Mumps (mumps). Causes, symptoms, treatment and prevention. Acute mumps Purulent mumps ICD 10

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Mumps (ICD-10 code: B26.8)

Inflammation of the parotid salivary gland. In acute nonspecific mumps, the causative agents of the disease are various microorganisms. Chronic nonspecific parotitis often results from acute mumps.

Main tasks laser therapy is to eliminate inflammatory phenomena in the gland, improve its metabolism and microcirculatory hemodynamics, and optimize excretory activity.

The treatment plan includes direct irradiation of the projection zone of the gland and additional exposure zones, including: receptor zones located in the zygomatic and buccal areas of the face, exposure to the dorsum of the hand and the inner surface of the forearm, the outer surface of the lower leg, and foot.

Treatment regimens for the treatment of mumps

Rice. 82. Projection of the parotid gland.

The duration of the course of therapy is up to 12 procedures with a mandatory repeated treatment course performed after 3-5 weeks.

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B26 Mumps

Parotitis or mumps - a mild viral disease manifested by swelling of the salivary glands on one or both sides lower jaw.

Mostly unvaccinated school-age children and young people are affected. Gender, genetics, lifestyle do not matter. The mumps virus enters the saliva of sick people, so it can spread through the air through coughing and sneezing.

The virus causes swelling of one or both parotid glands, which are located below and in front of the ear canal. If both glands are affected, the child acquires characteristic appearance hamster In teenage boys and young men (about 1 in 4), the virus can cause painful inflammation of one or both testicles and, in rare cases, may result in infertility.

About half of all infected people have mumps without symptoms, while most others develop symptoms within a few days. mild form. The main symptoms of mumps appear 2-3 weeks after infection and are as follows:

• soreness and swelling on one or both sides of the face, under and in front of the ears for at least 3 days;
• pain when swallowing.

The child may develop a sore throat and fever, and the salivary glands under the lower jaw may become painful. A person with mumps becomes contagious 7 days before symptoms appear and remains so for another 10 days after symptoms have disappeared.

The doctor diagnoses the disease by the characteristic swelling of the parotid salivary glands. Special treatment No, but to relieve discomfort you should drink plenty of cool liquids and take over-the-counter analgesics such as paracetamol.

Most people who get sick recover without treatment, although strong analgesics are prescribed to teenagers and young men with severe testicular inflammation. If complications develop, special treatment is recommended.

Young children are immunized immediately against measles, mumps and rubella, first at 12–15 months and then at 4–6 years.

Complete medical reference book/Trans. from English E. Makhiyanova and I. Dreval. - M.: AST, Astrel, 2006.p.

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Synonyms - mumps infection, parotitis epidemica, mumps, behind the ears, “trench” disease, “soldier’s” disease.

Mumps is an acute anthroponotic airborne infectious disease characterized by predominant damage to the salivary glands and other glandular organs (pancreas, gonads, usually testicles, etc.), as well as the central nervous system.

B26. Parotitis.

B26.0†. Mumps orchitis.

B26.1†. Mumps meningitis.

B26.2†. Mumps encephalitis.

B26.3†. Mumps pancreatitis.

B26.8. Mumps with other complications.

B26.9. Mumps is uncomplicated.

Causes and etiology of mumps

The causative agent of mumps- Pneumophila parotiditis virus, pathogenic for humans and monkeys. Belongs to paramyxoviruses (family Paramyxoviridae, genus Rubulavirus), antigenically close to the parainfluenza virus. The mumps virus genome is a single-stranded helical RNA surrounded by a nucleocapsid. The virus is characterized by pronounced polymorphism: its shape is round, spherical or irregular, and its dimensions can vary from 100 to 600 nm. It has hemolytic, neuraminidase and hemagglutinating activity associated with glycoproteins HN and F. The virus is well cultivated on chicken embryos and kidney culture guinea pig, monkeys, Syrian hamster, as well as human amnion cells, is poorly stable in the environment, inactivated when exposed to high temperature, ultraviolet irradiation, drying, quickly destroyed in disinfectant solutions (50% ethyl alcohol, 0.1% formaldehyde solution, etc.) . At low temperatures (–20 °C) it can persist in the environment for up to several weeks. The antigenic structure of the virus is stable.

There is only one known serotype of the virus, which has two antigens: V (viral) and S (soluble). The optimal pH for the virus is 6.5–7.0. Among laboratory animals, the most sensitive to the mumps virus are monkeys, in which it is possible to reproduce the disease by introducing virus-containing material into the salivary gland duct.

Epidemiology of mumps

Mumps is traditionally classified as a childhood infection. However, mumps in infants and under 2 years of age is rare. From 2 to 25 years the disease is very common, it becomes rare again after 40 years. Many doctors attribute mumps to a disease of school age and military service. The incidence rate in US troops during World War II was 49.1 per 1,000 troops.

In recent years, mumps in adults has become more common due to mass vaccination of children. In the majority of vaccinated people, the concentration of protective antibodies decreases significantly after 5–7 years. This increases the susceptibility of adolescents and adults to the disease.

Source of the pathogen- a person with mumps who begins to secrete the virus 1–2 days before the appearance of the first clinical symptoms and before the 9th day of illness. In this case, the most active release of the virus into the environment occurs in the first 3–5 days of the disease.

The virus is released from the patient's body in saliva and urine. It has been established that the virus can be detected in other biological fluids of the patient: blood, breast milk, cerebrospinal fluid and in the affected glandular tissue.

The virus is transmitted by airborne droplets. The intensity of virus release into the environment is low due to the absence of catarrhal symptoms. One of the factors accelerating the spread of the mumps virus is the presence of concomitant acute respiratory infections, in which coughing and sneezing increases the release of the pathogen into the environment. The possibility of infection through household items (toys, towels) contaminated with the patient’s saliva cannot be ruled out.

The vertical route of transmission of mumps from a sick pregnant woman to her fetus is described. After the symptoms of the disease disappear, the patient is not contagious.

Susceptibility to infection is high (up to 100%). The “sluggish” mechanism of transmission of the pathogen, long-term incubation, a large number of patients with erased forms of the disease, making it difficult to identify and isolate them, leads to the fact that outbreaks of mumps in children and adolescents occur over a long period of time, in waves over several months. Boys and adult men suffer from this disease 1.5 times more often than women. Seasonality is typical: the maximum incidence occurs in March–April, the minimum in August–September. Among the adult population, epidemic outbreaks are recorded more often in closed and semi-closed communities - barracks, dormitories, ship crews. Increases in incidence are noted at intervals of 7–8 years.

Mumps is classified as a controlled infection. After the introduction of immunization, the incidence rate decreased significantly, but only 42% of countries around the world include vaccination against mumps in national vaccination calendars. Due to the constant circulation of the virus, 80–90% of people over 15 years of age have anti-mumps antibodies. This indicates the widespread distribution of this infection, and it is believed that in 25% of cases, mumps occurs inappropriately.

After an illness, patients develop stable lifelong immunity; recurrent illnesses are extremely rare.

Pathogenesis of mumps

The mumps virus enters the body through the mucous membrane of the upper respiratory tract and conjunctiva. It has been experimentally shown that application of the virus to the mucous membrane of the nose or cheek leads to the development of the disease. After entering the body, the virus multiplies in the epithelial cells of the respiratory tract and spreads through the bloodstream to all organs, of which the salivary, reproductive and pancreas glands, as well as the central nervous system, are the most sensitive to it. The hematogenous spread of infection is evidenced by early viremia and damage to various organs and systems distant from each other.

The viremia phase does not exceed five days. Damage to the central nervous system and other glandular organs can occur not only after, but also simultaneously, before, and even without damage to the salivary glands (the latter is observed very rarely). The nature of morphological changes in the affected organs has not been sufficiently studied. It has been established that damage to connective tissue, rather than glandular cells, predominates. At the same time, the development of edema and lymphocytic infiltration of the interstitial space of glandular tissue is typical for the acute period, however, the mumps virus can simultaneously infect the tissue itself. glandular tissue. A number of studies have shown that with orchitis, in addition to edema, the testicular parenchyma is also affected. This causes a decrease in androgen production and leads to impaired spermatogenesis. A similar nature of the lesion has been described for damage to the pancreas, which may result in atrophy of the islet apparatus with the development of diabetes mellitus.

Symptoms and clinical picture of mumps

There is no generally accepted classification of mumps. This is explained by different interpretations by specialists of the manifestations of the disease. A number of authors consider only damage to the salivary glands to be a characteristic manifestation of the disease, and damage to the nervous system and other glandular organs as complications or manifestations atypical course diseases.

The position according to which lesions not only of the salivary glands, but also of other localizations caused by the mumps virus, should be considered precisely as manifestations, and not complications of the disease, is pathogenetically substantiated. Moreover, they can manifest themselves in isolation without affecting the salivary glands. At the same time, lesions of various organs as isolated manifestations of mumps infection are rarely observed (an atypical form of the disease).

On the other hand, the erased form of the disease, which was diagnosed before the start of routine vaccination during almost every outbreak of the disease in children and adolescents and during routine examinations, cannot be considered atypical. An asymptomatic infection is not considered a disease. The classification should also reflect the frequent adverse long-term consequences of mumps. Severity criteria are not included in this table, since they are completely different for different forms diseases and do not have nosological specificity. Complications are rare and do not have characteristic features, so they are not considered in the classification. Clinical classification mumps includes the following clinical forms.

