What is the appropriate treatment for mumps?

Mumps Treatment

Mumps treatment is entirely supportive—there is no specific antiviral therapy—and management focuses on symptom control, strict isolation for 5 days after parotitis onset, and vigilant monitoring for potentially serious complications that are more common and severe in adults. 1, 2

Immediate Symptomatic Management

• Administer acetaminophen or NSAIDs for pain and fever control to manage fever, headache, and parotid gland pain 1, 2
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2
• Recommend soft foods and avoid acidic foods that may stimulate salivary flow and worsen parotid pain 1, 2

Critical Isolation Requirements

• 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 parotitis onset 1, 2
• Educate patients and family members about transmission through respiratory droplets and direct contact with saliva 2, 3
• Report probable or confirmed cases immediately to state and local health departments 1, 3

Monitoring for Complications

The CDC and AAP emphasize that complications are significantly more common and severe in adults than children, requiring heightened surveillance in young adults. 1, 2

Neurological Complications

• Watch for aseptic meningitis (occurs in 4-6% of cases), characterized by severe headache, neck stiffness, photophobia, or altered mental status 1, 2
• Assess for encephalitis signs, including seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae 1, 2
• Monitor for hearing loss, as sudden sensorineural deafness can be bilateral and permanent—mumps was a major cause of childhood deafness in the pre-vaccine era 1, 2

Reproductive System Complications

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases), characterized by testicular pain and swelling, though sterility is rare 1, 2
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1, 2

Other Systemic Complications

• Watch for pancreatitis, characterized by severe abdominal pain, nausea, and vomiting 1, 2
• Monitor liver enzymes if right upper quadrant discomfort, nausea, or jaundice develops, as mumps-associated hepatitis is rare but can occur with transient elevation of liver enzymes 4

Special Management for 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, 2
• Provide eye protection to prevent corneal damage if facial weakness prevents complete eye closure 1, 2
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1, 2

Management of Meningoencephalitis

• Obtain CSF testing by PCR for mumps virus, enteroviruses, HSV-1, HSV-2, and VZV to confirm viral etiology 3
• Perform MRI (preferred over CT) for detecting intracranial lesions if focal neurologic deficits, seizures, altered mental status, or signs of increased intracranial pressure develop 3
• Administer standard anticonvulsant therapy for seizures occurring in mumps meningoencephalitis 3
• Monitor closely for increased intracranial pressure and consider neurosurgical intervention with external ventricular drain placement if obstructive hydrocephalus develops 3

Laboratory Confirmation

The WHO recommends laboratory confirmation over clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes. 3

• Obtain an oral or buccal swab of the affected parotid region for viral culture or PCR; PCR is most sensitive when performed 5-9 days after symptom onset 1
• Perform serologic testing: detect mumps-specific IgM antibodies or demonstrate a ≥4-fold rise in IgG titers between acute and convalescent specimens collected 5-10 days apart 1
• Note that in previously immunized patients, IgM may be absent, so viral isolation or RNA detection is required for confirmation 1

Critical Clinical Caveats

• Parotitis is NOT present in all cases—only 30-40% of mumps infections produce typical acute parotitis, while 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 1, 2
• Do not assume immunity based on vaccination alone—recent outbreaks have occurred in highly vaccinated populations, particularly among young adults in college settings 1
• Do not overlook complications in patients without parotitis—serious complications can occur without evidence of parotid swelling 1
• Do not administer mumps vaccine to pregnant women due to theoretical risk of fetal harm from live-virus vaccine 1, 3
• Mumps infection during first trimester increases risk for fetal death, but is NOT associated with congenital malformations 3