Mumps and Tonsillitis

Mumps and tonsillitis

Epidemiology of Mumps
Definition of Mumps
• Mumps: An acute systemic viral disease characterized by fever and painful salivary glands usually the parotid and sometimes also the sublingual or sub maxillary.

Epidemiology of Mumps
• Death from mumps is extremely rare but can occur as the result of complicating encephalitis, meningitis and orchitis.
• Mumps is relatively trivial illness in young children but if contracted after puberty it can have serious complications for example orchitis in 20-35% of the males and oophoritis in about 5% of females, sterility may follow bilateral orchitis and oophoritis.
• Transmission is by droplet spread and direct contact with saliva of an infected person or indirect through freshly infected articles.
• Immunity to mumps is usually acquired between the ages of 5 to 14 years.

Clinical Features and Differential Diagnosis of Mumps
        Clinical Features of Mumps
• Uncomplicated mumps present with fever difficult in swallowing, swelling and
tenderness of salivary glands.
• At first unilateral salivary glands are involved and later both sides become affected.
• Swelling of the salivary glands occurs in up to 95% of all symptomatic cases.
• The parotid glands are often involved and moderate febrile response is present at the time of disease onset.
• There is no rash and the fever and swelling subside in a few days.
• Other organs that may be involved include the testes, CNS, epididymis, prostate, ovaries,
liver, pancreas, spleen, thyroid, kidneys, eyes, thymus, heart and joints.
• The onset of mumps meningitis is marked by fever, with vomiting, neck stiffness, headache and lethargy.

Differential Diagnosis of Mumps
• Dental abscess
• Cervical lymphadenitis, in which the ear lobe is not lifted upwards and outwards (exclude TB)

Kwashiorkor may cause swelling of parotid glands but no tenderness and fever
• Burkitt’s lymphoma, swelling is unilateral firm and fixed to the jaw
Diagnosis
• Diagnosis of mumps is based on clinical findings e.g. swelling of the glands.
• This is seldom missed.
• In well equipped hospitals, other advanced investigations may be done e.g. determination of virus-specific IgM and IgG levels.
• No specific treatment is available, only bed rest and symptomatic management.
• Analgesics and scrotal support are important in orchitis.
• Ensure proper fluid intake.
• The tension in the testes can be relieved by surgical decompression or reduction of edema by the use of corticosteroids.

Complications of Mumps
• Pancreatitis: Presenting with severe upper abdominal pain, vomiting and fever
• Orchitis: swelling and severe pain of testes, usually one-sided
• Oophoritis: presenting with severe lower abdominal pain, vomiting
• Prostatitis: may present with unexplained fever, dysuria
• Meningitis: common and is associated with headache, fever, vomiting and neck rigidity
• Encephalitis: rare; severe headache, fever, vomiting, cranial nerve palsies, convulsions, drowsiness and coma; mortality about 2%
• Unilateral deafness
• Thyroiditis

Management, Prevention and Control of Mumps
Management of Mumps
• There are currently no anti-viral medications that can be used to treat mumps
• Treatment is focused on providing relief from symptoms until the body’s immune system manages to fight off the infection
• The following self-care techniques are recommended
o Plenty of bed rest until symptoms have resolved
o Over-the-counter (OTC) painkillers, such as ibuprofen or paracetamol can help reduce symptoms of pain.
o Children, who are 16 years of age, or under, should not be given aspirin.
o Plenty of fluids but avoid drinks that are known to stimulate saliva production, such as fruit juice, because excess saliva can cause pain.
o Water is usually the best fluid to drink.
o Applying a cold compress to the swollen glands should help to reduce the pain.
o Eat foods that do not require a lot of chewing, such as soup, mashed potatoes, and scrambled eggs.

Prevention and Control of Mumps
• In people with mumps, preventing the spread of infection is also important.
• The advice below explains the best way to do this.
o Stay away from school, college, or work until five days after the onset of your
symptom

.    Avoid overcrowding during acute stage.
o Wash hands regularly using soap and water.
o Always use a tissue to cover your mouth and nose when you cough and sneeze, and dispose of the tissue in a bin immediately afterwards.
• There is a live attenuated vaccine available and one which is combined with measles and rubella (MMR vaccine).
• This is not in the Tanzania vaccination program.

Epidemiology of Tonsillitis
Definition of Tonsilitis
• Tonsillitis (sore throat): An acute inflammation of the throat (Tonsils).
• Tonsillitis is also known as sore throat, sometimes involving the pharynx leading to pharyngitis (inflammation of the pharynx).
• Sore throat is equally common as the common cold and may accompany it.

Epidemiology of Tonsilitis
• The commonest cause of tonsillitis is streptococcal infection which may be followed by reaction in some cases leading to acute rheumatic fever and rheumatic heart disease.
• However most severe sore throats are also caused by viruses.
• It is a very common condition, most frequent in children aged 5 to 10 years and young adults between 15 and 25 years.
• In one study, rates of asymptomatic carriage of Group A streptococcus were:
o 10.9% aged 14 or less
o 2.3% aged 15 to 44
o 0.6% aged 45 and over

Clinical Features of Tonsillitis
• Fever
• Painful swallowing
• The pharynx, tonsils and adenoids may be red and swollen
• When the sore throat is caused by herpangina, small painful blisters may be present on the mucosa of the throat and the cheeks

Complications of Tonsillitis
• An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis.
• This is termed a peritonsillar abscess (or quinsy).

• Rarely, the infection may spread beyond the tonsil resulting in inflammation and
infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).
• Bacteria feeding on mucus which accumulates in pits (referred to as ‘crypts’) in the tonsils may produce whitish-yellow deposits known as tonsilloliths.
• These may emit an odour due to the presence of volatile sulfur compounds.
• Hypertrophy of the tonsils can result in:
o Snoring
o Mouth breathing
o Disturbed sleep
o obstructive sleep apnea
• Rheumatic fever and rheumatic heart disease
Management, Prevention and Control
Treatment
• For streptococcal sore throat give Procaine Penicillin fortified (PPF) 0.8 MU, for 10 days to prevent rheumatic fever.
• A single dose of Benzathine Penicillin G 1.2 MU is also effective.
• Patient with rheumatic fever or established rheumatic heart disease should be protected against further infection with either benzathine penicillin 1.2 MU every 3 weeks till age
21 or Oral Penicillin V 125 – 250mg daily.
• Patients allergic to Penicillin should be treated with Erythromycin.
• For viral sore throat, gargle with salt water and take Paracetamol to relieve fever and pain.
• There is no definitive treatment for herpangina; it is usually self-limiting within a few days.
• Patients with repeated tonsillitis should be treated surgically (i.e. tonsillectomy).

Prevention and Control of Sore Throat
• Most of airborne diseases will spread more easily when there is overcrowding and in congested houses, classrooms, public transport, canteens, dance and cinemas halls.
• Therefore people should avoid these situations.
• Discuss with other/senior staff on the use and indications of antibiotics.
• Examine routinely patient complaining of sore throat.

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