With isolated damage to the salivary glands:

– with damage to the salivary glands and other glandular organs;

– with damage to the salivary glands and nervous system.

Atypical (without damage to the salivary glands).

With damage to glandular organs.

With damage to the nervous system.

Recovery from residual pathology:

The incubation period ranges from 11 to 23 days (usually 18–20). Often the full picture of the disease is preceded by a prodromal period.

In some patients (more often in adults), 1–2 days before the development of the typical picture, prodromal phenomena are observed in the form of weakness, malaise, hyperemia of the oropharynx, muscle pain, headache, sleep disturbances and appetite.

Typically acute onset, chills and fever up to 39–40 °C.

One of the early signs of the disease is pain behind the earlobe (Filatov's symptom).

Swelling of the parotid gland most often appears towards the end of the day or on the second day of illness, first on one side, and after 1–2 days in 80–90% of patients, on the other. In this case, tinnitus, pain in the ear area, aggravated by chewing and talking, are usually noted, trismus is possible. The enlargement of the parotid gland is clearly visible. The gland fills the cavity between the mastoid process and the lower jaw. With a significant increase in the parotid gland, the auricle protrudes and the earlobe rises upward (hence the popular name “mumps”). The swelling spreads in three directions: anteriorly - on the cheek, downwards and posteriorly - on the neck and upwards - on the mastoid region. Swelling is especially noticeable when examining the patient from the back of the head. The skin over the affected gland is tense, of normal color, when palpating the gland it has a test consistency, and is moderately painful. The swelling reaches its maximum on the 3rd–5th day of the disease, then gradually decreases and disappears, as a rule, on the 6th–9th day (in adults on the 10th–16th day). During this period, salivation is reduced, the oral mucosa is dry, and patients complain of thirst. Stenon's duct is clearly visible on the mucous membrane of the cheek in the form of a hyperemic, edematous ring (Mursu's symptom). In most cases, not only the parotid, but also the submandibular salivary glands are involved in the process, which are determined in the form of slightly painful fusiform swellings of test consistency; if the sublingual gland is affected, the swelling is noted in the chin area and under the tongue. Damage to only the submandibular (submaxillitis) or sublingual glands is extremely rare. Internal organs with isolated mumps, as a rule, they are not changed. In some cases, patients experience tachycardia, apical murmur, muffled heart sounds, and hypotension.

Symptoms of mumps in children and adults

Damage to the central nervous system is manifested by headache, insomnia, and adynamia. The total duration of the febrile period is often 3–4 days, in severe cases up to 6–9 days.

A common symptom of mumps in adolescents and adults is testicular damage (orchitis). The frequency of mumps orchitis directly depends on the severity of the disease. In severe and moderate forms, it occurs in approximately 50% of cases. Orchitis without damage to the salivary glands is possible. Signs of orchitis are noted on the 5th–8th day of illness against the background of a decrease and normalization of temperature.

At the same time, the patients’ condition worsens again: body temperature rises to 38–39 °C, chills appear, headache, nausea and vomiting are possible. Severe pain is noted in the scrotum and testicles, sometimes radiating to the lower abdomen. The testicle enlarges 2–3 times (to the size of a goose egg), becomes painful and dense, the skin of the scrotum is hyperemic, often with a bluish tint. Most often one testicle is affected. Severe clinical manifestations of orchitis persist for 5–7 days. Then the pain disappears, the testicle gradually decreases in size. In the future, signs of its atrophy can be noted.

In almost 20% of patients, orchitis is combined with epididymitis. The epididymis is palpated as an oblong painful swelling. This condition leads to impaired spermatogenesis. Data have been obtained on the erased form of orchitis, which may also be the cause male infertility. In case of mumps orchitis, pulmonary infarction due to thrombosis of the prostate veins and pelvic organs. An even rarer complication of mumps orchitis is priapism. Women may develop oophoritis, bartholinitis, and mastitis. Oophoritis, which does not affect fertility and does not lead to sterility, is uncommon in female patients during the postpubertal period. It should be noted that mastitis can also develop in men.

A common manifestation of mumps is acute pancreatitis, which is often asymptomatic and diagnosed only on the basis of increased amylase and diastase activity in the blood and urine. The incidence of pancreatitis, according to various authors, varies widely - from 2 to 50%. It most often develops in children and adolescents. This scatter of data is associated with the use of different criteria for diagnosing pancreatitis. Pancreatitis usually develops on the 4th–7th day of illness. Nausea, repeated vomiting, diarrhea, and girdling pain in the middle part of the abdomen are observed. With severe pain, tension in the abdominal muscles and symptoms of peritoneal irritation are sometimes noted. Characterized by a significant increase in amylase (diastase) activity, which persists for up to one month, while other symptoms of the disease disappear after 5–10 days. Damage to the pancreas can lead to atrophy of the islet apparatus and the development of diabetes.

In rare cases, other glandular organs may also be affected, usually in combination with the salivary glands. Thyroiditis, parathyroiditis, dacryoadenitis, thymoiditis have been described.

Damage to the nervous system is one of the frequent and significant manifestations of mumps infection. Serous meningitis is most often observed. Meningoencephalitis and neuritis are also possible cranial nerves, polyradiculoneuritis.

The clinical picture of mumps meningitis is polymorphic, so the diagnostic criterion can only be the identification of inflammatory changes in the CSF.

There may be cases of mumps occurring with meningismus syndrome when the CSF is intact. On the contrary, inflammatory changes in the CSF are often noted without the presence of meningeal symptoms, therefore data on the frequency of meningitis, according to various authors, vary from 2–3 to 30%. Meanwhile timely diagnosis and treatment of meningitis and other central nervous system lesions significantly affects the long-term consequences of the disease.

Meningitis is most often observed in children aged 3–10 years. In most cases, it develops on the 4th–9th day of illness, i.e. in the midst of damage to the salivary glands or against the background of subsiding of the disease. However, it is also possible that symptoms of meningitis may appear simultaneously with damage to the salivary glands or even earlier.

There may be cases of meningitis without damage to the salivary glands, in rare cases - in combination with pancreatitis. The onset of meningitis is characterized by a rapid increase in body temperature to 38–39.5 ° C, accompanied by intense diffuse headache, nausea and frequent vomiting, skin hyperesthesia. Children become lethargic and adynamic. Already on the first day of the disease, meningeal symptoms, which are expressed moderately, often not in full, for example, only the symptom of planting (“tripod”).

In young children, convulsions and loss of consciousness are possible; in older children, psychomotor agitation, delirium, and hallucinations are possible. General cerebral symptoms usually regress within 1–2 days. Persistence for a longer period of time indicates the development of encephalitis. Intracranial hypertension plays a significant role in the development of meningeal and cerebral symptoms with an increase in LD to 300–600 mm H2O. Careful dropwise evacuation of CSF during lumbar puncture to a normal LD ​​level (200 mmH2O) is accompanied by a marked improvement in the patient’s condition (cessation of vomiting, clearing of consciousness, reduction in the intensity of headache).

CSF in mumps meningitis is clear or opalescent, pleocytosis is 200–400 in 1 μl. The protein content is increased to 0.3–0.6/l, sometimes up to 1.0–1.5/l; reduced or normal protein levels are rarely observed. Cytosis is usually lymphocytic (90% or higher); on days 1–2 of the illness it can be mixed. The concentration of glucose in the blood plasma is within normal values or increased. Sanitation of the cerebrospinal fluid occurs after the regression of meningeal syndrome, by the 3rd week of the disease, but can be delayed, especially in older children, up to 1–1.5 months.

With meningoencephalitis, 2–4 days after the development of the meningitis picture, against the background of weakening of meningeal symptoms, general cerebral symptoms increase, focal symptoms appear: smoothness of the nasolabial fold, tongue deviation, revival of tendon reflexes, anisoreflexia, muscle hypertonicity, pyramidal signs, symptoms of oral automatism, foot clonus, ataxia, intention tremor, nystagmus, transient hemiparesis. In young children, cerebellar disorders are possible. Mumps meningitis and meningoencephalitis are benign. As a rule, complete restoration of central nervous system functions occurs, but sometimes intracranial hypertension, asthenia, decreased memory, attention, and hearing may persist.

Against the background of meningitis, meningoencephalitis, sometimes in isolation, the development of neuritis of the cranial nerves, most often the VIII pair, is possible. In this case, dizziness, vomiting, worsening with changes in body position, and nystagmus are noted.

Patients try to lie still with their eyes closed. These symptoms are associated with damage to the vestibular apparatus, but cochlear neuritis is also possible, which is characterized by the appearance of noise in the ear, hearing loss, mainly in the high-frequency zone. The process is usually one-sided, but often full recovery no hearing occurs. It should be borne in mind that with severe mumps, short-term hearing loss is possible due to swelling of the external auditory canal.

Polyradiculoneuritis develops against the background of meningitis or meningoencephalitis; it is always preceded by damage to the salivary glands. In this case, the appearance of radicular pain and symmetrical paresis of predominantly distal limbs is characteristic; the process is usually reversible, and damage to the respiratory muscles is possible.

