Parotitis: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Aug 4, 2023

Parotitis is also known as “mumps” as the ears appear larger than normal (the swelling rotates the pinnae forward and out) or “crawling” due to the resemblance to a cat with a deformed face, precisely due to swelling affecting the salivary glands

It is a contagious disease, considered to occur in childhood but kept under control in many countries thanks to vaccination.

Symptoms

After an incubation period which can vary from a minimum of 12 to a maximum of 25 days (usually 16-18 days), symptoms such as:

fever
heachache
muscle aches,
loss of appetite
swelling of one or more salivary glands. Glandular swelling is usually bilateral (affecting the area behind the parotid, in front of and below the ear) and lasts at least for 5-7 days, accompanied by pain when chewing or swallowing.

In the most acute phase of the disease, the patient may experience intense pain under and behind the earlobe and, on palpation, between the posterior margin of the jaw and the auricle.

After reaching its peak in 2-3 days, the swelling slowly begins to subside within a week, as do the remaining symptoms.

In some cases, however, the disease lasts longer: there are relapsing forms that even last for 1 month.

Before the advent of the mumps vaccines, most people were infected with the mumps virus before their teenage years. However, there have also been outbreaks of mumps in which the majority of cases were found in adults.

Mumps, like measles and rubella, is an endemic-epidemic disease, i.e. always present in communities, with epidemic peaks every 2-5 years, linked to the fact that newborns progressively form a mass of subjects susceptible to infection.

Mumps, whether in the clinically evident form or, as frequently happens, as a vague or inapparent infection, leaves a lifelong immunity against subsequent infections.

The immunity produced by the vaccine also lasts a very long time.

Parotitis is an infectious disease of viral origin

The virus involved – an RNA virus belonging to the Rubulavirus genus of the Paramyxovirus family – generates acute inflammation and painful enlargement of some salivary glands.

Typically, the parotids – on the sides of the ears – and sometimes the sublingual or submandibular glands are involved.

Mumps is transmitted

by air with respiratory droplets (droplets) emitted by coughing, sneezing or simply talking
through direct contact with the saliva of the infected patient.

The mumps virus can be found in saliva 1-6 days before the onset of symptoms and for the duration of the disease.

The virus is also eliminated in the urine and, passing through the placenta, can infect the fetus, even if there is no scientific evidence of its responsibility in the manifestation of congenital malformations; mumps infections contracted in the first three months of pregnancy may, on the other hand, be linked to an increase in miscarriage.

The period of contagiousness, in which the disease can be transmitted by infected people (with or without evident symptoms), goes from 6-7 days before the onset of the swollen salivary glands, up to 9 days after the regression of the same.

In particular, infectivity is highest in the 48 hours preceding the swelling of the salivary glands.

Complications of mumps are fortunately very rare.

In particular, subjects can be affected by

benign aseptic meningitis, an inflammation of the meninges, the membranes that cover the brain. Presents with severe headache, stiff neck and high fever and usually resolves without sequelae after 3-10 days
permanent hearing damage due to the direct action of the virus on the cells of the inner ear. Sensorineural deafness from mumps is immediate in onset, can affect both ears, and is permanent
pancreatitis, a painful inflammation of the pancreas.
from orchitis (inflammation of one and both testicles), in adolescent and adult males. In rare cases, orchitis can lead to infertility.
Inflammation of the ovaries (oophoritis) in female subjects.

If you suspect mumps, you should contact your pediatrician or general practitioner immediately, who will make a diagnosis based on the history and clinical examination.

Treatment

The diagnosis is generally simple due to the bilateral involvement of the glands, the course of the fever, the consistency of the glandular swelling.

In uncomplicated mumps, laboratory tests typically reveal nothing specific except an increase in the number of white blood cells, which denotes inflammation and infection.

The diagnosis of mumps can be confirmed through laboratory tests which generally involve the isolation of the virus from saliva or urine and the search in the blood for specific antibodies (the so-called IgG and IgM) directed against the viral agent.

Viral parotitis must be differentiated

from bacterial mumps, which are unilateral rather than bilateral
from tumors of the salivary glands
from Sjögren’s syndrome (an autoimmune disease)
from bromide and heavy metal poisoning.

As far as the treatment of mumps is concerned, there is no specific treatment.

For uncomplicated forms, rest until healing and a healthy, light diet are sufficient.

In the acute phase it is desirable to ingest liquids or semi-liquid foods, through the use of a straw to alleviate the pain caused by chewing.

On the other hand, citrus fruits and sour foods in general are not recommended, as they can increase the discomfort attributable to inflammation.

If necessary, the doctor can indicate the most suitable therapy to alleviate the symptoms.

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For example, he could prescribe antipyretics to lower fever (note that acetylsalicylic acid is not recommended for children under 12 in favor of paracetamol) and analgesics to treat pain caused by inflammation.

Prevention against mumps is carried out through specific vaccination.

The vaccine is part of the measles-mumps-rubella (MMR) immunization.

In children, the vaccination schedule recommends the first dose at 13-15 months, the second at 5-6 years of age.

For adolescents and adults who have not received the vaccine, two doses are given at least 4 weeks apart.

It is also important to check whether the woman is immune to mumps in anticipation of pregnancy. In the absence of immunization against this disease, vaccination with an interval of one month between doses should be used.

Vaccines against MMR, containing live attenuated virus vaccines, cannot be carried out in pregnancy, although the accidental administration of the vaccination in women who did not know they were pregnant has never led to an increase in miscarriages or malformations.

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