Epidemic parotitis is caused byMumps virusAcute self limited respiratory infectious disease caused by infection.The main people who are often touched are children and teenagers. Usually, they are also known as mumps in traditional Chinese medicine, and they are often called fried mumps in the folk.In addition to the parotid gland, the virus may also invadenervous systemAnd other gland tissues, leading tomeningitis、Meningoencephalitis、Orchitis、Oophoritis、pancreatitisandmyocarditisEtc.
The virus is highly infectious from 6 days before the patient's parotid gland enlargement to 9 days after the onset of the disease.The virus is transmitted through respiratory droplets, direct contact between people, or mother to child transmission.The clinical symptoms of the virus include parotid gland swelling, pain, and temperature rise.Other salivary glands invaded by the virusSubmandibular glandandSublingual glandIt may also cause obvious swelling in the neck and mandible, sublingual swelling, dysphagia and other accompanying symptoms.
At present, there is no specific antiviral treatment for the disease, mainly symptomatic treatment including rest, isolation, medication, etc.Although the disease is infectious, the prognosis of most patients with mumps is good. Only a few patients with severe complications such as viral encephalitis and myocarditis may cause life danger.
Epidemic parotitis is caused by infectionMumps virusCaused by.Mumps virus belongs toParamyxovirus, spherical, 85~300nm in diameter, single negative strand RNA virus.NucleocapsidSpiral symmetry, withenvelope。There are hemagglutinin neuraminidase spike and fusion factor spike on the capsule.
There is only one serotype of mumps virus, which can obtain lasting immunity after recovery or vaccination.Mumps virus has weak resistance and can be inactivated at 56 ℃ for 30 minutesultraviolet raysAnd fat solvent sensitivity.
Mumps virus spreads from person to person through upper respiratory tract or direct contact.Mumps virus invades the body through mouth and nose, invades the blood after local reproduction, and then spreads toparotid gland, or even other gland organs or systems (such asnervous system、testis、ovary、pancreasEtc.).
Predisposing factors
The disease is common in children and adolescents.It may be related to insufficient immune function, unsatisfactory vaccination effect and lack of wild type infection exposure.
symptom
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The incubation period of mumps ranges from 8 to 30 days, with an average of 18 days.Most patients have no obvious prodromal symptoms. A few patients may have muscle soreness, headache, lack of appetite, general discomfort, chills and fever.One to two days later, parotid gland swelling and pain occurred, and the body temperature reached 38 to 40 ℃.The swelling reached its peak in the first three days of the course of disease, and gradually subsided after 4-5 days.The severity of symptoms varies greatly among individuals. Generally, adult symptoms are more serious than children.
Typical symptoms
The parotid gland enlargement generally starts from one side and spreads to the other side after 1-4 days. It gradually develops forward, backward and downward with the earlobe as the center, presenting pear shaped swelling.
The enlarged parotid gland has unclear edges, is tough and elastic, has obvious swelling pain, and is locally hot but not red.
Because the salivary gland tube is blocked, the salivary secretion will increase when eating acidic food, but the discharge of saliva is blocked, resulting in salivary retention, thus aggravating the swelling and pain of parotid gland.
Accompanying symptoms
During the epidemic period, the other two pairs of salivary glands, submandibular glands and sublingual glands can also be affected simultaneously or alone.When submandibular gland inflammation occurs, the front and lower jaw of the neck are obviously swollen, and the oval submandibular gland can be felt;When sublingual gland inflammation occurs, there may be sublingual swelling and sometimes dysphagia.
Medical treatment
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In case of parotid swelling, pain and other epidemic parotitis symptoms, seek medical advice immediately.It should be noted that the disease is infectious and should be well isolated and protected.
Visiting department
Children can go to the Department of Pediatrics in the Department of Infectious Diseases or the Infectious Diseases Hospital.
Relevant inspection
Medical history and physical examination
Personal and family history
Doctors will ask patients about their age, occupation, whether their families have mumps, and whether they go to schools, shopping malls and other densely populated areas during the epidemic period.
Conscious symptom
The doctor will ask if there are any symptoms such as fever, parotid swelling and pain, general discomfort, muscle soreness, headache, and lack of appetite.
physical examination
The doctor will check whether the patient has parotid gland enlargement, cheek mucosa congestion and other manifestations.
laboratory examination
Determination of amylase in serum and urine
In the early stage of the disease, about 90% of the patients' blood and urine amylase levels are increased, and the degree of increase is generally proportional to the degree of parotid gland swelling, which is helpful for doctors to diagnose.
Immunological and serological tests
Early diagnosis can use specific antibody or monoclonal antibody to detect mumps virus antigen, and specific antibody can be detected after the second week of the disease course.The antibody was detected by complement binding test and hemagglutination inhibition test. The antibody titer in the recovery phase was 4 times or more higher than that in the acute phase.
Detection of Mumps Virus RNA
Using polymerase chain reaction (PCR) technology to detect mumps virus RNA has very high sensitivity and specificity, which can significantly improve the diagnostic rate of suspicious patients.The salivacerebrospinal fluidTake samples from urine for detection.
Virus isolation and detection
Early isolation of mumps virus from saliva, blood, urine, cerebrospinal fluid and other samples of patients can be confirmed.
diagnostic criteria
According to health industry standards《Diagnostic criteria for epidemic parotitis》(WS 270-2007), according to the patient's epidemiological data, clinical manifestations and laboratory examination results, the suspected diagnosis, clinical diagnosis and definitive diagnosis were made after comprehensive analysis.