Sometimes, usually on the 10th–14th day of the disease, more often in men, polyarthritis develops. Large joints (shoulders, knees) are mainly affected. The process is usually reversible and ends with complete recovery within 1–2 weeks.

Complications (angina, otitis media, laryngitis, nephritis, myocarditis) are extremely rare. Blood changes during mumps are insignificant and are characterized by leukopenia, relative lymphocytosis, monocytosis, increased ESR, and leukocytosis is sometimes noted in adults.

Diagnosis of mumps

Diagnosis is based mainly on the characteristic clinical picture and epidemiological history, and in typical cases does not cause difficulties. Of the laboratory methods for confirming the diagnosis, the most conclusive is the isolation of the mumps virus from the blood, parotid gland secretions, urine, CSF and pharyngeal swabs, but in practice this is not used.

In recent years, serological diagnostic methods have begun to be used more often; ELISA, RSK and RTGA are most often used. A high titer of IgM and a low titer of IgG during the acute period of infection can serve as a sign of mumps. The diagnosis can be definitively confirmed after 3–4 weeks by re-examining the antibody titer, while an increase in IgG titer by 4 times or more has diagnostic value. When using RSK and RTGA, cross-reactions with the parainfluenza virus are possible.

Recently, diagnostic methods have been developed using PCR of the mumps virus. For diagnosis, the activity of amylase and diastase in the blood and urine is often determined, the content of which increases in most patients. This is especially important not only for the diagnosis of pancreatitis, but also for indirect confirmation of the mumps etiology of serous meningitis.

Differential diagnosis

Differential diagnosis of mumps should first of all be carried out with bacterial mumps and salivary stone disease. Enlargement of the salivary glands is also seen in sarcoidosis and tumors. Mumps meningitis is differentiated from serous meningitis of enteroviral etiology, lymphocytic choriomeningitis, and sometimes tuberculous meningitis. In this case, an increase in the activity of pancreatic enzymes in the blood and urine during mumps meningitis is of particular importance.

The greatest danger is in cases where swelling subcutaneous tissue neck and lymphadenitis, which occurs in toxic forms of oropharyngeal diphtheria (sometimes with infectious mononucleosis and herpesvirus infections), is mistaken by the doctor for mumps. Acute pancreatitis should be differentiated from acute surgical diseases abdominal cavity (appendicitis, acute cholecystitis).

Mumps orchitis is differentiated from tuberculous, gonorrheal, traumatic and brucellosis orchitis.

Algorithm for diagnosing mumps infection in adults.

Symptoms of intoxication - Yes - Pain when chewing and opening the mouth in the area of ​​the salivary glands - Yes - Enlargement of one or more salivary glands (parotid, submandibular) - Yes - Simultaneous damage to the salivary glands and pancreas, testicles, mammary glands, development serous meningitis- Yes - Study completed, diagnosis: mumps

Table Differential diagnosis of mumps

Indications for consultation with other specialists

If neurological symptoms are present, consultation with a neurologist is indicated; if pancreatitis develops (abdominal pain, vomiting), consult a surgeon; if orchitis develops, consult a urologist.

An example of a diagnosis formulation

B26, B26.3. Mumps, pancreatitis, moderate course of the disease.

Treatment of mumps

Patients from closed children's groups (orphanages, boarding schools, military units) are hospitalized. As a rule, patients are treated at home. Hospitalization is indicated for severe disease (hyperthermia over 39.5 °C, signs of central nervous system damage, pancreatitis, orchitis). In order to reduce the risk of complications, regardless of the severity of the disease, patients should remain in bed during the entire period of fever. It was shown that in men who did not comply with bed rest in the first 10 days of illness, orchitis developed 3 times more often.

During the acute period of the disease (up to the 3rd–4th day of illness), patients should receive only liquid and semi-liquid food. Considering salivation disorders, great attention should be paid to oral care, and during the recovery period it is necessary to stimulate salivary secretion, using, in particular, lemon juice.

To prevent pancreatitis, a dairy-vegetable diet is advisable (table No. 5). Drinking plenty of fluids (fruit drinks, juices, tea, mineral water) is recommended.

For headaches, metamizole sodium, acetylsalicylic acid, and paracetamol are prescribed. It is advisable to prescribe desensitizing drugs.

To reduce local manifestations of the disease, light and heat therapy (Sollux lamp) is prescribed to the area of ​​the salivary glands.

For orchitis, prednisolone is used for 3-4 days at a dose of 2-3 mg/kg per day, followed by a dose reduction of 5 mg daily. It is necessary to wear a suspensor for 2-3 weeks to ensure the elevated position of the testicles.

In case of acute pancreatitis, a gentle diet is prescribed (on the first day - a starvation diet). Cold on the stomach is indicated. To reduce pain, analgesics are administered and aprotinin is used.

If meningitis is suspected, a lumbar puncture is indicated, which has not only diagnostic but also therapeutic value. In this case, analgesics, dehydration therapy using furosemide (Lasix) at a dose of 1 mg/kg per day, and acetazolamide are also prescribed.

In case of severe cerebral syndrome, dexamethasone is prescribed at 0.25–0.5 mg/kg per day for 3–4 days; for meningoencephalitis, nootropic drugs are prescribed in courses of 2–3 weeks.

Forecast

Favorable, deaths are rare (1 per 100 thousand cases of mumps). Some patients may develop epilepsy, deafness, diabetes mellitus, decreased potency, testicular atrophy with subsequent development of azospermia.

Approximate periods of incapacity for work

The period of incapacity for work is determined depending on clinical course mumps, the presence of meningitis and meningoencephalitis, pancreatitis, orchitis and other specific lesions.

Clinical examination

Not regulated. It is carried out by an infectious disease specialist depending on the clinical picture and the presence of complications. If necessary, specialists from other specialties are involved (endocrinologists, neurologists, etc.).

Prevention of mumps

Patients with mumps are isolated from children's groups for 9 days. Contact persons (children under 10 years of age who have not had mumps and have not been vaccinated) are subject to separation for a period of 21 days, and in cases where the exact date of contact is established - from the 11th to the 21st day. Carry out wet cleaning of the premises using disinfectants and ventilation of the room. Children who have had contact with the patient are under medical supervision for the period of isolation. The basis of prevention is vaccination within the framework of the national calendar of preventive vaccinations in Russia.

Vaccination is carried out with a domestically produced mumps culture-based live dry vaccine, taking into account contraindications at 12 months and revaccination at 6 years. The vaccine is administered subcutaneously in a volume of 0.5 ml under the shoulder blade or into the outer surface of the shoulder. After administration of the vaccine, short-term fever, catarrhal symptoms for 4–12 days are possible, and very rarely, enlargement of the salivary glands and serous meningitis. For emergency prevention to those who have not been vaccinated against mumps and those who have not been ill, the vaccine is administered no later than 72 hours after contact with the patient. The mumps-measles cultural live dry vaccine (manufactured in Russia) and the live attenuated lyophilized vaccine against measles, mumps and rubella (manufactured in India) are also certified.

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MUMPS INFECTION (ICD-10 code - B26

Mumps infection (mumps, mumps) is an acute viral disease primarily affecting the salivary glands; Other glandular organs are less commonly affected: pancreas, testicles, ovaries, mammary glands, etc., as well as the nervous system (serous meningitis, meningoencephalitis, neuritis, etc.).

1-2 days the gland from the opposite side is involved in it. The skin over the swelling is tense, but without inflammatory changes. On palpation, the salivary gland has a soft or doughy consistency and is painful. N.F. painful points are identified. Filatova: in front of the earlobe, in the area of ​​the apex of the mastoid process and at the site of the mandibular notch.

Damage to the submandibular salivary glands (submaxillitis) is often combined with damage to the parotid salivary glands, and is rarely the primary and only manifestation of the disease. In these cases, the swelling is located in submandibular region in the form of a round formation with a doughy consistency. In severe forms, swelling of the tissue may appear in the gland area, spreading to the neck.

Isolated damage to the sublingual salivary gland - sublingual - is extremely rare. In this case, swelling appears under the tongue.

Orchitis usually appears 1-2 weeks after the onset of damage to the salivary glands; The primary localization of mumps infection is the testicles. The disease manifests itself as pain in the scrotum and testicles. The testicle enlarges, thickens, with

Rice. 2. Lesion of the parotid gland on the left

palpation is sharply painful. The skin of the scrotum is slightly hyperemic.

Damage to the nervous system in mumps manifests itself as serous meningitis, meningoencephalitis, and rarely neuritis or polyradiculoneuritis.

Serous meningitis most often appears on the 7-10th day of illness, after the symptoms of damage to the salivary glands begin to subside or are almost completely eliminated. It begins acutely, with fever, headache and repeated vomiting. From the first days of the disease, meningeal syndrome is detected: stiff neck, positive Kernig and Brudzinsky symptoms. The severity of clinical manifestations may vary, which determines the severity of the disease. The final diagnosis is made based on the results of a spinal puncture. With mumps meningitis, the cerebrospinal fluid is transparent, flows out in frequent drops or streams, high lymphocytic cytosis is detected (from 0.5x106/l to 3x106/l), up to 95-98% of lymphocytes. The protein content is slightly increased (from 0.99 to 1.98 g/l), and the amount of glucose and chlorides is within normal limits.

