Infectious diseases. Parotitis. Etiology, epidemiology, pathogenesis, clinical picture, treatment (lecture notes)

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Infectious diseases. Parotitis. Etiology, epidemiology, pathogenesis, clinical picture, treatment (lecture notes)

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LECTURE No. 6. Epidemic mumps. Etiology, epidemiology, pathogenesis, clinic, treatment

Mumps (mumps) is an acute viral infectious disease that has an airborne transmission pattern, manifested by inflammation of the salivary glands and other glandular organs and often by the development of serous meningitis, affecting mainly children under 15 years of age.

Etiology. The causative agent is an RNA-containing virus from the paramyxovirus family, stable in the external environment. It remains active for a long time at low temperatures, and at room temperature it remains for several days. It quickly dies under the influence of high temperatures, ultraviolet radiation, and drying. The infection is transmitted by airborne droplets, and the contact route of transmission through objects is also possible. The source of infection is a sick person. The patient becomes contagious in the last 1-2 days of the incubation period and in the first 3-5 days of the disease.

Pathogenesis. The entrance gate of infection is the mucous membranes of the nose, mouth, nasopharynx. Through the bloodstream, the pathogen is introduced into various organs, contributing to tropism in relation to the glandular organs and the central nervous system (mainly the pia mater). Most often, the parotid glands are affected, in which the phenomena of periparotitis develop. The transferred disease contributes to the creation of stable immunity. Clinic: the incubation period lasts 11-21 days (rarely can be extended from 23-26 days). The prodromal period is short and unstable, it is characterized by fever, malaise, loss of appetite, headache. The disease begins with fever and painful swelling of the parotid gland, sometimes simultaneously on both sides. The gland acquires a doughy or elastic consistency. The skin above it is tense, but not hyperemic. There is pain at the points when pressing on the tragus, mastoid process and in the region of the posterior mandibular fossa. The swelling increases within a few days and then subsides within 5-7 days. Suppuration does not occur. During the recovery period, the temperature normalizes, health improves, and the function of the affected glands is restored. In about 50% of cases, the submandibular and occasionally sublingual salivary glands are involved in the process. In adolescents and young men, orchitis often occurs (in women - oophoritis), the pancreas is less often affected (acute pancreatitis), and even less often - other glandular organs (mastitis, bartholinitis, dacryocystitis, etc.). Often the disease is manifested by acute serous meningitis (in the cerebrospinal fluid - lymphocytic pleocytosis, a slight increase in the content of sugar and chlorides). A very rare and dangerous complication is encephalitis or meningoencephalitis, middle ear damage may occur.

Diagnosis is based on complaints, clinical and laboratory data. When diagnosing, secondary bacterial mumps, upper cervical lymphadenitis should be excluded, and in the presence of serous meningitis, enteroviral and tuberculous meningitis. If necessary, use laboratory methods (RSK, RTGA).

Differential diagnosis is carried out with acute, purulent and toxic parotitis, salivary stone disease, lymphadenitis, toxic diphtheria of the oropharynx.

Treatment is carried out on an outpatient basis, in severe cases with complications from the central nervous system, genital organs and other complications, or according to epidemiological indications, patients are hospitalized. Bed rest must be observed during the entire acute period, and for meningitis and orchitis - at least 2-3 weeks. Symptomatic treatment is prescribed. Apply antihistamines, multivitamins. Antiviral therapy is carried out in combination with detoxification (glucose) and dehydration (lasix, diacarb) therapy. Thermal dry procedures (woolen wraps, heated salts, sand, etc.), UHF therapy are applied locally. Compresses are contraindicated. Treatment of orchitis, pancreatitis and meningitis is carried out according to general rules. In severe cases of orchitis, corticosteroid hormones are often used.

Forecast. In most cases, the prognosis is favorable. In rare cases, lesions of the inner ear end with the development of persistent deafness. Bilateral orchitis in some cases leads to testicular atrophy with subsequent reproductive dysfunction.

Prevention. The patient is isolated at home for 9 days from the moment of illness, provided that acute clinical phenomena disappear. They are hospitalized only in severe cases of the disease and for epidemiological indications. Children under 10 years of age who have been in contact with a sick person are subject to separation for 21 days. If the exact time of contact is established, they are not allowed into children's institutions from the 11th to the 21st day from the moment of possible infection. Specific prevention is carried out by active immunization with a live mumps vaccine for children aged 12-15 months simultaneously with vaccination against measles, and revaccination is carried out at the age of 6 years.

Author: Gavrilova N.V.

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