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Mumps Update



2. MUMPSHIPPOCRATES 5thCentury BC A Disease of Children, Non SuppurativeEnlargement ofParotid Gland. 1934 Good Pasture/Johnson Dr.T.V.Rao MD 3. Paramyxoviruses Dr.T.V.Rao MD 4. Mumps belongs toParmyxoviridaeViruses in the familyParmyxoviridae are classified intwo subfamilies, Paramyxovirinaeand Pneumovirinae. The lattersubfamily contains twogenera, Pneumovirus andMetapneumovirus.Dr.T.V.Rao MD 5. Data on Mumps Dr.T.V.Rao MD 6. Mumps belongs to ParmyxoviridaeLooks similar to Orthomyxovirus,Larger in size, More Pleomorphic.Spherical in shape 100 to 300 nmSome times appear as filamentous,Gaint formsare present.But contains only single stranded RNA.Do not contain segmented RNA likeOrthomyxoviruses,Antigenic variation absent.Reassortments like Influenza viruses ABSENT. Dr.T.V.Rao MD 7. MUMPS - VirusMumps is a single-stranded RNA virus anda member of the familyParmyxoviridae, genusParamyxoviruses. It has2 major surfaceglycoproteins: the hemagglutinin-neuraminidase and thefusion protein. Mumpsvirus is sensitive to heatand ultraviolet light Dr.T.V.Rao MD 8. Properties of MUMPS virus.Posses HN and Fproperties.Growth in ChickEmbryos, in the Amnioticcavity, Adopts in allantoiccavity,Cell cultures PrimaryMonkey kidney,TypicalParamyxoviruses,Dr.T.V.Rao MDproduce Cytopathic 9. MUMPSMumps is an acute viralinfection of theparamyxoviruses family.As its alternative name(infectious parotitis)suggests, the infection ischaracterized by swellingmore commonly bilateralthan unilateral of theparotid salivary glands. Dr.T.V.Rao MD 10. MumpsThe incubation periodis 14-21 days and iscommunicable from 6days before to 9 daysafter facial swelling isapparent. It can leadto braininflammation, deafness or sterility Dr.T.V.Rao MD 11. Mumbling speech - Mumps Name "mumps" comes from an old word for "lump" or an old word for "mumble."Dr.T.V.Rao MD 12. MumpsMumps or epidemic parotitis is aviral disease of the human species,caused by the mumps virus. Prior tothe development of vaccination andthe introduction of a vaccine, it was acommon childhood diseaseworldwide, and is still a significantthreat to health in the DevelopingWorldDr.T.V.Rao MD 13. Mumps Clinical Case DefinitionAcute onset ofunilateral or bilateraltender, self-limitedswelling of theparotid or othersalivary gland lastingmore than 2 dayswithout otherapparent causeDr.T.V.Rao MD 14. Involvement of Salivary GlandsPainful swelling ofthe salivary glands(classically theparotid gland isthe most typicalpresentation)Painful testicularswelling (orchitis)and rash may alsooccurDr.T.V.Rao MD 15. Involvement of Parotid Gland aMajor Manifestation Swelling of the salivary glands follows these symptoms. Swelling of the glands near the jaw line below the ears may give you "chipmunk cheeksDr.T.V.Rao MD 16. Pathogenesis - MumpsRespiratorytransmission of virusReplication innasopharynx andregional lymph nodesViremia 12-25 daysafter exposure withspread to tissuesMultiple tissuesinfected during ViremiaDr.T.V.Rao MD 17. Mumps Clinical Features Incubation period 14- 18 days Nonspecific prodrome of myalgia, malaise, head ache, low-grade fever Parotitis in 30%-40% Up to 20% of infections asymptomaticDr.T.V.Rao MD 18. Clinical Features MUMPS Inhalation / Conjunctiva. Replicates in URT Cervical Lymph nodes. Blood stream to other organs Incubation period 12- 25 days. Manifest with Parotid swelling Unilateral or Bilateral.Fever , Local pain at parotid region and Tenderness.Subsides In a Week. Dr.T.V.Rao MD 19. Immunity Antibodies are produced against the S and V surface antigens.. Mumps rare before 6 months of age. Dr.T.V.Rao MD 20. Complication with MUMPS.Epididymo orchids.May lead to atrophy, sterility, Low spermcounts.CNS involvement in 60% casesMay manifest with Aseptic meningitis,Deafness,Arthritis, Oopharitis,Nephritis andMyocarditis,Dr.T.V.Rao MD 21. Complication with MUMPS.Orchitis. This inflammatorycondition causes swelling of one orboth testicles. Orchitis is painful.Pancreatitis..Encephalitis. A viral infection, suchas mumps, can lead to inflammationof the brain (encephalitis). Althoughits serious, encephalitis