Is mumps characterized by bilateral salivary gland enlargement?

Mumps and Salivary Gland Enlargement

Mumps can present with either unilateral or bilateral salivary gland enlargement, most commonly affecting the parotid glands. According to the CDC clinical case definition, mumps is characterized by "acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting greater than or equal to 2 days, and without other apparent cause" 1.

Diagnostic Features of Mumps

• Salivary Gland Involvement Pattern:

  • Can affect parotid glands either unilaterally or bilaterally
  • May involve other salivary glands as well
  • Swelling is typically tender and self-limited
  • Duration of at least 2 days is characteristic

• Laboratory Confirmation:

  • Isolation of mumps virus from clinical specimen
  • Significant rise between acute and convalescent-phase titers in serum mumps IgG antibody
  • Positive serologic test for mumps IgM antibody 1

Clinical Presentation and Diagnosis

The CDC and WHO recommend the following diagnostic approach 2:

• RT-PCR of oral/buccal swab specimens (preferably from parotid duct)
• Serology for mumps IgM antibodies
• Paired acute and convalescent serum samples to demonstrate 4-fold rise in mumps IgG

For optimal viral detection, buccal/oral swab should be collected within 3 days of symptom onset 2.

Important Clinical Considerations

• Differential Diagnosis:

  • Other causes of parotid enlargement include other viral infections, bacterial sialadenitis, sarcoidosis, and non-inflammatory conditions like sialadenosis 1, 3
  • Parotitis may have other infectious and noninfectious causes, making laboratory confirmation important 1

• Complications:

  • Aseptic meningitis (up to 15% of cases)
  • Orchitis (20-30% of postpubertal males)
  • Oophoritis
  • Pancreatitis
  • Sensorineural hearing loss (1 per 20,000 cases) 2

Management

• Primary Treatment:

  • Supportive care (no specific antiviral therapy available)
  • Analgesics for pain relief
  • Adequate hydration
  • Warm or cold compresses to reduce parotid pain and swelling 2

• Prevention:

  • MMR vaccination is the most effective preventive measure
  • Two doses provide better protection against mumps 2
  • Isolation of infected individuals to prevent spread

Key Pitfalls to Avoid

1. Diagnostic Errors: Relying solely on clinical diagnosis without laboratory confirmation can lead to misdiagnosis, as parotitis can have multiple causes 1

2. Inadequate Specimen Collection: Collecting specimens too late after symptom onset reduces chances of viral detection 2

3. Overlooking Complications: Particularly in adults, where complications like orchitis, meningitis, and hearing loss are more common 4

4. Failure to Isolate: Not implementing proper isolation measures can lead to outbreaks, especially in close-contact settings 2

Remember that while the classic presentation of mumps involves bilateral parotid swelling, unilateral involvement is also common and should not rule out mumps as a diagnosis 5, 4.