When serous meningitis is combined with encephalitis (meningoencephalitis), the disease is manifested by impaired consciousness, delirium, convulsions, hyperkinesis and pathological reflexes are possible.

Neuritis and polyradiculoneuritis are rare. A sharp enlargement of the parotid gland can lead to compression of the facial nerve and paralysis. In this case, on the affected side facial nerve function is impaired facial muscles: the folds of the forehead are smoothed, the eyebrow is somewhat pubescent, the palpebral socket does not close (hare eye), the nasolabial fold is smoothed. Pain appears at the exit point of the facial nerve.

During the period of convalescence of mumps, polyradiculitis of the Guillain-Barre type is possible. Clinically, they are manifested by gait disturbances, paresis and paralysis of the lower extremities, which have all the signs of peripheral ones: absence of reflexes, decreased muscle tone, muscle atrophy, symmetry of the lesion. At the same time, pain occurs. In the cerebrospinal fluid, the protein content increases and lymphocytic cytosis increases.

Mumps pancreatitis usually develops in combination with damage to other organs and systems and occurs on the 5-9th day from the onset of the disease. In rare cases, it is the only manifestation of the disease. The diagnosis is established by increasing the level of amylase in the blood.

For laboratory confirmation using ELISA, specific antibodies of class 1§M are detected in the blood. Specific antibodies of class 1§C appear somewhat later and persist for many years.

Mumps infection, which occurs with damage to the salivary glands, is differentiated from purulent parotitis, mumps in sepsis, infectious mononucleotide

zom, with blockage of the salivary gland duct, etc. Mumps meningitis is differentiated from enteroviral serous meningitis, tuberculous meningitis. Mumps orchitis is differentiated from enteroviral orchitis, bacterial orchitis, etc.

Purulent parotitis usually occurs against the background of some bacterial infection oral cavity, paranasal sinuses, sepsis.

With infectious mononucleosis, the lymph nodes are enlarged, including the parotid ones. The salivary glands remain unaffected.

When the salivary gland duct is blocked, the process is one-sided, there is no fever. Salivary gland stones can be detected using sialography or ultrasound.

Serous meningitis of enteroviral etiology is rarely the only manifestation of the disease. The data of the epidemic history and the results of laboratory examination are of decisive importance.

Tuberculous meningitis is characterized by a gradual onset of the disease, a slow increase in meningeal symptoms, and the loss of a fibrinous film in the form of a cobweb in a test tube with cerebrospinal fluid. The disease usually develops against the background of active respiratory tuberculosis.

There is no specific treatment.

When clinical symptoms of pancreatitis appear, the patient needs bed rest and a stricter diet. In severe cases, they resort to intravenous drip administration of fluid with proteolysis inhibitors - aprotinin (Gordox, Contrical, Trasylol). To relieve pain, antispasmodics and analgesics are prescribed: metamizole sodium (analgin), papaverine, drotaverine (no-shpu). To improve

Rice. 3. Submaxillitis

Digestive medicine is recommended to be prescribed enzyme preparations(pancreatin, panzi-norm, festal). To prevent the development of complications in patients with severe forms of the disease, inducers of interferonogenesis (Viferon, Cycloferon, Anaferon for children, etc.) are recommended.

It is better to hospitalize a patient with orchitis. Bed rest and suspension are prescribed for the acute period of the disease. Corticosteroid hormones are used as anti-inflammatory drugs at the rate of

2-3 mg/kg per day (prednisolone) in 3-4 doses over 3-4 days, followed by a rapid dose reduction with a total course duration of no more than 7-10 days. To relieve pain, analgesics and desensitizing drugs are prescribed: chloropyramine (suprastin), promethazine (pipolfen), hifenadine (fenkarol). In case of significant swelling of the testicle, in order to eliminate

To reduce pressure on the parenchyma of the organ, surgical intervention is justified - dissection tunica albuginea.

If you suspect mumps meningitis with diagnostic purpose A spinal puncture is indicated; in rare cases, it can also be performed as a therapeutic measure to reduce intracranial pressure. Lasix is ​​administered for the purpose of dehydration. IN severe cases resort to infusion therapy (1.5% reamberin solution, 20% glucose solution, B vitamins).

Those sick with mumps infection are isolated from the children's group until clinical manifestations disappear (for no more than 9 days). Among contact persons, children under 10 years of age who have not had mumps infection and have not received active immunization are subject to separation for a period of 21 days. In cases where the exact date of contact is established, the separation time is reduced and children are subject to isolation from the 11th to the 21st day of the incubation period. Final disinfection is not carried out at the source of infection, but the room should be ventilated and wet cleaning should be carried out using disinfectants.

The only reliable method of prevention is active immunization.

For vaccination, domestic mumps culture is used. live vaccine, as well as live attenuated mumps-measles vaccine. The vaccine strain of the domestic vaccine is grown on a cell culture of Japanese quail embryos. The following combined vaccines for the prevention of measles, rubella and mumps are also approved in Russia: Priorix (GlaxoSmithKline, England), MM R-11 (Merck Sharp and Dome, USA), measles, mumps, rubella vaccine produced in India (" Serum Institute"). Foreign vaccine strains are cultivated on chicken embryos.

Children aged 12 months, with revaccination at 6 years, who have not had mumps infection, are subject to vaccination. The vaccine is administered subcutaneously in a volume of 0.5 ml into the outer surface of the shoulder. After vaccination and revaccination, strong (possibly lifelong) immunity is formed. It is also recommended that vaccination be carried out according to epidemiological indications for adolescents and adults who are seronegative for the epidemic.

The vaccine is slightly reactogenic. Contraindications to vaccination are immunodeficiency conditions, severe forms allergic reactions on egg white, aminoglycosides.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2016

Mumps (B26)

Short description

Approved
Joint Commission on Healthcare Quality
Ministry of Health and Social Development of the Republic of Kazakhstan
from August 16, 2016
Protocol No. 9

Mumps infection. Epidemic mumps (parotitis epidemica) is an acute viral disease caused by paramyxovirus, characterized by fever, general intoxication, enlargement of one or more salivary glands, and often damage to other glandular organs and the central nervous system.

Correlation of ICD-10 and ICD-9 codes

ICD-10		ICD-9
Code	Name	Code	Name
At 26	Parotitis	-	-
At 26.0	Mumps orchitis
At 26.1	Mumps meningitis
At 26.2	Mumps encephalitis
At 26.3	Mumps pancreatitis
At 26.8	Mumps with other complications
At 26.9	Mumps without complications

Date of development of the protocol: 2016

Protocol users: emergency doctors emergency care, paramedics, doctors general practice, therapists, infectious disease specialists.

Level of evidence scale:

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	High-quality (++) systematic review of cohort or case-control studies, or High-quality (++) cohort or case-control studies with very low risk of bias, or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+). The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the relevant population.
D	Case series or uncontrolled study or expert opinion.

Classification

Clinical classification of mumps (Lobzin Yu.V., 2003).

Type:
A. Typical forms:
· uncomplicated: damage to only the salivary glands, one or more;
· complicated: damage to the salivary glands and other organs (meningitis, meningoencephalitis, pancreatitis, orchitis, mastitis, myocarditis, arthritis, nephritis).

By severity:
· easy;
· average;
· heavy.

B. Atypical forms:
· erased;
· inapparent.

B. Residual phenomena of mumps:
testicular atrophy;
· infertility;
· diabetes;
· deafness;
· dysfunction of the central nervous system.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS

Diagnostic criteria:
Complaints:
· body temperature up to 38.0-40.0°C;
· headache;
· chills;
sleep and appetite disturbances;
· weakness, malaise;

pain in the ear area;
· dry mouth.

Anamnesis:
Acute onset of the disease;

· contact with the patient;

Physical examination
Characteristic syndromes:
Intoxication syndrome:
Increase in temperature from low-grade fever (with mild degree severity) up to 38.0-40.0°C (with moderate and severe severity). Fever reaches its maximum severity on days 1-2 of illness and lasts 4-7 days; the temperature decreases lytically. With a complicated course of mumps, intoxication and fever occur in waves, each wave is associated with the appearance of another complication.

Mumps (



· the skin over the swelling is stretched, difficult to fold, has
normal color, local temperature is not changed;
· positive symptom Filatova (swelling and pain when pressing on the tragus, mastoid process and in the area of ​​the retromandibular fossa),

· reduction of salivation.

· reduction of salivation.

Sublinguit:

· reduction of salivation;

Complications:


· nausea, vomiting;

loose stools or constipation.

Orchitis (damage to the gonads):
increased body temperature;


· dense consistency;

· the skin of the scrotum is hyperemic;


· “autonomous” orchitis (the only) manifestation of the disease.

Prostatitis (damage to the prostate gland):

):
increased body temperature;
· weakness, malaise;

Serous meningitis:
Serous meningitis is combined with damage to other organs and systems and begins 3-6 days after the onset of symptoms of mumps:
· acute onset;

· headache;
repeated vomiting;
· insomnia;
· hyperesthesia;
photophobia;
· hyperacusis;
· convulsions;
· delirium;

In rare cases, symptoms of serous meningitis precede damage to the salivary glands.

