands, squeezing, and promote saliva outflow. Oral saliva-stimulating agents, such as fruity vitamin C, can make saliva flow out through taste stimulation to prevent retrograde infection. Parotid angiography has not only a diagnostic effect but also a therapeutic effect. Galili (1986) reported that parotid angiography has a therapeutic effect. In this group of data, the frequency of attacks was 2 to 20 times / year before re-examination within 5 years. There was no other treatment for 1 year after parotid angiography. 9/23 cases of swelling within 1 year, up to 2 times / year. One week was shortened to 2 to 3 days. Although there is no strict pairing comparison, judging from the comparison of the children's own parotid angiography before and after, the swelling episodes did decrease significantly after parotid angiography, which may be related to the anti-inflammatory effect of iodine contrast agents and the expansion of the catheter. For those with frequent swelling attacks, consider injecting a small amount of 40% iodized oil regularly for about six months. Enhance the whole body constitution, especially the whole body immunity. Some scholars believe that the body fluid and cellular immune deficiency of the disease, it is recommended to use immunomodulators, such as intramuscular injection of thymosin in children with frequent swelling. In the onset of swelling, in addition to adherence to the above self-conservative treatment, fever patients should be treated with antibiotics for anti-infective treatment.

1, mostly light food, pay attention to diet rules.

2. Eat a reasonable diet based on your doctor's recommendations.

There are no effective preventive measures for this disease. Pay attention to the details of life. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Blatt (1964) reported that children and adults with recurrent mumps and Shegren Syndrome (SS) have similar tissues and consider them to be autoimmune diseases. Children and adults with recurrent mumps are an incomplete manifestation of SS.

The disease needs to be distinguished from Sjogren's syndrome (SS) subclinical type, SS secondary parotid infection and chronic obstructive mumps.

1.SS subclinical Wang Songling, Zou Zhaoju, etc., conducted long-term follow-up observations of 22 cases of mumps in adults (Table 1). At the initial diagnosis, 22 patients had recurrent swelling of the parotid gland of unknown origin, no dry mouth and dry eyes. The ink application test was normal, and the distal film ducts and spherical expansion were found in the films. Follow-up observations revealed that 12 children who had no history of repeated parotid swelling during childhood had obvious symptoms of dry mouth and dry eyes. The Smolt test and the total saliva rate were lower than normal. The parotid glands in these patients repeatedly swelled, appearing 1.5 to 14 years before dry mouth and dry eyes, with an average of 5.2 years. Six of them detected their own immune antibodies, such as antinuclear antibodies and rheumatoid factor. In 8 cases of parotid angiography, 6 cases had exacerbations (for example, only spot-like dilatation to spherical dilatation and changes in the main catheter at the initial diagnosis), and 2 cases had no changes. Of these 12 cases, only 2 cases were associated with rheumatoid arthritis, and secondary SS was considered, and the remaining 10 cases were primary SS. Another 10 patients with a history of repeated parotid swelling in childhood did not have any discomfort at the time of follow-up, neither had dry mouth or dry eyes. The Smog test and the total saliva flow rate were normal. Follow-up observation of parotid angiography showed that the dilatation of the peripheral duct disappeared in one case. Significant reductions were seen in 4 cases and no changes were found in 2 cases. None developed SS.

Patients with SS had dry mouth, dry eyes, and connective tissue disease before they developed the three elements of parotid gland. The parotid gland swelled and pus repeatedly. The angiography also showed peripheral duct points and spherical expansion. Due to repeated swelling of the parotid glands, and no symptoms such as dry mouth and dry eyes, these patients cannot be diagnosed as SS according to the currently recognized diagnostic criteria for SS. They are often diagnosed as chronic suppurative mumps, and dry mouth and eyes appear after several years Dry symptoms. Domestic scholars suggest to call it SS subclinical. These patients are more common in middle-aged women and account for about 10% of total SS patients. SS subclinical and recurrent mumps in adults constituted a major part of adenitis in previously chronic suppurative mumps. The nature of the two is different. The former is an autoimmune disease and the latter is an inflammatory disease. The main points for distinguishing between the two are: The former has no childhood swelling of the parotid glands, while the latter has. The former serum immunological tests such as anti-SSA, SSB, anti-nuclear antibodies can be positive, the latter are mostly negative. Follow-up observation, the former gradually appeared with dry mouth, dry eyes and other symptoms with age. The total saliva flow rate and the ink application test decreased, and gradually developed to complete SS. The number of parotid swelling did not change or worsened, and the parotid angiography may be aggravated. Or unchanged. The latter increases with age, reduces the number of symptoms, and shortens the duration. The parotid angiography of the parotid angiography is reduced to disappear, showing a tendency of self-remission.

2. SS secondary parotid gland infection. SS patients have repeated swelling of the parotid gland after dry mouth, dry eyes, and connective tissue disease. Identification is not difficult. When the patient complains of repeated swelling of the parotid gland, ask about dry mouth, dry eyes, arthritis Wait for the medical history, and do objective examinations such as dry mouth and dry eyes, serum immunological examination, parotid angiography and labial gland biopsy. It is not difficult to diagnose according to recognized SS diagnostic criteria.

3. Chronic obstructive mumps. Partial chronic obstructive mumps. The swelling of the parotid glands is not typical of food swelling. In addition to the expansion of the main duct on the parotid angiography, with the point-like expansion of the peripheral duct, it is also easy to be confused with adult recurrent mumps. Identification points: Chronic obstructive mumps does not have a history of repeated swelling of the parotid glands in childhood, and the point-like expansion occurs after the main catheter spreads to the branch duct on the radiography, without exception. In addition to childhood medical history of recurrent mumps in adults, only the peripheral dilatation of the distal catheter or the dilatation of the primary duct with mild main duct dilatation is shown on the angiogram. There is no branch dilatation and dilatation between the interleaf and interleaflet.

