What are the management guidelines for a patient with mumps?

Management Guidelines for Mumps

Mumps is a self-limiting viral illness requiring primarily supportive care with symptomatic management, strict isolation precautions, and vigilant monitoring for complications that are more severe in adults. 1

Immediate Symptomatic Management

Provide pain and fever control with acetaminophen or NSAIDs to manage fever, headache, and parotid gland pain. 1

• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful. 1
• Recommend soft foods and avoidance of acidic foods that may stimulate salivary flow and worsen parotid pain. 1
• Treatment is entirely supportive—there is no specific antiviral therapy for mumps. 2, 3

Isolation and Infection Control

Implement droplet precautions immediately and isolate patients for 5 days after onset of parotitis. 1

• Patients are contagious from 7 days before through 8 days after parotitis onset. 1
• Educate patients and family members about transmission through respiratory droplets and direct contact with saliva. 1
• Report probable or confirmed cases immediately to state and local health departments. 4

Common pitfall: Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms. 4, 1 Do not rule out mumps based solely on absence of parotitis.

Diagnostic Confirmation

Laboratory confirmation is preferred over clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes. 4

Laboratory criteria include:

• Isolation of mumps virus from clinical specimens (parotid duct swabs after massaging gland for 30 seconds, buccal swabs, or urine). 4
• Significant rise in serum mumps IgG antibody between acute and convalescent-phase titers. 4
• Positive serologic test for mumps IgM antibody. 4

For suspected mumps encephalitis, CSF PCR is the most accurate confirmatory test. 4

Monitoring for Complications

Complications are significantly more common and severe in adults than children, requiring heightened surveillance. 4, 1

Neurological Complications

• Monitor for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status. 4, 1
• Watch for encephalitis signs: seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae including aqueductal stenosis and hydrocephalus. 4, 1
• Assess for hearing loss: sudden sensorineural deafness can be bilateral and permanent. 4, 1

Reproductive System Complications

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling. 4, 1
  • Sterility is rare despite high orchitis rates. 4
  • Treatment includes bed rest, scrotal support, local cooling, and NSAIDs. 5
  • Consider antibiotics initially if bacterial orchitis cannot be excluded. 5
• In postpubertal females, monitor for oophoritis (ovarian inflammation). 1

Other Systemic Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting. 1

Special Management: Facial Nerve Involvement

If facial droop or weakness develops, initiate corticosteroid therapy promptly with prednisone 1-2 mg/kg/day for 5-7 days followed by a taper over 5-7 days to reduce inflammation and improve nerve function. 1, 6

• Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure. 1, 6
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months. 1, 6

Management in Pregnancy

Treatment in pregnant women follows the same supportive care principles with acetaminophen or NSAIDs for pain control, hydration, and soft foods. 7

• Critical caveat: Mumps vaccine is contraindicated during pregnancy due to theoretical risk from live-virus vaccine. 4, 7
• Mumps infection during first trimester increases risk for fetal death, but is NOT associated with congenital malformations. 4, 7
• Monitor for the same complications as non-pregnant patients, including oophoritis which may present with pelvic pain. 7

Outbreak Control Measures

In outbreak settings, identify and vaccinate susceptible contacts immediately. 4

• Exclude susceptible students from affected schools until they are vaccinated or until 26 days after onset of parotitis in the last case. 4
• In healthcare settings, exclude workers lacking immunity from day 12 after first exposure through day 26 after last exposure. 4
• Maintain active surveillance for two incubation periods (5-6 weeks) after the last case. 4