What Are the Symptoms of Mumps In Children?

Mumps in children is an acute respiratory infectious disease caused by the mumps virus, which has a worldwide distribution. It belongs to the legal category C infectious disease in China, and it can occur throughout the year, with peaks in winter and spring. It is more common in children and is distributed or epidemic. Outbreaks can occur in collective child institutions. Clinically, it is characterized by acute non-purulent swelling of salivary glands, often accompanied by meningitis, pancreatitis, and orchitis. There is no special treatment drug, and symptomatic treatment is mainly adopted.

Basic Information

English name: children mumps
Visiting department: Pediatrics
Multiple groups: child

Common locations: Parotid gland
Common causes: Mumps virus
Common symptoms: Fever, local parotid redness, swelling, heat, pain
Contagious: Have

Causes of mumps in children

The pathogen is mumps virus with a diameter of about 90 to 135 nm. It is an RNA virus and belongs to paramyxovirus. This virus has V antigen (virus antigen) and S antigen (soluble antibody). S antibody can appear in the patient's body within 1 week after infection. It reaches a peak within 2 weeks and then gradually decreases. This antibody can persist for 6 to 12 months. Does not have immune protection. V antibody appears late, can be measured 2 to 3 weeks after the disease, reached a peak in 4 to 5 weeks, can still be detected after 2 years, this antibody has immunoprotective effect on children.

The virus can be killed in ethanol, methanol, 1% Lysin solution for several minutes, and it can quickly die when exposed to ultraviolet rays. It can survive longer under freezing conditions, -45 can survive for 9 months, 4 can maintain vitality for 2 months, and can only survive at 37 for 24 hours. The virus can also be proliferated in the amniotic cavity of chicken embryos and various tissues (humans and monkeys). Under certain conditions, it can agglutinate with red blood cells of dolphins, chickens, and sheep.

There are increasing reports that other viruses can also cause acute mumps. Such as Group A Coxsackie virus (Howlett in 1957), Parainfluenza virus (Zollar in 1970), Herpes simplex virus (Coffin in 1975), Influenza A virus (Stuart in 1977), Japanese Encephalitis virus (Duan Shucheng in 1981), etc . In 1995 Du Weibo et al reported that 42 cases of mumps caused by coxsackie virus.

Clinical manifestations of mumps in children

Incubation period

It is 2 to 3 weeks, with an average of 18 days.

2. Prodromal performance

The prodromal period is short, ranging from several hours to 1-2 days. Fever, loss of appetite, general weakness, headache, vomiting, etc. A small number of children with early meningitis may have meningeal irritation.

3. Parotid enlargement

The parotid swelling precedes one side, and then the other side also swells. There are also cases where only one side is enlarged or the parotid glands are not enlarged. The swelling is characterized by the earlobe as the center, enlarged to the surroundings, the edges are unclear, the touch is elastic and tender, and the surface skin is not red. The upper edge of the swelling can reach the zygomatic arch, the posterior edge can reach the sternocleidomastoid muscle, and the lower edge can reach the submandibular to the neck. The parotid swelling peaks in about 3 to 5 days, and then gradually decreases and usually subsides in about 1 week, and occasionally extends to 2 weeks. Sometimes the submandibular glands and sublingual glands can be enlarged. The former is more common. In some cases, only the submandibular glands are enlarged and the parotid glands are not large. In some children, the submandibular glands, sublingual glands, and parotid glands are always without obvious swelling, but only the symptoms of viremia or complications. Redness and swelling can be seen at the parotid duct. The child felt local tenderness and hypersensitivity of the parotid glands, which was more obvious when opening and chewing. The body temperature is still high while the parotid is swollen, but the extent and duration of the increase in body temperature has nothing to do with the degree of parotid enlargement. The duration of fever varies, the short one being 1-2 days, and a few up to two weeks. Fever is more common in moderate, low and high fever are rare, about 20% of the body temperature is always normal.

Pediatric Mumps Diagnosis

When the parotid gland is significantly swollen and there is a clear history of exposure, it is not difficult to make a clinical diagnosis unless the parotid gland is enlarged due to other reasons. In cases of simple enlargement of the submandibular or sublingual glands, the diagnosis can be made after there is a clear source of infection and local lymphadenitis is excluded. Patients with encephalitis before or without parotid enlargement have a difficult clinical diagnosis.

Peripheral blood white blood cell counts were mostly normal or slightly increased, and lymphocytes were relatively increased in classification tests. Serum and urine amylase assays are mild to moderately elevated, but they need to be distinguished from pancreatitis. Serum lipase assays are helpful for the diagnosis of pancreatitis. Cerebrospinal fluid examination can be done for those with suspected meningitis, but the symptoms are obvious, and those with a clear diagnosis of mumps do not need to check the cerebrospinal fluid. There is no special treatment for mild cases. To make an etiological diagnosis, blood, saliva, urine, and cerebrospinal fluid viruses should be isolated.