Laboratory inspection:

A group of domestic data reported that the total saliva flow rate of chewing ash from 30 patients was examined, 29 within the normal range (6ml / 6min), and 1 patient with hypoparathyroidism was 1ml / 6min. The ink application test of 30 patients, 26 cases were normal (1.0cm / 5mm), 4 cases were less than 1.0cm / 5min. There are obvious trachoma. Eighteen patients had peripheral blood tests: protein electrophoresis and rheumatoid factor were normal. Three patients were positive for antinuclear antibodies, including one with nephritis.

Other auxiliary checks:

Parotid angiography manifestations: 32 of the 35 cases had bilateral parotid swelling, and bilateral parotid angiography showed peripheral ductal points and globular expansion; 3 cases of unilateral parotid swollen angiography showed swollen dots with spherical expansion; the non-swollen side had normal morphology and delayed function .

Zou Zhaoju and Wang Songling performed follow-up observations on 35 patients for 0.5 to 23 years, with an average of 8.5 years. Of these 35 cases, 9 cases were diagnosed as mumps in a foreign hospital, 7 cases were chronic suppurative mumps, and 1 case was early in SS. The others were diagnosed in our hospital. The absence of seizures for more than two years was considered to be clinically cured. At the time of review, 35 patients had clinical recovery and 13 patients had symptoms. The upper point and spherical expansion of the parotid angiography disappeared, and the glands returned to normal. At the time of reexamination, parotid angiography showed that 11 cases were cured, and 24 cases were still dilated and spherical. The age at which the symptoms disappeared ranged from 8 to 38 years, with an average of 18 years. On the radiography, healed from 16 to 38 years old, with an average of 23 years old. Healing on angiography occurred several years after clinical healing, and a set of domestic statistics about 5 years. Three patients with anti-nuclear antibody positive at the time of initial follow-up were observed for 9 to 10 years. Two patients had completely recovered clinically and angiographically. Dry mouth and dry eyes were normal. Antinuclear antibodies turned negative. The other patient was associated with chronic nephritis, and the clinical and angiographic findings were recovered during the review, but the antinuclear antibody was still positive. In 35 patients who underwent angiographic review, it was found that in 3 patients except for the spot-shaped expansion at the initial diagnosis, the main duct was dilated and showed chronic obstructive mumps. One case was associated with negative stones, which was thought to be related to the delayed retention of saliva.

Hemenway (1971) reported a case of repeated swelling of the parotid glands from the age of 8 years, and radiation of the right parotid glands, parotid biopsy, catheter ligation, and superficial lobectomy of the right parotid glands at the age of 11-15 years. Epithelial hyperplasia of the inner duct, scattered infiltration of lymphocytes. Watkin (1986) reported 8 children and 22 adults with recurrent parotitis or spotted parotitis with labial or buccal biopsy, all of which had lymphocytic infiltration and glandular atrophy, but 20 of them had insufficient lesions to diagnose SS. There was no significant difference in the histology of recurrent parotitis in children and adults. A 29-year-old patient's tissue and ultramicropathological manifestations. The patient repeatedly swollen his parotid glands more than 10 times at the age of 8 to 14 years, each lasting for 1 week. After 14 years of age, his cheeks swelled only occasionally after a cold. The parotid gland is slightly enlarged and the right parotid gland is swollen. The examination showed mild swelling of the parotid gland, the squeezed secretion solution was clear, the ink application test was normal (3cm / 5min left, 1.5cm / 5min right), the total saliva flow rate of chewing white wax was 10ml / 6min, and no abnormalities were found in the laboratory tests including antinuclear antibodies negative. Double parotid angiography showed scattered spot and spherical expansion (Figure 2). Histopathology of the right parotid gland showed an increase in acinar volume with many vacuoles, disappearance of secreted particles at the top of the cytoplasm of acinar cells, and expansion of the interlobular and intralobular ducts ( Figure 3), pathological report of degeneration of parotid glands. Electron microscopy showed that part of the epithelial cells in the excretory tube disappeared and were replaced by collagen fibers. Partially visible main duct epithelial cells were connected by desmosomes, mitochondria expanded in the cytoplasm, and medium electron density in the lumen of the rough endoplasmic reticulum on both sides of the nucleus. Granular deposits. The fibrous tissue of the tube wall was partially denatured. The acinar cells are arranged normally, and there are desmosome connections between the acinar cells. It can be seen that small finger-like cytoplasmic processes protrude into the intercellular space and form a chimera with the cytoplasmic processes of adjacent cells. There are a large number of vacuoles in the cytoplasm, with different sizes and irregular shapes, and some can be fused into pieces. Some of the vacuoles are uniformly low electron density, and some are medium electron density. Most of the cytoplasm has reduced organelles and visible mitochondria. expansion. Part of the nucleus shrinks. The intralobular ducts dilate, the microvilli protruding into the cavity are reduced, and the epithelium becomes flat. Increased intercellular space. The nucleus of myoepithelial cells is triangular, the nuclear membrane is clear, and there are a few mitochondria in the cytoplasm. Muscle filaments are clearly visible. The thickness of the base film is uniform. The collagen fibers between the acinus and the duct were partially degenerated and the structure was unclear. Both histopathology and ultramicropathology are characterized by the degeneration of the glands, which may be related to chronic chronic inflammation in the glands.