Reappraisal of clinical characteristics of mumps

Syed Hasan Imam Al-Masum1, Md. Jahangir Alam2, Abu Yousuf Fakir3
Background: Mumps is a common childhood infection caused by the mumps virus,
a RNA virus of genus paramyxovirus of family paramyxoviridae. Since the
introduction of measles, mumps, and rubella (MMR) triple vaccine in 1980s in the
developed countries the incidence of mumps has reduced and its clinical pattern has
also been changed. In Bangladesh, though, the MMR vaccine is not included in the
EPI schedule, and no demonstrable change in the incidence of the disease has yet
been reported, a shift in the age incidence of the mumps with higher rates of
complications is reported. The present study intends to update the clinical features
and complications of mumps.
Methods: A total of 271 cases of mumps were consecutively included at paediatric
ENT outpatient department of Dhaka Shishu Hospital between January 2008 to
Decemeber 2008. The patient presented with the acute onset of unilateral or bilateral
tender, swelling of the parotid gland, lasting greater than or equal to 2 days, and
without any evidences of other apparent causes of parotid swelling was defined as a
‘case’ of mumps.
Results: The mean age of the patients was 6.5 ± 2.2 years and the youngest and oldest
patients were 3 and 12 years old respectively. A male preponderance was observed among
the study cases with male to female ratio 3:2. Of the total cases, 93% presented with
bilateral parotid swelling and the rest 7% with unilateral swelling. More than 45% had
fever and nearly 20% complaints of headache. All patients felt pain on pressure over the
parotid region. The complications encountered by the patients were epigastric pain (10.3%)
followed by aseptic meningitis (6.6%), orchitis (5.5%), oophoritis (2.6%). About 20% of the
patients developed at least one complication. More than 60% of the patients received
erythromycin, 19.9% cefixime, 11.8% cephalosporin and 7.1% amoxicillin as prophylaxis
from secondary infection. Seventeen patients were treated with steroid to reduce severity
of local inflammation. About two third (67.2%) of the patients were completely cured in
10 – 21 days with mean duration of treatment being 15.2 days.
Conclusion: The clinical presentation of mumps has not been changed from the
classic presentation of tender, bilateral parotid swelling with prodormal symptoms.
However, epigastric pain was more frequently encountered than any other
complications. A better representation of clinical features may be obtained if mumps
cases of all age groups are included.

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