Differential diagnosis of mumps in children

1. Mumps caused by other viruses

It is known that influenza, parainfluenza, adenovirus, enterovirus, etc. can cause mumps. The preliminary identification can refer to the epidemiological history and clinical accompanying symptoms, and the final identification method is to conduct an etiology and serological examination.

2.Suppurative mumps

Frequent recurrences, and all are located on the same side of the parotid gland, suppurative parotitis should be suspected. Squeezing the glands can see the pus outflow from the parotid gland. The local skin is red and swollen, tenderness is obvious, peripheral boundaries are unclear, peripheral white blood cells and neutrophils are increased. It can occur in children of all ages, and can disappear naturally by adolescence. Use saliva (such as chewing gum) to make saliva smooth and antibiotic treatment effective.

3. Parotid enlargement caused by other reasons

(1) The parotid glands can swell in chronic wasting diseases and malnutrition. Mostly bilateral, mild swelling, no tenderness, no skin sensation, lasting time, usually without symptoms of acute infection, and no local pain and tenderness.

(2) When the salivary tube is blocked by stones, the parotid glands can be swollen or tender, but there are no symptoms of acute infection. Repeated attacks, the parotid glands suddenly swell and quickly subside, often on the same side.

4. Local lymphadenitis

Acute lymphadenitis is mostly a unilateral case, located in the submandibular or subcondylar area. The mass is not centered on the earlobe, and the lymph nodes begin to swell and become hard. The edges are clear, tenderness is obvious, and pharyngeal inflammation is often present. There is no swelling in the parotid duct.

5. Other central nervous system infections

Such as encephalitis, meningitis, myelitis, cranial nerve damage, etc. appear before parotid swelling, or after a period of swelling, or no parotid swelling, need to be distinguished from other pathogens, especially other viral central nervous system infections. Diagnosis is often determined by serological examination.

Pediatric Mumps Complications

Mumps in children is not a serious illness, but there are many complications and some are more severe.

Neurological complications

It is reported that about 10% to 20% of the cases may have clinical manifestations. The clinical manifestations are encephalitis (about 5%), meningoencephalitis (about 27%), and encephalomyelitis. Patients with cerebellar lesions predominantly showed ataxia; those with lenticular lesions predominantly exhibited torsional spasm; cranial nerve injury and hydrocephalus were still seen. The overall prognosis is good, but there are occasional deaths and those with sequelae. Meningoencephalitis can occur before, at the same time as, and after swelling of the parotid glands. Statistics show that the incidence rate is 1.6% from 6 to 10 days before swelling, 11% from 1 to 5 days, 2.5% from the same time, 20.3% from 1 to 5 days after swelling, 11% from 6 to 10 days, and 1.6 from 11 to 26 days. %. Specifically, meningoencephalitis can occur two weeks before and after a parotid swelling. The main clinical manifestations are fever, headache, vomiting, lethargy, and stiff neck. A few cases may have coma and convulsions. As the cerebrospinal fluid is generally not checked, the exact incidence and changes of the cerebrospinal fluid are difficult to know. It is generally believed that the number of cerebrospinal fluid cells increases slightly, mostly tens to hundreds, and occasionally more than 1000 × 106 / L. Mostly, sugar and chloride are normal, and protein is slightly increased. It takes a long time for cerebrospinal fluid to return to normal, usually 3 to 6 weeks.

2. Reproductive organ complications

Mumps virus can also invade the gonads, manifested as orchitis or ovarian inflammation, the former is more common than the latter, and may be related to clinical ease of detection. This complication is more common in adolescents or adults and rare in childhood. It usually occurs 3 to 13 days after the swelling of the parotid gland, and it is more unilateral, and only 2% to 3% is seen on both sides. Clinical manifestations include high fever, headache, nausea, vomiting, and local pain. The scrotum is swollen and the skin is red. The course of disease is about 10 days. Ovariitis is less frequent than orchitis, and the clinical symptoms are also mild, with only back pain, tenderness in the lower abdomen, and menstrual disorders. Can cause about 30% to 50% testicular or ovarian atrophy to varying degrees, bilateral atrophy can cause infertility.

3. Acute pancreatitis

Can be seen in older children, most of which occur 3 to 5 days to 1 week after swelling of the parotid glands. Mainly manifested as a sudden rise in body temperature, accompanied by repeated frequent vomiting, severe upper abdominal pain, diarrhea, bloating or constipation. Abdominal tenderness is obvious, local muscles are tense, and B-ultrasound sometimes shows pancreatic enlargement. Blood and urine amylase increased, but in 90% of cases of simple mumps, the amylase also increased slightly or moderately. Serum lipase measurement is helpful for the diagnosis of pancreatitis. In recent years, amylase isoenzymes have been measured, which can distinguish parotid (P-type) and salivary gland (S-type) amylase.

