Mumps ( Mumps ) - Causes, Symptoms and Treatment .MF .
Mumps or, as they call the patients, mumps - an acute infectious viral disease mainly affecting the glandular organs and / or nervous system, accompanied on this background, fever and general intoxication.
Hippocrates described the mumps, but only in 1934 was formed the final presentation of the symptoms and the viral nature of the proof of the pathogen.Some people believe that the name comes from two Greek and Latin phrases: para-about and otos- ear and -its- ending indicates inflammation.Thus, the name reflects the most common site of inflammation - the parotid gland.
causative agent of mumps
causative agent of mumps (Parotits epidemica) - RNA virus belonging to the family of paramyxoviruses, and the corresponding characteristic parameters of this family: large dimensions, irregularly spherical shape, typical for this family of antigenic structure - N (neuraminidase) and H(hemagglutinin).N - causes attachment and further penetration of the virus through the mucous membranes of the upper respirator
virus is relatively stable in the environment: is stored at room temperature for several days at low temperatures of up to 6 months.Specific inactivation of the virus occurs when heated to 80⁰S for 30 minutes, and has a pernicious effect of UVB, 1% Lysol solution and a 2% formalin solution and other disinfectants.
prevalence of mumps infection
recorded throughout the year, with the rise of the incidence in winter and spring.Spread everywhere and sensitivity as high as 50%.The highest incidence is observed from 3-6let children first year of life, being breast-fed, are resistant to the virus due to passive immunity produced by maternal IgA, providing the first line of defense.People neimmunnizirovannye retain susceptibility life.After suffering an infection formed a strong immunity.After vaccination, formed a strong immunity for 20 years.
Causes of mumps
source - the sick person, the allocation of mumps virus starts in the incubation period, which is asymptomatic, ie 1-2 days before onset of overt symptoms, and after 8 days after the clinical signs.Modes of transmission - airborne, contact-household (through saliva contaminated household items).Infection facilitates population density, background respiratory diseases and immunodeficiency states (IDS).
Symptoms of mumps
incubation period 9-26 days (average 15-19) - is characterized by the absence of any clinical manifestations.During this period, fixation and reproduction of the virus in the mucous membranes of the upper respiratory tract, followed by its concentration reaches a maximum, and he breaks into the blood - there primary viremia .
This gives start to the sharp top - increase in temperature in the evening to 38-40⁰S and intoxication (malaise, muscle and joint pain).During the first days of the onset of the disease there is an increase in the parotid gland, and in another day affected the other salivary glands.In the early stages affects the parotid and / or submandibular.
mumps lesions in the early stages
should be noted that affected not the glandular tissue and the tissue around the excretory ducts, ie, is their blockage, which results in the formation of the following symptoms:
• dry mouth;
• soreness and increase in place of the projection of the affected gland;
• tenderness of the affected area, it is soft in consistency as the dough, so the external swelling has no clear boundaries.
With the accumulation of the pathogen in the tissues glands and maximize his number of virus breakthrough occurs and re-entering it in the blood - secondary viremia .Then, by hematogenous (blood), the virus reaches the other glands and / or nerve tissue that will shape the next stages of the symptoms.Possible:
• The defeat of the testicles in boys - orchitis, girls - oophoritis (since they too are glandular tissue): pain in the abdomen, of referred to the scrotum and testes, and then they are sealed and there is a sharp pain due to violation of excretoryducts, as in any other glandular tissue, the skin of the scrotum becomes congested, with a bluish tint.Symptom passes through 1.5 weeks on average.
Mumps infection.Bilateral orchitis
• The defeat of the brain and spinal cord (aseptic meningitis): develops 3-5 days from the time of the defeat of the salivary glands, and there is a change of places of symptoms - mumps subsides, and the general condition is deteriorating:
- a new rise in temperature to 38-39⁰S
- lethargy and weakness
- headache, against which it may be nausea and vomiting, not bringing relief
- become positive meningeal signs (neck stiffness - in the supine position can not touch your chin to the sternum; Brudzinskogo symptoms - the attempt to tilthead to the chest, causing flexion in the knee / hip joints; Kernig symptom - a violation of straightening the bent leg at the knee joint) - when these symptoms need immediate hospitalization !
• Polyneuropathy (multiple lesions of peripheral nerves):
- compression of the facial nerve, resulting in a breach of mimic muscles or neuralgia (severe pain, shooting character) -with lesions of the parotid gland
- paralysis of the lower limbs and / or pain (at poliradikulonevrapatii)
- permanent loss of hearing (cochlear nerve damage)
• The defeat of the pancreas (pancreatitis) develops in 5-9 days from the first symptoms
- a new rise in temperature on the background of the general state of deterioration,
- nausea and vomiting, bringing relief,
- painabdominal / left upper quadrant, with irradiation (spreading pain) in the back, or the nature of herpes zoster,
- liquid fatty stools at the younger age contingent, and the presence of constipation in older age groups.
recovery period comes after the disappearance of symptoms - in about 9 days.