Meningoencephalitis develops on days 6-10 of the disease, a rare, severe complication of mumps:
· Strong headache;
repeated vomiting;
adynamia;
· drowsiness;
· lethargy;
· loss of consciousness;

· paresis of cranial nerves;
· hemiparesis;
· cerebellar ataxia.

Mononeuritis (

Myelitis and encephalomyelitis

Severity criteria mumps:

Light form:
· symptoms of intoxication are absent or mild (increase in body temperature to subfebrile levels, slight weakness, malaise, headache);
· no complications.

Moderate form:


· presence of complications.

Severe form:

· multiple complications;

Laboratory research
Clinical analysis:

Biochemical analysis:
· biochemical blood test: increased amylase activity;
· biochemical urine analysis: increased diastase activity.

Serological blood test:
· ELISA - detection of IgM to the mumps virus.

Instrumental studies:
· not performed on an outpatient basis.

Diagnostic algorithm

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL

Diagnostic criteria at the hospital level
Complaints:
· body temperature up to 38.0-40.0°C;
· headache;
· chills;
sleep and appetite disturbances;
· weakness, malaise;
Pain when chewing and opening the mouth;
pain in the ear area;
· dry mouth.

Anamnesis:
Acute onset of the disease;
· the appearance of swelling in the parotid area on one side, a few days later on the other;
· contact with the patient;
· lack of vaccination and past mumps.

Physical examination
Intoxication syndrome:
· Increase in temperature from subfebrile levels (with mild severity) to 38.0-40.0°C (with severe severity). Fever reaches its maximum severity on the 1st-2nd day of illness and lasts 4-7 days; the temperature decreases lytically. With a complicated course of mumps, intoxication and fever occur in waves, each wave is associated with the appearance of another complication.

Glandular organ syndrome
Mumps (unilateral or bilateral damage to the parotid salivary glands):
Moderately painful swelling in the parotid area in front, below and behind auricle, doughy consistency, a compaction in the center, the earlobe is protruding, the inflamed gland fills the hole between the neck and lower jaw;
· with bilateral damage to the glands, the head is “pear-shaped”, the ears are protruding;
· swelling of the tissue around the gland, spreading to the cheek, temporal region and mastoid region (not always);
· the skin over the swelling is tense, difficult to fold, has a normal color, the local temperature is not changed;
· positive Filatov's sign (swelling and pain when pressing on the tragus, mastoid process and in the area of ​​the retromandibular fossa;
positive Murson's sign (when examining the mucous membrane of the cheeks, swelling and hyperemia around the mouth of the parotid (Stenon) duct of the parotid gland);
· reduction of salivation.

Submaxillitis (unilateral or bilateral damage to the submandibular salivary glands):
· a spindle-shaped painful formation with a doughy consistency is palpated under the lower jaw;
· swelling of soft tissues spreading to the neck (not always);
· reduction of salivation.

Sublinguit:
· swelling and tenderness in the chin area and under the tongue;
· reduction of salivation;
· possible development of edema of the pharynx, larynx, tongue with a pronounced increase in the submandibular and sublingual salivary glands.

Pancreatitis (damage to the pancreas):
increased body temperature;
· nausea, vomiting;
· pain in the upper abdomen;
loose stools or constipation.

Orchitis (damage to the gonads)
increased body temperature;
· pain in the affected testicle with irradiation to the inguinal and femoral areas;
· testicle enlargement 2-3 times (usually unilateral damage to the right testicle);
· “primary” orchitis (precedes an enlargement of the parotid salivary glands);
· “concomitant” orchitis (develops simultaneously with mumps);
· “autonomous” orchitis (the only manifestation of the disease);
· dense consistency;
· pain on palpation;
· hyperemia of the skin of the scrotum.

Prostatitis (damage to the prostate gland)
· pain in the perineum and anus;
· enlargement of the prostate gland using digital examination of the rectum.

Oophoritis (damage to the female reproductive glands)
increased body temperature;
· weakness, malaise;
· pain in the iliac region.

Syndrome of damage to the central and peripheral nervous system
Serous meningitis:
Serous meningitis is combined with damage to other organs and systems and begins 3-6 days after the onset of symptoms of mumps.
· acute onset;
· sharp increase in body temperature to 39.0-40.0°C;
· headache;
repeated vomiting;
· insomnia;
· hyperesthesia;
photophobia;
· hyperacusis;
· convulsions;
· delirium;
· loss of consciousness;
Positive meningeal symptoms (stiff neck, Brudzinski's, Kernig's symptoms).
In rare cases, symptoms of serous meningitis precede damage to the salivary glands.

Meningoencephalitis develops on the 6-10th day of the disease, a rare, severe complication of mumps:
· Strong headache;
repeated vomiting;
adynamia;
· drowsiness;
· lethargy;
· loss of consciousness;
· clonic-tonic convulsions;
· paresis of cranial nerves;
· hemiparesis;
· cerebellar ataxia.

Mononeuritis ( damage to the cranial nerves), mainly lesions of the VII pair of the peripheral type and VIII pair:
· with damage to the auditory nerve - dizziness, nystagmus, tinnitus, hearing loss.

Myelitis and encephalomyelitis appear on the 10-12th day of illness, manifested by spastic lower paraparesis, dysfunction of the pelvic organs (incontinence of stool, urine).

Rare complications of mumps: mastitis, bartholinitis, thyroiditis, nephritis, urethritis, hemorrhagic cystitis, myocarditis, dacryocystitis, damage to the respiratory system, swelling of the pharynx, larynx, tongue.

Severity criteria mumps:
· severity of symptoms of intoxication;
· presence or absence of complications.

Light form:
· symptoms of intoxication are absent or mild (increase in body temperature to subfebrile levels, slight weakness, malaise, headache), there are no complications.

Moderate form:
· febrile body temperature (38.0-39.0°C), symptoms of intoxication are pronounced - general weakness, headache, chills, arthralgia, myalgia;
· significant enlargement of the salivary glands;
· presence of complications.

Severe form:
· symptoms of severe intoxication: body temperature above 40°C, severe weakness, sleep disturbance, tachycardia, decreased blood pressure;
· multiple complications;
· toxicosis and fever occur in the form of waves, each new wave is associated with the appearance of another complication.

Laboratory research:
· CBC: leukopenia, lymphocytosis, ESR is not changed.
OAM: proteinuria, cylindruria (with severe course diseases).

CSF examination:
· color - colorless;

· pressure - liquid flows out in a stream or frequent drops, the pressure reaches 300-500 mm of water. Art.;

(according to indications):
· spinal tap - when cerebral symptoms or positive meningeal symptoms appear;

· Ultrasound of the abdominal organs - to determine the degree of damage to the size and structure of the pancreas tissue;

Diagnostic algorithm: see outpatient level.

List of main diagnostic measures:
· CBC: leukopenia, lymphocytosis, ESR is not changed;
· OAM: proteinuria, cylindruria (in severe disease);
· Biochemical blood test: increased activity of amylase, diastase.

Serological blood test:
· ELISA - detection of Ig M to the mumps virus.
· RSK, RTGA - increase in antibody titer by 4 times or more when studying paired sera (the first is taken at the onset of the disease, the second after 2-3 weeks), with a single study the diagnostic titer is 1:80.

Molecular genetic method:
· PCR - detection of virus RNA in saliva and nasopharyngeal wash.

List of additional diagnostic measures:
CSF examination(according to indications):
· color - colorless;
· transparency - transparent or slightly opalescent;
· pressure - liquid flows out in a stream or frequent drops, the pressure reaches 300-500 mm water column;
· pleocytosis - lymphocytic within 300-700 cells, up to 1000 in 1 μl;
· increase in protein to 0.3-0.9 g/l (with the development of meningoencephalitis, the indicators are higher);
· glucose level is unchanged or slightly increased;
· chloride level is not changed.

Instrumental studies(according to indications):
spinal puncture - when identifying cerebral symptoms, positive meningeal symptoms;
· Ultrasound of the salivary glands - to clarify the extent of damage;
· Ultrasound of the abdominal organs - to determine the extent of damage to the size and structure of the pancreas;
Ultrasound of the scrotum and pelvis - to determine the degree of organ damage reproductive system;
· ECG - for disorders of the cardiovascular system, for early detection heart damage (with severe severity);
· Radiography of organs chest- if there is a suspicion of the development of inflammatory changes in the lower parts of the respiratory system, including pneumonia;
· EEG - in the presence of focal neurological symptoms, seizures, signs of intracranial hypertension.