4. Sensorineural deafness

Hearing loss and even deafness are complications and sequelae of mumps, which have been reported at home and abroad. This change is not only seen in patients with encephalitis, but also in children with simple mumps in children. It has been observed that deafness mostly occurs on one side, and the incidence of older children is high, and most of them occur within 10 days after the onset of illness. If encephalitis is complicated, the incidence of deafness is about 23.8% higher. Deafness caused by auditory nerve edema can be restored within about 6 months by reducing edema and improving local microcirculation. Deafness caused by auditory nerve degeneration often becomes lifelong damage.

5. Other complications

Mumps with nephritis is about 1.14%, which can occur at the same time as parotid swelling or within 1 week of mumps. In addition to the symptoms of mumps, there may be back pain, frequent urination, oliguria, hematuria, eyelid and lower limb edema, hypertension and other manifestations. Urine routine examination showed varying degrees of proteinuria and hematuria. Renal function is mostly normal or temporarily reduced. With the improvement of mumps, the inflammation of nephritis also reduced, and usually recovered within 3 weeks. The virus can sometimes be detected in the urine, suggesting the possibility of the virus directly damaging the kidneys. About 2% to 4% of children with mumps are complicated by myocarditis and pericarditis with mild clinical symptoms. Various types of cardiac rhythm disorders and ST-T changes can be seen on the ECG. Most returned to normal within a few days, and a few patients with severe illness could develop cardiac insufficiency. There were also reports of 8 cases of Alzheimer's syndrome. Concurrent hepatitis is about 1.25%. There are also a few complications of arthritis, which often involve large joints, and most of the symptoms disappear within 3 months. In addition, thrombocytopenia was approximately 2.6%. There are mastitis, lacrimal gland inflammation, anterior sternal soft tissue edema, facial nerve paralysis, gastrointestinal bleeding and epidemic hemorrhagic fever.

Pediatric Mumps Treatment

There is no special treatment medication for mumps in children, and symptomatic treatment is mainly adopted.

The child should rest in bed and be given symptomatic treatment until the adenomas completely disappear. High fever and cooling, in order to reduce acidic irritation to the mouth, enteric aspirin or acetaminophen can be used. Mouthwash with compound boric acid solution, sulfa drugs and antibacterials are not effective. Traditional Chinese medicine is a commonly used medicine. Oral administration can use Puji disinfection drink. The topical use of Zijin tablets or Ruyi Jinhuang powder, after topical application with vinegar, is indeed effective, to be confirmed by strict control observation in a certain number of cases. There are different opinions on whether interferon treatment is used clinically to accelerate swelling and shorten the course of treatment. Locally, diathermy and infrared light therapy are also available.

When complicated with orchitis, cotton and T-belts can be used to support the testicles, and local cold compresses can be used to reduce pain. In severe cases, hydrocortisone can be used for short periods.

When complicated with pancreatitis, fasting, intravenous infusion and antibiotics should be used. Meningoencephalitis patients are mainly treated symptomatically, and those with increased intracranial pressure can use dehydration therapy.

Prognosis of mumps in children

The prognosis of the disease is good, and all can fully recover. Patients with meningoencephalitis generally have a good prognosis, and occasionally die from severe respiratory or circulatory failure. A few cases can occur with permanent sensorineural hearing loss on one side.

Prevention of mumps in children

Automatic immunity

Live attenuated mumps vaccine has been proven to be safe and effective. Recently, triple vaccines for measles, rubella and mumps have been used. After inoculation, the antibody positive rate can reach 96%, and the protective effect of mumps natural infection can reach 97%. Neutralizing antibodies can be maintained for at least 9.5 years after immunization. The vaccine generally has no fever or other reactions, but pregnant women, immunodeficiency, and children with allergies to eggs should not be used.

2. Passive immunity

Neither gamma globulin nor mumps expensive immunoglobulins have a preventive effect. Nor can it relieve symptoms and reduce complications.

3. Isolation and observation

The patient should be isolated until the parotid swelling completely disappears. Contacts should be checked daily, and if there are suspicious symptoms, they should be observed in isolation. Collective children's institutions should be quarantined for 3 weeks.

references

1. Hu Yamei, editor in chief, Jiang Zaifang. Seventh edition of Practical Pediatrics, People's Medical Publishing House, 2002: 756-759.

2. Fei Fangrong, Feng Luzhao, Xu Zhen, Feng Zijian. Analysis of Epidemiological Characteristics of Mumps in China from 2008 to 2010. Disease Surveillance, 2011, 26 (9): 691-693.

3. Industry standards for mumps in the People's Republic of China. Diagnosis criteria for mumps S WS. 2007.

4. Dong Qinghua et al. Mumps Encephalitis Complicated by Hearing Impairment. Chinese Journal of Pediatrics, 1988, 6: 338.

5.Centers for Disease Control and Prevention, Mumps. Available at: http://www.cdc.gov/mumps/index.html, 2011-04-02.

6. World Health Organization. Immunization, Vaccines and Biologicals. Available at: http://www.Who.int/immunization/pp_mumps_en.pdf, 2011-04 -02.