Management of Viral Parotitis (Mumps)

Viral parotitis is managed with supportive care only, as no specific antiviral therapy exists for mumps infection. 1

Immediate Management Priorities

Laboratory confirmation is essential before assuming viral etiology, as clinical diagnosis alone is unreliable and misdiagnoses occur in approximately one-third of cases 2
Obtain mumps IgM antibody testing, viral PCR from parotid duct swabs (after massaging the parotid gland for 30 seconds), or buccal swabs within 9 days of symptom onset 3
Consider urine PCR for mumps (positive for at least 5 days after oral detection) 3
Rule out bacterial suppurative parotitis, which requires different management—look for purulent discharge from Stensen's duct, severe toxicity, and unilateral presentation in dehydrated or immunocompromised patients 4, 5

Implement droplet precautions immediately and isolate the patient for 5 days after onset of parotitis, as patients are contagious from 7 days before through 8 days after parotid swelling begins 3, 1
Use standard precautions plus gown and gloves for patient contact; negative pressure rooms are not required 3
Only healthcare personnel with documented immunity (two doses of MMR vaccine or laboratory evidence of immunity) should care for the patient 3

Maintain adequate hydration through oral fluids or IV fluids if oral intake is compromised 4, 5
Provide analgesics for pain control (acetaminophen or NSAIDs) 6
Apply warm or cold compresses to affected parotid glands for comfort 6
Encourage good oral hygiene to prevent secondary bacterial infection 4
Recommend soft, bland diet avoiding acidic foods that stimulate salivation and increase pain 6

Assess for orchitis in postpubertal males (occurs in up to 38% of cases), typically developing 3-5 days after parotitis onset 1, 7
Watch for signs of aseptic meningitis/meningoencephalitis (occurs in 4-6% of cases)—headache, neck stiffness, altered mental status 1
Monitor for pancreatitis (abdominal pain, nausea, vomiting), which develops at days 3-5 of illness 1, 7
Be alert for hearing loss, particularly in children 1

Expected hospitalization duration: 7 days for children, 10-14 days for adults with uncomplicated parotitis 7
Patients with serous meningitis require approximately 14 days of hospitalization 7
Pancreatitis generally has positive outcomes, though pain syndrome in adults may persist for 1-1.5 months 7
Most cases of infectious parotitis involving the parotid gland resolve with positive outcomes 7

Do not prescribe antibiotics for confirmed viral parotitis, as this contributes to antimicrobial resistance without clinical benefit 8
Do not rely on clinical diagnosis alone—other viruses (EBV, CMV, HIV, influenza A, parainfluenza, adenovirus, enteroviruses) can cause identical parotitis 2, 5
Test for HIV in all patients with parotitis, regardless of apparent risk factors, as HIV can present with parotid swelling 3, 2
Do not administer MMR vaccine for post-exposure prophylaxis expecting immediate protection—antibody response develops too slowly to prevent disease in exposed individuals, though vaccination should still be offered to non-immune contacts for future protection 3

Refer to hospital if patient develops severe complications (meningitis, severe pancreatitis, respiratory compromise) 6
Consider ENT consultation for diagnostic uncertainty, suspected abscess formation, or failure to improve with supportive care 6
Pregnant women with mumps in first trimester require close monitoring due to increased risk of fetal death 1