Differential diagnosis

Diagnosis	Rationale for differential diagnosis	Surveys	Diagnosis exclusion criteria
Purulent parotitis	General symptoms: acute onset, severe symptoms intoxication, fever, swelling in the parotid area.	Surgeon consultation	Fever above 390C. The swelling in the area of ​​the salivary glands is sharply painful, dense with gradual softening and fluctuation. The defeat is always one-sided. Discharge of pus from the mouth of the Stenon's duct. In the CBC, leukocytosis with a neutrophilic shift to the left, increased ESR.
Infectious mononucleosis	General symptoms: acute onset, fever, symptoms of intoxication, swelling in the parotid and submandibular areas.	Consultation with an infectious disease specialist	Enlarged cervical lymph nodes located in the form of chains along the sternocleidomastoid muscles, sore throat, hepatosplenomegaly, rash, possible presence of icteric syndrome. Persistent prolonged fever. In the UAC, leukocytosis with a neutrophilic shift to the left, accelerated ESR. The diagnosis is confirmed by detection of atypical mononuclear cells in the blood and an increase in the titer of antibodies that agglutinate foreign red blood cells (Paul-Bunnel reaction).
Lymphogranulomatosis	General symptoms: swelling in the parotid and submandibular areas.	Consultation with an infectious disease specialist, hematologist, oncologist	Damage to lymph nodes (all possible groups of lymph nodes). In this case, the latter is usually preceded by “causeless” weakness, asthenia, periodic increase body temperature, increased sweating. The disease is characterized by a long progressive course. In the CBC, leukocytosis with a neutrophilic shift to the left, pronounced monocytosis, accelerated ESR. The final diagnosis of lymphogranulomatosis is confirmed by the results of a lymph node biopsy.
Salivary stone disease		Surgeon consultation	No fever or intoxication. Relapsing course of the disease. The swelling either increases or decreases, and “salivary colic” intensifies when eating. There is no damage to other organs. There are no changes to the UAC.
Mikulicz syndrome	General symptoms: swelling in the parotid area	Surgeon consultation	The onset of the disease is gradual with chronicity of the process. Increased body temperature, lack of intoxication. The enlargement of the salivary glands is bilateral, lumpy, and slightly painful. Damage to other organs: enlargement of the lymph glands, liver, spleen, ptosis. In the UAC thrombocytopenia, anemia.

Algorithm for differential diagnostic search if a patient has swelling in the submandibular and parotid areas

Treatment abroad

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Treatment

Drugs (active ingredients) used in treatment

Amoxicillin

Aprotinin

Ascorbic acid

Acetazolamide

Dexamethasone

Dextrose

Diclofenac

Ibuprofen

Clavulanic acid

Loratadine

Mannitol

Meglumine

Sodium chloride

Omeprazole

Pancreatin

Pantoprazole

Paracetamol

Prednisolone

Furosemide

Chloropyramine

Cetirizine

Cefazolin

Ceftriaxone

Treatment (outpatient clinic)

OUTPATIENT TREATMENT

On an outpatient basis, mild and moderate forms of mumps are treated without complications.

Non-drug treatment :

Drug treatment
Etiotropic therapy: is not carried out.

Pathogenetic therapy
Detoxification therapy:
· drink plenty of water at the rate of 20-40 ml/kg.

Desensitization therapy:


or
· cetirizine 5 mg, 10 mg, 1 tablet orally 1 time per day, 5-7 days [UD-B],
or

Vitamin therapy

Symptomatic therapy:
When body temperature rises above 38.0°C
one of the following drugs:
ibuprofen 200 mg, 400 mg, 1 tablet orally 3-4 times a day, until fever subsides [UD - A];
or

or

· ascorbic acid, 50 mg, orally [UD - C].

ibuprofen 200 mg, 400 mg, orally [UD-A];
or
Diclofenac 75 mg/2 ml, IM [UD - A];
or
· paracetamol 500 mg, orally [UD - A].
· chloropyramine 25 mg, orally [UD - C];
or
cetirizine 5 mg, 10 mg, orally [UD - B];
or
· loratadine 10 mg, orally [LE - B].

Indications for consultation with specialists:
· consultation with a surgeon: when developing a clinical picture of an acute abdomen and resolving the issue of surgical treatment of severe orchitis;



· consultation with an obstetrician-gynecologist: for mumps in pregnant women, in persons with damage to the female reproductive glands.

Preventive actions:
Isolation until the 9th day from the moment of illness. Final disinfection of outbreaks is not carried out. The room is ventilated and wet cleaned using disinfectants.
Among contacts, children under 10 years of age who have not had mumps and have not been vaccinated are subject to separation for a period of 21 days. From the 10th day of contact, systematic medical observation (examination, thermometry) is carried out.

In foci of mumps, the circle of people subject to immunization according to epidemic indications is determined. Immunization is subject to persons who have had contact with the patient (if the disease is suspected), who have not had mumps before, who have not been vaccinated (or once vaccinated), with an unknown infectious and vaccination history, as well as persons who have not had antibodies in their protective shields during a serological examination. titers to the mumps virus. Immunization against mumps according to epidemic indications is carried out within 7 days from the moment the first patient is identified in the outbreak.

Children who have not been vaccinated against mumps (under vaccination age or who have not received vaccination due to medical contraindications or refusal of vaccinations) no later than the 5th day from the moment of contact with the patient, normal human immunoglobulin is administered in accordance with the instructions for its use. Information about the vaccinations performed and the administration of immunoglobulin (date, name of the drug, dose, series, control number, expiration date, manufacturer) is entered into the registration forms in accordance with the requirements for the organization of vaccination.
Specific prophylaxis is carried out with a live KKP vaccine at 12 months, revaccination at 6 years.

Monitoring the patient's condition:
· re-examination by the local doctor after 2 days or earlier, if the patient has become worse, a fever above 38 o C, repeated vomiting, severe headache, drowsiness, lethargy have appeared;
· inform the patient in what situation it is necessary to see a doctor again;
Refer the patient to hospital treatment: when complications occur from the nervous system (impaired consciousness, delirium, convulsions, meningeal symptoms), gastrointestinal tract(pain in the upper abdomen, repeated vomiting), genitourinary system(pain in groin area, testicular enlargement).

Indicators of treatment effectiveness

· no complications.

Treatment (inpatient)

INPATIENT TREATMENT

Treatment tactics

Non-drug treatment :
· Regimen: bed in the acute period of illness (7-10 days).
· Diet No. 2: drink plenty of fluids, sour fruit juices and fruit drinks, water with lemon juice(to stimulate the secretion of saliva by the salivary glands). Food is liquid, semi-liquid, dairy-vegetable, limiting baked goods, pasta, fatty, fried foods, cabbage. Brown bread, rice, and potatoes are allowed.
· Apply dry heat locally to the area of ​​the salivary glands.
· Oral care, rinsing the oropharynx (warm boiled water, herbal decoction, 2% sodium bicarbonate solution, antiseptics) 4-6 times a day.
· For orchitis - wearing a suspensor.

Drug treatment
Etiotropic therapy not developed.

Detoxification therapy:
· for moderate disease without complications - drink plenty of fluids at the rate of 20-40 ml/kg;
· in severe cases of the disease with complications - infusion therapy- administration of isotonic (0.9% sodium chloride solution, 400; 5% dextrose solution, 400.0) and colloidal (meglumine sodium succinate, 400.0) solutions in a ratio of 3-4:1 in a total volume of 1200-1500 ml per within 3-5 days.

Desensitization therapy:
one of the following drugs:
· chloropyramine 25 mg, 1 tablet orally 3 times a day, 5-7 days [UD - C];
or
· cetirizine 5 mg, 10 mg, 1 tablet orally 1 time per day, 5-7 days [UD-B];
or
· Loratadine 10 mg, 1 tablet orally 1 time per day, 5-7 days [EL-B].

Vitamin therapy for the regulation of redox processes, antioxidant purpose:
· ascorbic acid 50 mg, 2 tablets orally 3 times a day, course 2 weeks.
Symptomatic therapy:
If body temperature rises above 38.0°C:
one of the following drugs:
· ibuprofen 200 mg, 400 mg, 1 tablet orally 3-4 times a day, until fever subsides [UD - A];
or
Diclofenac 75 mg/2 ml, IM [UD - A];
or
· paracetamol 500 mg, 1 tablet orally, with an interval of at least 4 hours [UD - A].

Pathogenetic treatment of mumps with complications

Serous meningitis	Pancreatitis	Orchitis	Bacterial complications
GCS therapy -Prednisolone, ampoules 30 mg/ml, 25 mg/ml, calculated at 2 mg/kg/day. i/v, i/m; -Dexamethasone, ampoules 4 mg/ml at the rate of 0.2 mg/kg/day, course of treatment up to 3 days. Dehydration therapy from 4-5 days of illness Furosemide, ampoules 10 mg/ml, 2.0 ml (in severe cases up to 100 mg/day), course of treatment 1-3 days; - mannitol (10, 15 and 20%) - 400.0 ml intravenously over 10-20 minutes. (if there is a threat of cerebral edema); -acetazolamide 250 mg, 1 tablet per day	Antisecretory therapy One of the following drugs -Pantoprazole 20 mg, 40 mg orally 2 times a day, -Omeprazole 20 mg, 40 mg 2 times a day. Protease inhibitors -Aprotinin 10,000 units, ampoules, intravenous drip, course 5-7 days. Treatment of deficiency exocrine function pancreas -Pancreatin 10000, 25000 units. for meals	GCS therapy Prednisol 5 mg, orally 40-60 mg for 5-7 days, followed by a daily dose reduction of 5 mg	Antibacterial therapy One of the following drugs -Amoxicillin + clavulonic acid 500/125 mg, 875/125 mg, 1 tablet 2-3 times a day, course 7-10 days; -Cefazolin powder for the preparation of solution for injection in a bottle 1g, 2g 2-3 times a day IM, IV, course 7-10 days; -Ceftriaxone powder for the preparation of solution for injection in a bottle 1g, 2g 2-3 times a day IM, IV, course 7-10 days.