Suspected diagnosis
Patients who meet one of the following conditions should be regarded as suspected cases of mumps:
The swelling and pain of unilateral or bilateral parotid glands and/or other salivary glands, the opening of the mouth and the chewing or the eating of acidic food aggravate the pain.
It conforms to the epidemiological history (there is a history of contact with mumps patients 14 to 28 days before the onset of the disease or there is a local epidemic of mumps), and it also has fever and headache, or is accompanied by meningoencephalitis, or orchitis, or pancreatitis.
clinical diagnosis
Those who meet the two conditions of suspected diagnosis can be regarded as clinical diagnosis.
Determine diagnosis
For suspected cases or clinically diagnosed cases, mumps virus specific IgM antibody is detected in the serum (no live attenuated mumps vaccine has been inoculated within one month), or the ratio of mumps virus IgG antibody titer in the serum of the recovery phase and the acute phase (2 to 4 weeks apart) is 4 times or more higher (including positive conversion of antibody), or mumps virus is isolated from saliva, urine, cerebrospinal fluid and other body fluids.
Most of them are swollen parotid gland on one side, with obvious local redness, swelling and pain. Most of them have wave sensation in the later stage. When squeezing, pus can be seen flowing out of the parotid gland tube mouth, without inflammation of testicles and other glands.
His parotid gland is swollen
The parotid gland enlargement caused by diabetes, malnutrition, chronic liver disease or some drugs (such as iodide, Baotaisong, etc.) is mostly symmetrical, soft and without tenderness.
Local lymphadenitis
Most of the mandibular, preauricular and postauricular lymphadenitis are accompanied by local or oral and pharyngeal inflammation. The swollen lymph nodes are not centered on the earlobe.
Other viral mumps
Influenza A、Parainfluenza、Herpes simplex, Coxsackie A, cytomegalovirus and other viruses can also cause mumps, which can only be identified by serological and virological tests.
treatment
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There is no specific antiviral treatment for mumps, and symptomatic treatment is the main treatment.
General treatment
The patient should rest in bed and be isolated until the parotid gland swelling subsides.
Pay attention to oral hygiene at ordinary times.
Use a liquid or semi liquid diet, and try to avoid eating acidic food.
Patients with pancreatitis should fast and take intravenous nutrition.
medication
Pathogen treatment
Trial use at the early stage of the diseaseribavirin1g/d, 15mg/kg intravenous drip for children, the course of treatment is 5-7 days, but the effect remains to be determined.
Symptomatic treatment
Physical or drug cooling can be used in case of high fever.
Analgesics can be used when headache or parotid gland swelling and pain are obvious.
TCM treatment
It is called mumps in traditional Chinese medicine. Mumps are divided into wind heat type and phlegm toxin type. The treatment principle is to clear wind and heat, detoxify and detumescence.
For those with orchitis and distention pain, local cold compress or cotton pad and T-belt can be used to relieve the pain, and oral administration can also be taken at the same timeDiethylstilbestrol2~5mg each time, three times a day, to promote faster disappearance of inflammation, and reduce testicular atrophy and other sequelae.Adrenal cortical hormone can also be used in patients with severe symptoms.
Patients with encephalitis, meningitis and increased intracranial pressure should be dehydrated in time (intravenous injection of 20%mannitol1~2g/kg, once every 4~6 hours, until the symptoms improve), reduceintracranial pressureTo prevent encephalopathy and reduce mortality.
prognosis
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Most patients with mumps have a good prognosis. Only a few patients with severe complications such as viral encephalitis and myocarditis may endanger their lives.
complication
In addition to parotid gland, mumps virus can often invade multiple systems and organs. About 75% of mumps patients have complications.
Neurological complications
The most common complications of children with mumps are aseptic meningitis, encephalitis and meningoencephalitis.The main manifestations include fever, lethargy, headache, vomiting, meningeal irritation, severe convulsion, disturbance of consciousness, and cerebrospinal fluid changes similar to other viral encephalitis.Some patients may also have other neurological damage and sequelae, such aspoliomyelitis、Polyneuritis, can causehemiplegia、paraplegia, paralysis, deafness, etc.
Reproductive system complications
It mostly occurs in adults, and children's reproductive organs are not yet mature, so most of them can be spared.
Orchitis
About 1/3 of adult male patients can develop orchitis, which is mostly unilateral.Generally, when the parotid gland swelling begins to subside, the patient starts to get hot again, the testis is swollen and painful, and there is obvious tenderness, which will gradually improve after 3 to 5 days, and can be complicatedEpididymitis、Hydrocele of tunica vaginalis、Scrotal oedema, can also be accompanied byTesticular atrophy, but generally does not affect fertility.
Oophoritis
About 5%~7% of adult female parotitis patients are accompanied by oophoritis, but the symptoms are relatively mild, with only lower abdominal pain, which generally has no impact on fertility.
hearing loss
The hearing loss caused by parotitis is mainly manifested as unilateral deep sensorineural hearing loss, which is difficult to treat.In rare cases of bilateral total deafness, cochlear implant is beneficial to speech perception.Mumps vaccination is recommended to prevent mumps related hearing loss.