is a rarecomplication of mumps. Dr.T.V.Rao MD 22. Meningoencephalitis, In clinically diagnosed Meningoencephalitis, a CSF mononuclear pleocytosis occurs, as does normal glucose, although hypoglycorrhachia has been reported. The mumps virus may be isolated from CSF early in the illness. Mumps Meningoencephalitis carries a good prognosis and is usually associated with an uneventful recovery.Dr.T.V.Rao MD 23. Laboratory Diagnosis No Laboratory confirmation needed. Atypical infection needs laboratory Diagnosis. Virus isolated from Saliva Urine CSF.Culturing in Human amnion, He la cells.Immunofluorescence Methods. Isolation in Chick EmbryosELISA, Complement fixation tests, Dr.T.V.Rao MD 24. Mumps Laboratory DiagnosisIsolation of mumps virusDetection of mumps antigen by PCRSerologic testingpositive IgM antibodysignificant increase in IgG antibodybetween acute and convalescentspecimensDr.T.V.Rao MD 25. CDC recommendsCDC recommendsthat a bloodspecimen and buccal/oral swab becollected from allpatients with clinicalfeatures compatiblewith mumps.Recommendationsstands mainly forepidemiologicalsurveys Dr.T.V.Rao MD 26. Vaccination Live attenuated vaccine Jernyl Lynn StrainGrown in chick embryo fibroblastsVaccine as MMR vaccineA single dose protects for 10 years. Dr.T.V.Rao MD 27. Mumps (MMR) VaccineIndicationsOne dose (as MMR) for preschool-age children 12 months of age andolder and persons born during orafter 1957 not at high risk ofmumps exposureNeed for second doseSecond dose (as MMR) for school-age children andadults at high risk of mumps exposure(i.e., healthcare personnel, international travelers andstudents at post-high school educational institutions Dr.T.V.Rao MD 28. MMR VaccineContraindications and PrecautionsSevere allergic reaction to vaccinecomponent or following a prior dosePregnancyImmunosuppressionModerate or severe acute illness ofother etiologiesDr.T.V.Rao MD 29. MMR Vaccine and AutismThere is no scientific evidence that the riskof autism is higher among children whoreceive measles or MMR vaccine thanamong unvaccinated childrenThe evidence favors a rejection of a causalrelationship at the population levelbetween MMR vaccine and autismspectrum disorders (ASD).- Institute of Medicine, April 2001 Dr.T.V.Rao MD 30. MMR combined vaccine is beneficialthan separate component vaccinesSeparate administration ofmeasles, mumps, and rubella vaccines tochildren provides no benefit overadministration of the combination MMRvaccine and could result in delays inimmunization. Paediatricians need to work with families toensure that children are protected early inthe second year of life from thesepreventable diseases. Dr.T.V.Rao MD 31. Mumps Vaccine and HIV InfectionMMR recommendedfor persons withasymptomatic andmildly symptomaticHIV infectionNOT recommendedfor those withevidence of severeimmuno-suppressionHIV testing beforevaccination is notrecommendedDr.T.V.Rao MD 32. EpidemiologyEndemic Prevalence all over the worldImmunization . Reduced the incidence.Epidemics in children between 5-15.No carriers.Spread by Direct ContactSaliva and urine are infective.One Attack produces life time Immunity.Dr.T.V.Rao MD 33. Control of Mumps:Mumps control: The control of mumps canbe achieved through high routine coveragewith an effective mumps-containing vaccineadministered at 1218 months of age.Children immunized with most mumpsvaccines at the age of 12 months or olderhave excellent serological response rates.Programmes should aim at infant coverageof more than 90%. Low immunizationcoverage may reduce the number of cases ininfants but fails to interrupt circulation of themumps virus in the community.Dr.T.V.Rao MD 34. Passive immunizationagainst mumps Immune globulin ineffective for postexposure prophylaxis does not prevent disease or reducecomplications Trans placental maternal antibodyappears to protect infants for first yearof lifeDr.T.V.Rao MD 35. For Article of Current Interest Visit me onDr.T.V.Rao MD 36. Programme Created byDr.T.V.Rao MD for Medical and Paramedical Students in Developing WorldEmaildoctortvrao@gmail.comDr.T.V.Rao MD


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