List of essential medicines
· ascorbic acid, 50 mg, tablets orally [UD - C].

List of additional medicines
ibuprofen 200 mg, 400 mg, tablets orally [UD-A];
· or diclofenac 75 mg/2 ml, IM ampoules [UD - A].
· or paracetamol 500 mg, tablets orally [UD - A].
· chloropyramine 25 mg, tablets orally [UD - C];
· or cetirizine 5 mg, 10 mg, tablets orally [UD-B],
· or loratadine 10 mg, tablets orally [UD-B].
Prednisolone, 30 mg/ml, 25 mg/ml, ampoules IM, IV;
· dexamethasone, 4 mg/ml, ampoules IM, IV;
furosemide, 10 mg/2.0 ml, ampoules IM, IV;
· mannitol 10, 15 and 20% 400.0 ml bottle, IV;
· acetazolamide 250 mg, tablets orally;
pantoprazole 20, 40 mg tablets, or
· omeprazole 20, 40 mg tablets;
· aprotinin 10,000 units, ampoules, i.v.
· Pancreatin 10000, 25000 units, capsules;
amoxicillin + clavulonic acid 500/125 mg, 875/125 mg, tablets or
· cefazolin powder for the preparation of solution for injection in a bottle of 1g, 2g IM, IV, or
· ceftriaxone powder for the preparation of solution for injection in a bottle 1g, intramuscularly, intravenously;
· 0.9% sodium chloride solution, 400, IV bottle;
· 5% dextrose solution, 400.0, IV bottle;
· meglumine sodium succinate, 400.0, IV bottle.

Surgical intervention:
· in case of severe orchitis - dissection of the tunica albuginea of ​​the testicle.

Other types of treatment: No.

Indications for consultation with specialists
· consultation with a surgeon: for differential diagnosis with acute surgical diseases of the abdominal cavity, resolving the issue of surgical treatment of severe orchitis;
· consultation with an endocrinologist: with the development of diabetes mellitus and obesity as a result of mumps;
· consultation with a gastroenterologist: in case of damage to the pancreas;
· consultation with a urologist: in case of damage to the gonads and prostate gland;
· consultation with an obstetrician-gynecologist: for mumps in pregnant women, in persons with damage to the female reproductive glands;
· consultation clinical pharmacologist: for correction and justification of treatment.

Indications for transfer to the department intensive care and resuscitation
· severe forms of mumps with severe neurological disorders, development of emergency conditions (respiratory, cardiovascular failure, signs of depression of consciousness).

Indicators of treatment effectiveness:
· relief of symptoms of the disease;
· no complications;
normalization laboratory parameters- UAC, biochemical analysis blood;
· restoration of working capacity.

Further management:
· Monitoring of discharge and placement dispensary observation for convalescents. Discharge of a patient from the hospital after suffering from mumps is carried out according to clinical indications and in the absence of complications, no earlier than 9 days from the onset of the disease. Patients who have had mumps with complications are subject to dispensary observation by appropriate specialists, who determine the program and period of dispensary observation, deregistration after persistent disappearance of residual effects.

Hospitalization

Indications for planned hospitalization: No.

Indications for emergency hospitalization(infectious diseases hospital/department - boxes or small wards):
· moderate and severe forms with complications;
· presence of risk factors (chronic diseases, immunodeficiency states);
· epidemiological indications - persons living in family dormitories, communal apartments, unfavorable social conditions.

Information

Sources and literature

1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
   1. 1) Infectious diseases: national leadership. /Ed. N.D. Yushchuka, Yu.Ya. Vengerova. M.: GEOTAR-Media, 2009, pp. 441–53. 2) Manual infectious diseases. / Ed. corresponding member RAMS, prof. Yu.V. Lobzin. 3rd edition, expanded and revised. - St. Petersburg: Foliot, 2003.-936 p. 3) Amireev S.A., Bekshin Zh.M., Muminov T.A. and others. Standard definitions of cases and algorithms of measures for infectious diseases. Practical Guide, 2nd edition, updated. - Almaty, 2014 - 638 p. 4) Duysenova A.K., Shokalakova A.K., Sadykova A.M., Abildaeva I.Zh., Imanbaeva A.E. Features of the course of mumps infection in adults based on materials from the State Clinical Hospital named after. I.S. Zhekenova./ Journal “Medicine”.-No. 12.-2014.-P.63-66. 5) Clinical and laboratory diagnosis of infectious diseases. / Ed. Yu.V. Lobzin. Guide for doctors. - St. Petersburg: Foliot, 2001.-384 p. 6) Mumps. Modern representations about the pathogen, clinic, diagnosis, prevention./Ed. A.P. Agafonova.- Novosibirsk: JSC “Medical and Biological Union”, 2007.-82 p. 7) Clinical recommendations for the provision of medical care to children with mumps/ Public organization"Eurasian Society for Infectious Diseases", Chairman Yu.V. Lobzin, 2015.

Information

Abbreviations used in the protocol

Ig G immunoglobulins G
Ig M immunoglobulins M
blood pressure
ELISA enzyme immunoassay
IU International Units
UAC general analysis blood
OAM general urinalysis
PCR polymerase chain reaction
RNA ribonucleic acid
RSC complement fixation reaction
RTHA hemagglutination inhibition reaction
CSF cerebrospinal fluid
ESR erythrocyte sedimentation rate
Ultrasound ultrasound examination
ECG electrocardiography
EEG echoencephalography

List of protocol developers:
1) Kosherova Bakhyt Nurgalievna - Doctor of Medical Sciences, RSE at the Karaganda State medical University", professor, vice-rector for clinical work and continuous professional development, chief freelance infectious disease specialist of the Ministry of Health of the Republic of Kazakhstan.
2) Kim Antonina Arkadyevna - Candidate of Medical Sciences, RSE at Karaganda State Medical University, Associate Professor, Head of the Department of Infectious Diseases and Dermatovenereology.
3) Nurpeisova Aiman ​​Zhenaevna - Municipal State Enterprise “Polyclinic No. 1” of the Health Administration of the Kostanay region, head of the hepatology center, infectious disease doctor of the highest category, chief freelance infectious disease specialist.
4) Mazhitov Talgat Mansurovich - Doctor of Medical Sciences, Astana Medical University JSC, Professor of the Department of Clinical Pharmacology and Internship.

Conflict of interest: absent.

List of reviewers: Doskozhaeva Saule Temirbulatovna - Doctor of Medical Sciences, JSC "Kazakh Medical University of Continuing Education", Vice-Rector for educational work, Head of the Department of Infectious Diseases with a course on childhood infections.

Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

Attached files

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The incubation period varies from several days to a month, most often it lasts 18-20 days.
In children, quite rarely, it may be followed by a short (1-3 days) prodromal period, manifested by chills, headache, muscle and joint pain, dry mouth, and unpleasant sensations in the area of ​​the parotid salivary glands. More often, the disease begins acutely with chills and an increase in body temperature from low-grade to high; fever persists for no more than 1 week. However, there are often cases of the disease occurring with normal body temperature. Fever is accompanied by headache, general weakness, malaise, and insomnia. The main manifestation of mumps is inflammation of the parotid, and possibly also the submandibular and sublingual salivary glands. In the projection of these glands, a swelling appears, painful on palpation (more in the center), having a dough-like consistency. With a pronounced enlargement of the parotid salivary gland, the patient's face takes on a pear-shaped shape, and the earlobe on the affected side rises. The skin in the area of ​​swelling is stretched, shiny, difficult to fold, and its color is usually unchanged. More often the process is bilateral, involving the parotid gland on the opposite side after 1-2 days, but unilateral lesions are also possible. The patient is bothered by a feeling of tension and pain in the parotid region, especially at night; When the tumor compresses the Eustachian tube, noise and pain in the ears may occur. When pressing behind the earlobe, severe pain appears (Filatov's symptom). This symptom is the most important and early sign of mumps. The mucous membrane around the opening of the Stenon's duct is hyperemic and edematous (Mursu's symptom); Hyperemia of the pharynx is often noted. In some cases, the patient cannot chew food due to pain, and in even more severe cases, functional trismus of the masticatory muscles develops. Decreased salivation, dry mouth, and decreased hearing are possible. The pain continues for 3-4 days, sometimes radiating to the ear or neck, and gradually subsides by the end of the week. Around this time or a few days later, swelling in the projection of the salivary glands disappears. With mumps, regional lymphadenopathy is usually not noted.
In adults, the prodromal period is observed more often and is characterized by more pronounced clinical manifestations. In addition to general toxicity, catarrhal and dyspeptic symptoms are possible during this period. Acute phase The disease is usually more severe. Much more often than in children, lesions (possibly isolated) of the submandibular and sublingual salivary glands are observed. With submaxillitis, the salivary gland has a doughy consistency and is slightly painful, elongated along the lower jaw, which is recognized when the head is tilted back and to the side. Swelling of the subcutaneous tissue around the gland sometimes spreads to the neck. Sublinguitis is manifested by swelling in the chin area of ​​the same nature, pain under the tongue, especially when protruding it, local hyperemia and swelling of the mucous membrane. Swelling in the projection of the salivary glands in adults persists longer (2 weeks or more).