1.Obktivny method (inspection), taking into account information about possible contacts with infectious patients.
• Virological - the use of biological materials which may be a virus: urine, saliva and cerebrospinal fluid, but not later than 5 days of illness
• IFA (immunofluorescence reaction) is a rapid method and to determine the virus in tissue cultures haveafter 2 days from the time the intake
• Serological methods detect the presence of Al (antibodies)
- RNC (complement fixation) - is considered the most highly specific and sensitive method by which detect the presence of antibodies to the s-antigen or v-antigen and thusdetermine the period of illness or the degree protivoparatitnoy immunization;The presence of antibodies to the s-antigen talks about the acute period, and the presence of antibodies to v-antigen suggests the recovery period if he is in high titers, if low titers (on the background of anti-s-antigen) - the acute phase of the disease.
- HAI (hemagglutination inhibition) - determine the antibody titer;
- RN (neutralization reaction) - will point to the qualitative and quantitative correlation of antibody (or antitoxin) and antigen (or antitoxin)
- ELISA (enzyme-linked immunosorbent assay) - determination of immunoglobulin IgM and G, page by which determine the period of the disease: M - saysan acute period, G - the process of calming.
Treatment of mumps
- Postelny / polupostelny mode.
- Gentle vitaminized diet except obligate allergens (all artificial, containing a lot of chemicals and dyes) + copious drinking;Vitamins can be in the form of tablets or dragees.
- Causal treatment (against the causative agent): Antiviral (izoprinozin -by 50-100mg / kg / day divided into 4 reception and receive within 7-10 days), immunomodulators (interferon - intranasally 5 drops every 30 minutes within 4 hoursin the following days - 5 times a day for 5 -7 days viferon - 2 candles per day);immunostimulants (tsikloferon- used only since 4 years: 1 tablet / day, 7 years - 2 tablets, adults - 3 tablets).
- antipyretics (drugs of NSAIDs -paratsetamol / ibuprofen / Nurofen, in the absence of contraindications).
- dry heat to the affected gland
Upon accession, the nervous form of the infection (meningitis and / or polyneuropathy) was added to the above clinic still some groups of preparations and transferred to hospital treatment, because the appointment of certain drugs should be carried out laboratory control:
- Strict bed rest.
- Dehydration, detoxification and glucocorticosteroid therapy (to prevent swelling of the brain and / or peripheral nerves sdevleniya due to swelling of other glands) - diakarb and furosemide in combination with potassium preparations.
- drug improves cerebral blood flow and metabolic activity (aktovegin, trental, agopurin etc.).
- Vitamins C, B, E and PP-acid
Upon accession orchitis conducted observation of the surgeon, by taking into account the implementation of standard therapy
strict bed rest is prescribed for the development of pancreatitis and in the first 2 days of illness - hungry days (complete rejection ofeating and the introduction of nutrient preparations only parenterally, ie, intravenously), then gradually move on to an easy diet - table №5 with a fractional power.
- to standard therapy, which is represented by the above - prescribed inhibitors of proteolytic enzymes (contrycal, gordoks etc.) - because it is due to blockage of the excretory ducts, there is a "samoperivarivanie" gland at the expense of its own enzymes
- non-narcotic analgesics and antispasmodics (spazmalgon, ketorolac)
- enzymatic preparations for improving digestion, because the enzymes of the liver for the same reason, the blockage no longer flow into the duodenum;to that end, appoint pancreatin mezim forte, enzistal
glandular form of mumps can be treated at home, but any other manifestation (orchitis, meningitis, polyneuritis, pancreatitis) should be treated only in a hospital.The duration of treatment on average - 2 weeks
After suffering mumps
Rehabilitation is to a dispensary observation convalescents, the duration of which depends on the form of mumps infection:
• at the postponed meningitis - surveillance for a month in a clinic, and then for the past 2 years;repeated neurological examination and electrophysiological intervals 1,3,6 months;limiting the physical and mental load during the year
• at the postponed orchitis (oophoritis) - observation of the endocrinologist for a year
• pancreatitis - watching a pediatrician and / or gastroenterologist
Complications of mumps
encephalitis, brain swelling fatalities, infertility as amen and women (inflammation associated with a history of sexual glands at an early age), the development of diabetes, unilateral hearing loss can not be restored.Back in 2000, mortality was 1.5%.
• isolation of patients at 10 days
• insulation contact unvaccinated 21-day
• active by vaccination immunization DRI (live mumps vaccine) or MMR-II (measles, mumps, rubella) - is carried out first in 12 months,6 years later.In 4-12 days after vaccination may be an increase in temperature and a slight increase of the parotid salivary glands.Vaccinations are carried out taking into account all contraindications.And not introduced the vaccine to those who received the immunization as an immunoglobulin, its introduction is delayed for a certain period, which is set by your doctor.
therapists Shabanova I.E