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Disease code - B26 (ICD 10)

Syn.: mumps, behind the ear
Mumps (parotitis epidemica) is an acute viral disease characterized by fever, general intoxication, enlargement of one or more salivary glands, and often damage to other glandular organs and the nervous system.

Historical information

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Mumps was described by Hippocrates in the 5th century. BC. Hamilton (1790) identified symptoms of central nervous system damage and orchitis as frequent manifestations of the disease. At the end of the 19th century. data on the epidemiology, pathogenesis and clinical picture of mumps were summarized. Domestic scientists I.V. Troitsky, A.D. Romanov, N.F. Filatov made a great contribution to the study of this problem.

In 1934 it was proven viral etiology diseases.

Etiology

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Pathogen mumps infection belongs to the family Paramyxoviridae, genus Paramyxovirus, and has a size of 120 x 300 nm. The virus contains RNA and has hemagglutinating, neuraminidase and hemolytic activity.

Antigenic structure the virus is stable.

In laboratory conditions, the virus is cultivated on 7–8-day chicken embryos and cell cultures. Laboratory animals are insensitive to the causative agent of mumps. In the experiment, only in monkeys is it possible to reproduce a disease similar to human mumps.

Sustainability. The virus is unstable, inactivated by heating (at a temperature of 70 ° C for 10 minutes), ultraviolet irradiation, exposure to solutions of formaldehyde and low concentrations of Lysol. It is well preserved at low temperatures (–10–70 °C).

Epidemiology

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Source of infection is a sick person, including the erased and asymptomatic form of mumps. The patient is contagious in last days incubation period, in the prodromal period and in the first 5 days of the height of the disease. Convalescents are not sources of infection.

Mechanism of infection. Infection occurs by airborne droplets, the virus is released in saliva. Transmission of infection through infected household items and toys is allowed. In some cases, intrauterine infection with the mumps virus has been described - a vertical route of transmission.

Mostly children get sick at the age of 1 year – 15 years, boys are 1.5 times more likely than girls. Persons who have not had mumps remain susceptible to it throughout their lives, which leads to the development of the disease in different age groups.

Seasonal increase in incidence is typical at the end of winter - in spring (March - April). The disease occurs in both sporadic cases and epidemic outbreaks.

Mumps infection is one of the most common viral diseases that occurs in all countries of the world.

After past illness strong specific immunity remains.

Pathogenesis and pathological picture

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Entrance gate infections are caused by the mucous membranes of the upper respiratory tract and, possibly, the oral cavity. After accumulation in epithelial cells, the virus enters the blood (primary viremia) and spreads with its current to various organs and tissues. The virus, hematogenously introduced into the salivary glands, finds optimal conditions for reproduction here and causes a local inflammatory reaction. Reproduction of the virus also occurs in other organs, but at a much less intense rate. As a rule, damage to other glandular organs (testes, pancreas) and the nervous system does not develop from the first days of the disease, which is associated with the slow replication of the virus in them, as well as secondary viremia, which is a consequence of intensive reproduction of the virus and its release into the blood from inflamed areas. parotid salivary glands. In the development of complications, the functional state of organs (for example, weakening of the blood-brain barrier), as well as immune mechanisms (circulating immune complexes, autoimmune reactions) are important.

Pathological picture uncomplicated mumps has not been sufficiently studied due to the benign course of the disease. The tissue of the parotid gland retains its acinar structure, but swelling and infiltration with lymphocytes are noted around the salivary ducts. The main changes are localized in the ducts of the salivary glands - from slight swelling of the epithelium to its complete desquamation and obstruction of the duct with cellular detritus. Suppurative processes are extremely rare.

Using testicular biopsy for mumps orchitis, the lymphocytic infiltration interstitial tissue, foci of hemorrhage. Foci of necrosis of the glandular epithelium with blockage of the tubules by cellular detritus, fibrin and leukocytes are often observed. In severe cases, after inflammation, ovarian atrophy may occur. Inflammatory and degenerative processes have been described in the ovaries.

Changes in the pancreas have not been studied enough. There is evidence of the possibility of developing necrotizing pancreatitis with damage to both endocrine and exocrine tissue of the gland, in severe cases with subsequent atrophy. CNS lesions are nonspecific.

Clinical picture (Symptoms) of mumps

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The duration of the incubation period ranges from 11 to 23 days (usually 15–19 days).

The prodromal period is rare.

Within 1–2 days, patients complain of malaise, general weakness, weakness, chilling, headache, pain in muscles and joints, and loss of appetite.

In typical cases, there is an acute onset of the disease with an increase in body temperature to 38–40 °C and the development of signs of general intoxication. Fever often reaches its maximum severity on the 1st–2nd day of illness and lasts 4–7 days, followed by a lytic decline.

Damage to the parotid salivary glands is the first and characteristic feature illnesses . Swelling and pain appear in the area of ​​the parotid glands, first on one side, then on the other. Other salivary glands – submaxillary and sublingual – may also be involved in the process. The area of ​​the enlarged gland is painful on palpation and has a soft doughy consistency. The pain is especially pronounced in some points: in front and behind the earlobe (Filatov's symptom) and in the mastoid area.

Mursu's (Murson) symptom is of diagnostic significance - hyperemia, an inflammatory reaction of the mucous membrane in the area of ​​the excretory duct of the affected parotid gland. Hyperemia and swelling of the tonsils are possible. The swelling may spread to the neck, the skin becomes tense, shiny, and there is no hyperemia. Patients are concerned about pain when chewing. In some cases, reflex trismus occurs, which prevents talking and eating. With unilateral damage to the salivary glands, the patient often tilts his head towards the affected gland. The enlargement of the salivary gland progresses rapidly and reaches a maximum within 3 days. The swelling lasts 2–3 days and then gradually (over 7–10 days) decreases. Against this background, various, often severe, complications can develop. There is no single idea on how to consider lesions of various organs with mumps - as manifestations or complications of the disease. There is no generally accepted classification of mumps. A.P. Kazantsev (1988) proposes to distinguish complicated and uncomplicated forms of the disease. According to the severity of the course - mild (including erased and atypical), moderate and severe form. The inapparent (asymptomatic) form of the disease is of great importance in the epidemiology of the disease. There are residual phenomena of mumps, which include such consequences as deafness, testicular atrophy, infertility, diabetes mellitus, and dysfunction of the central nervous system.

The severity of the disease is determined based on the severity of the intoxication syndrome. In severe forms, along with signs of intoxication and hyperthermia, patients experience nausea, vomiting, and diarrhea as a consequence of damage to the pancreas; enlargement of the liver and spleen is less typical. The more severe the disease, the more often it is accompanied by various complications.

Complications

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The development of meningitis, meningoencephalitis, orchitis, acute pancreatitis, arthritis, myocarditis, etc. is possible.

Serous meningitis

Serous meningitis - the most common and characteristic complication of mumps, which is observed after inflammation of the salivary glands or, less often, simultaneously with it, at different times from the onset of the disease, but more often after 4–10 days. Meningitis begins acutely, with the appearance of chills and a repeated increase in body temperature (up to 39 ° C and above). Patients are bothered by severe headache, vomiting, and severe meningeal syndrome develops (stiff neck, positive Kernig and Brudzinski sign). Cerebrospinal fluid is clear, colorless, flows under high blood pressure. A liquorogram reveals typical signs of serous meningitis: lymphocytic pleocytosis up to 500 and less often 1000 in 1 μl, a slight increase in protein content with normal levels of glucose and chlorides. After the symptoms of meningitis and intoxication subside, sanitation of the cerebrospinal fluid occurs relatively slowly (1.5–2 months or more).

Some patients develop clinical signs meningoencephalitis: impaired consciousness, lethargy, drowsiness, uneven tendon reflexes, facial nerve paresis, sluggish pupillary reflexes, pyramidal signs, hemiparesis, etc. The course of meningoencephalitis of mumps etiology is predominantly favorable.

Orchitis and epididymitis

Orchitis and epididymitis most common in adolescents and adults. They can develop either separately or together. Orchitis is observed, as a rule, 5–8 days from the onset of the disease and is characterized by a new rise in body temperature, the appearance of severe pain in the scrotum and testicle, sometimes radiating to the lower abdomen. Involvement of the right testicle sometimes stimulates acute appendicitis. The affected testicle is significantly enlarged, becomes dense, the skin over it swells and turns red. The enlargement of the testicle lasts 5–8 days, then its size decreases and the pain goes away. Later (after 1–2 months), some patients may develop signs of testicular atrophy.

Oophoritis

Oophoritis rarely complicates mumps and is accompanied by pain in the lower abdomen and signs of adnexitis.

Acute pancreatitis

Acute pancreatitis develop on the 4th–7th day of illness. Main symptoms: sharp pains in the abdominal area with localization in the mesogastrium, often of a cramping or shingles nature, fever, nausea, repeated vomiting, constipation or diarrhea. The amylase content in the blood and urine increases.

Damage to the hearing organ

Damage to the hearing organ It is rare but can lead to deafness. There is predominantly unilateral damage to the auditory nerve. The first signs are tinnitus, then manifestations of labyrinthitis appear: dizziness, lack of coordination of movement, vomiting. Hearing is usually not restored.

Rare complications include myocarditis, arthritis, mastitis, thyroiditis, bartholinitis, nephritis, etc.

Forecast

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Usually favorable.